Special Enrollment Period Applicable for Individuals Affected by the COVID-19 Pandemic

On Tuesday, the Centers for Medicare & Medicaid Services (CMS) issued a memorandum clarifying that the existing Special Enrollment Period (SEP) for Individuals Affected by a FEMA-Declared Weather Related Emergency or Major Disaster is applicable to, and available for, Medicare-eligible individuals who’ve been affected by the COVID-19 pandemic.

This SEP is available to residents of all states, tribes, territories and the District of Columbia as of March 1, 2020, for affected individuals who were unable to and did not make an election during another valid election period as a result of the COVID-19 emergency. This includes enrollment and disenrollment elections – including the Medicare Advantage Open Enrollment Period (OEP) which had overlap March 1 – March 31, 2020.

CMS considers individuals as “affected” and eligible for this SEP if they:

• Reside, or resided at the start of the incident period, in an area for which the Federal Emergency Management Agency (FEMA) has declared an emergency or a major disaster and has designated affected counties as being eligible to apply for individual or public level assistance;
• Had another valid election period at the time of the incident period; and
• Did not make an election during that other valid election period.

Additionally, individuals who do not live in the affected areas but rely on help to make healthcare decisions from friends or family members who live in the affected areas are eligible.

This SEP is available from the start of the incident period of March 1, 2020, through June 30, 2020.

Additionally, an eligible beneficiary will receive one opportunity to make that missed election as a result of this SEP. Beneficiaries do not have to provide proof that they were affected by the pandemic-related emergency.

Click here to read the CMS memorandum in its entirety. As before, we also invite you to visit our COVID-19 webpage for up-to-date information about the illness, our response and questions about coverage.

If you have any questions, please contact Broker Services at BrokerServices@healthalliance.org or by calling (877) 917-8489.