Centers for Medicare & Medicaid Services CMS is providing beneficiaries affected by the California wildfires an SEP that gives them an additional opportunity through March 31, 2018 to add, drop or change their Medicare health and prescription drug plan in the event they were unable to make an election during the fall open enrollment period or another election period for which they were eligible. Individuals will be considered “affected” and eligible for this SEP if they reside, or resided at the start of the incident
period, in the FEMA declared emergency or major disaster area related to the recent wildfires in California. We note that an individual can use this SEP once for each election period they missed. Thus, individuals who made an election during the annual election period (AEP) cannot use this SEP to make a second AEP election. Additional Guidance Coverage changes using the special enrollment opportunities due to these disasters will be effective the first of the month following the plan’s receipt of the enrollment request. These SEPs are also available to those individuals who don’t live in the affected areas but rely on help making healthcare decisions from friends or family members who live in the affected areas. Plan sponsors may ask for proof of residence to determine if an individual resided in an affected area (e.g., driver’s license, utility bills, etc.) at the start of the incident period, but must accept an attestation if an applicant states that his or her documents were destroyed or are inaccessible. We note that individuals with End-Stage Renal Disease (ESRD) have additional limitations that do not permit enrollment in another Medicare Advantage organization, even if they are eligible for a SEP. Such individuals should consider their options carefully before using this SEP to leave their current Medicare Advantage plan, as Medicare Fee-for-Service may be their only option. Should a displaced individual with ESRD leave their current plan then return to Puerto Rico or the U.S. Virgin Islands, he or
she would not be eligible to join their prior or another Medicare Advantage plan.
For more Information: https://www.cms.gov