Aetna received additional information from the Centers for Medicare & Medicaid Services (CMS) regarding the Medicare special enrollment period (SEP) for individuals affected by weather-related emergencies or major disasters. The information clarifies who is eligible for the SEP.
This SEP provides impacted beneficiaries with one additional opportunity to change their Medicare plan (MA/MAPD, PDP) in the event they were unable to make an election during another qualifying enrollment period due to the weather-related emergency or major disaster. Currently, this SEP runs through December 31, 2017, but CMS will evaluate whether to extend this SEP opportunity. Read the original CMS press release.
Please review the complete and updated information below. This message supersedes information in prior communications.
CMS has confirmed that:
- The SEP is for individuals who were eligible for an enrollment period but were prevented from making an election because of the declared disasters.
- The SEP is for beneficiaries impacted by Hurricanes Harvey, Irma and Maria—as well as beneficiaries affected by weather-related emergencies or natural disasters identified by the Federal Emergency Management Agency (FEMA) since September 29. With the exceptions of these 3 hurricanes, the SEP is not available for disaster declarations that occurred prior to September 29.
Beneficiaries who have already enrolled in a plan during the AEP are generally not permitted to make another election under this SEP unless they were eligible for a different enrollment but couldn’t use it because of the disaster.
Based on the latest clarification from CMS, the impacted areas eligible for this SEP are below.
· North Carolina
|· South Carolina
Click here to view a list of impacted counties where 2018 Aetna and Coventry MA/MAPD products are available.
Who’s eligible for this SEP?
- Individuals who were eligible for an enrollment period but were prevented from making an election because of the declared disasters.
- Individuals who reside, or resided at the start of the incident period, in an area where FEMA has declared an emergency or a major disaster.
- Individuals who live outside of the affected areas but who rely on help making healthcare decisions from friends or family members who live in the affected areas.
EASY instructions for assisting eligible beneficiaries
Producers may assist eligible beneficiaries with making these enrollment requests. If you submit enrollments directly to Aetna, you are eligible to earn a commission.
Make sure you use the enrollment form that corresponds with the expected effective date. For example, use the 2017 enrollment form for effective dates in 2017 and the 2018 enrollment form for effective dates in 2018.
|· If using a paper application, at the bottom of page 1, write in “OTH/SEP” and a description (i.e., “weather event in FL”). Also, clearly write in the proposed effective date of coverage on page 6.|
|· If submitting enrollments electronically (e.g., with the Ascend Virtual Sales Office app), in the Confirming Your Enrollment Period section, check the “Other” checkbox and then enter a reason for using the SEP (i.e., “major disaster in TX”).|
In addition, individuals may contact 1-800-MEDICARE directly to request enrollment using this special enrollment opportunity.
Please note: Our existing members don’t need to do a thing if they want to keep their current plan for next year. If their current plan is available in 2018 and they decide it still works for them, they’re all set. Aetna will automatically renew their coverage in this plan for next year.
Example scenarios when beneficiaries might use this SEP:
- Because of a recent natural disaster, a beneficiary had an enrollment period available but wasn’t able to review their 2018 plan options. Suddenly, it’s December 8 and AEP is over. Fortunately, the beneficiary is still eligible for this SEP through December 31, 2017, to enroll in a plan or change plans for 2018.
A beneficiary missed their Initial Enrollment Period due to one of the disasters. They used this SEP in October to enroll in a 2017 plan to receive coverage during the remaining months of 2017. They can then use AEP to enroll in a different plan, if needed, for 2018.
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