Situation
The shopper lives in an area in which a federal, state, or local government entity has declared a disaster. FEMA declared disaster. If the shopper volunteers information that they were impacted by a disaster which inhibited their ability to utilize a valid enrollment period which has since expired, they should qualify for the SEP. State and local disasters may be difficult to verify. Take the shopper at their word for state/local disasters they claim impacted them. CMS will determine if it is valid when processing the application. Federal disasters may be verified on the FEMA website.
Important Note: Speak with your supervisor for guidance on how/ when to use the Disaster SEP for COVID.
Process for Verification of Federally Declared Disaster
Open this link in a new window to navigate to the FEME FEMA Declared Disasters Website.
Select the participant’s state
Select “Search and Filter Disasters”
Review the FEMA Declared Disasters for the state
In the example above, AZ shows the Margo Fire disaster date range from “April 8, 2021 - Current date.”
The shopper should qualify for the SEP if the has fire impeded the customer’s ability to enroll into a plan during a valid enrollment period.
Enrollment Reasons
Plan | Medicare Code/Reason | Dialer Code/Reason | Uses |
|---|---|---|---|
MA/MAPD/PDP | DST | DST | May not be used again after the plan goes into effect |
Medigap | NA | NA | May not be used for Medigap enrollments |