A fallen tree along Tampa Bay coastline following FEMA-declared weather emergency, Hurricane Irma in Clearwater, Florida. Photo: Ensurem photographer, Alex Burnett.

You May Qualify to Make Changes to Your Medicare Coverage

By Dave Rich

Are you unhappy with your current Medicare coverage?

If you wanted to change your Medicare plans for 2021 and didn’t get it done by December 7 of last year, you may be out of luck until October 15.

That is unless you qualify for a special enrollment period (SEP.) If you were affected by a weather-related emergency or natural disaster recently, it’s likely you might qualify for one.

What is a Special Enrollment Period?

A SEP allows you to make changes to your Medicare coverage when certain events happen in your life. These can include typical life events like moving or losing employer group coverage after leaving a job. They can also include events out of your control, like weather-related emergencies and major disasters.

The Centers for Medicare & Medicaid Services (CMS) will oftentimes provide SEPs to individuals affected by these circumstances if they live in an area for which the Federal Emergency Management Agency (FEMA) declared an emergency or disaster. Typically, these include incidents like wildfires, hurricanes, or major earthquakes.

How do I qualify for the FEMA Disaster/Emergency SEP?

This special enrollment opportunity allows you to enroll in, disenroll from or switch Medicare health or prescription drug plans if you meet certain qualifications.

You must reside or have resided in an area for which FEMA declared an emergency or a major disaster at the start of the incident period.

FEMA’s declaration will include an incident start date and end date. You can find them on fema.gov/disaster-declarations by searching your state and the year. In addition, those individuals who don’t live in the affected areas but rely on help making decisions from friends or family members who do live in those areas may qualify as well.

You must have had another enrollment period at the time of the incident period.

For example, this could include the annual fall open enrollment period – a.k.a. the Annual Election Period (AEP) – which takes place every year between October 15 – December 7, or other SEPs you may have qualified for.

You must not have enrolled or made a change during that other enrollment period.
For example, if you were affected by a natural disaster or weather emergency during AEP last fall but still were able to take advantage of the enrollment period between October 15 – December 7, you will not qualify for this SEP.

What choices do I have during this SEP?

The options you have during this SEP depend on which enrollment period you missed during the FEMA-declared incident. For example, if you were unable to take advantage of last Fall’s AEP, this SEP would give you the same rights you had during that AEP, which include:

• Change from Original Medicare to Medicare Advantage Part C
• Change from Medicare Advantage Part C to Original Medicare
• Switch Medicare Advantage Plans
• Join or drop a Medicare Part D prescription drug plan
• Switch Medicare part D prescription drug plans

How long does this SEP last?

The FEMA disaster/emergency SEP lasts for four months starting the day FEMA declares the incident start date and ending the last day of the fourth calendar month.

For example, Pinellas County, Florida, was recently affected by Hurricane Eta. FEMA lists the incident start date for Eta as November 7, 2020. If you resided in Pinellas during the hurricane and it affected your ability to utilize your enrollment rights during the fall AEP between October 15 – December 7, you would then have until March 31 of this year to take advantage of the Hurricane Eta SEP.

Considering the SEP lasts for a finite amount of time, if you think you may qualify, it’s important to confirm your eligibility right away.

There are a few ways to do this. You can reach out to Medicare directly at 1-800-MEDICARE (1-800-633-4227). If you are already enrolled in a plan, you can always reach out to the insurance company providing your plan.

Lastly, you can reach out to an insurance broker specializing in Medicare products. An insurance broker tends to be more of a one-stop-shop solution since they typically are licensed to sell a wide variety of products from multiple insurance companies. For example, in just one call, they could confirm your eligibility for the SEP, complete a needs analysis to determine the best type of coverage for your needs, help you compare plans and rates, and enroll you into coverage.

SEPs are a powerful extension of your Medicare enrollment rights. They allow you to make changes to your coverage without having to wait until the next open enrollment period in October.

So, you can get into the right plan for your needs at the best price now instead of waiting to make a change into a plan that would not become effective until January first of next year.

Dave Rich is CEO of Ensurem, an online, multi-carrier insurance brokerage in the retail Medicare solutions market.