What to Do When a Declared Emergency or Disaster Delays Your Medicare Enrollment
Key Takeaways
- The Medicare Disaster Special Enrollment Period (SEP) allows those affected by FEMA-declared emergencies to enroll or modify their Medicare plans outside standard enrollment periods.
- The disaster SEP typically starts with the emergency declaration and can extend up to four months after the emergency ends.
- Eligible individuals can use the disaster SEP to enroll in Medicare Parts A and B or modify their Medicare Advantage (Part C) and prescription drug (Part D) plans.
- To use the disaster SEP, check FEMA’s emergency declarations, contact Medicare to start enrollment, and keep documentation of the disaster’s impact on your ability to enroll.
If an emergency like a hurricane, wildfire, or flood causes you to miss enrolling in Medicare or changing Medicare Advantage plans during an enrollment period, you may be eligible for an extended enrollment period. The Medicare Disaster Special Enrollment Period (SEP) gives people impacted by declared emergencies additional time to enroll or make coverage changes, preventing a lapse in coverage.
You Have Options in an Emergency
When disaster strikes, ensuring your safety and that of your loved ones is the top priority. But after you are secure, take advantage of the Medicare disaster Special Enrollment Period (SEP) given to those who experienced an emergency or disaster to ensure your health coverage does not lapse.
In 2023 alone, the United States faced 28 weather and climate disasters that caused widespread damage and loss of services. The disaster SEP for Medicare ensures that eligible individuals still have access to Medicare without suffering late enrollment penalties or waiting for the next enrollment period.
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How the Disaster SEP for Medicare Works
The Medicare disaster SEP (also known as the disaster Special Enrollment Period or Special Election Period) helps those who miss enrollment deadlines due to a declared emergency or natural disaster. Only incidents declared an emergency by the Federal Emergency Management Agency (FEMA) are eligible.
What are the Eligibility Criteria for the Medicare Disaster SEP?
Beneficiaries must meet the following criteria to be eligible for the Medicare disaster SEP:
- FEMA must declare the emergency. Typically, FEMA assesses the extent of damage caused and amount of people impacted to determine whether or not to officially declare an event an emergency.
You must reside in an affected area. You must live in or be relocating from an area designated as an emergency or disaster zone by FEMA or another federal authority. - You must have missed enrollment due to the disaster. The disaster must have prevented you from enrolling during your Initial Enrollment Period, Annual Enrollment Period, or General Enrollment Period.
- You must be eligible for Medicare. Most people are eligible for Medicare when they turn 65. However, beneficiaries can be under age 65 if they have a qualifying disability or chronic illness.
Eligibility for the Medicare disaster SEP depends on federal declarations, which can vary in timing and location. For the latest updates, visit the FEMA website to confirm whether your area is part of a declared emergency zone.
How Long Does the Medicare Disaster SEP Last?
The Medicare disaster SEP is typically available from the start of the declared emergency. The SEP can extend up to four months following the end of the emergency period. For example, if an emergency is declared on June 1 and ends on June 30, the SEP could extend until October 30.
Information about the start and end of declared emergencies is available through FEMA’s announcements or local news sources. Medicare applications submitted during the disaster SEP generally become active the month after acceptance.
What Can You Do During the Disaster SEP for Medicare?
During a disaster SEP, eligible individuals can do the following:
- Enroll in Medicare Part A or Part B for the first time. Newly eligible Medicare beneficiaries can apply for Part A or Part B if a disaster affected their ability to enroll during their Initial Enrollment Period (IEP).
- Enroll in Medigap. Medicare beneficiaries may enroll in or drop Medigap at any time throughout the year, but may be eligible for more time during their Initial Enrollment Period for Medigap.
- Modify coverage or enroll into a Medicare Advantage plan (Part C) or prescription drug coverage (Part D). Those with Medicare Advantage plans or Part D prescription drug plans can add, drop, or switch plans if they could not do so during the standard enrollment window.
How to Enroll in Medicare During a Disaster Special Enrollment Period
To take advantage of the Medicare disaster SEP, follow these steps:
- Check FEMA’s declarations. Visit the FEMA website to confirm that your area has been officially declared a disaster zone.
- Contact Medicare. Call Medicare or visit their website to begin the enrollment process. If you work with a licensed insurance agent, they can also help guide you through the process.
- Submit documentation. Though specific documents may not be required, keeping records of communication disruptions, mandatory evacuations, or similar evidence is a good idea.
- Replace lost documents. If any essential documents were lost in the disaster, contact the Social Security Administration or Medicare to request replacements.
See It in Action
Imagine a scenario where a hurricane strikes during your Medicare Initial Enrollment Period. The storm disrupts your area’s phone lines, mail delivery, and internet access. You missed your enrollment deadline but later learned that your county is part of a FEMA-declared disaster zone. With the disaster SEP, you can still enroll in Medicare Parts A and B once services are restored, ensuring that you don’t miss out on critical coverage.
Other Enrollment Periods to Know
The disaster SEP is one of several Medicare enrollment periods. Here’s a look at other key enrollment periods:
- Annual Enrollment Period (AEP): This period occurs from October 15 to December 7 each year, and it allows Medicare beneficiaries to join, switch, or drop Medicare Advantage or prescription drug plans.
- General Enrollment Period (GEP): This period allows Medicare-eligible individuals to enroll in Medicare Parts A and B from January 1 to March 31 each year.
- Medicare Advantage Open Enrollment Period (MAOEP): This period runs from January 1 to March 31, during which time Medicare Advantage enrollees can switch plans or revert to Original Medicare.
- Special Enrollment Period (SEP): This period allows beneficiaries to change their Medicare coverage outside the typical enrollment windows. Eligibility and duration depend on qualifying life events, such as moving out of your plan’s service area.
Putting It All Together
Declared emergencies can delay Medicare enrollment, but the Medicare disaster SEP provides relief for affected individuals. Understanding how and when to use this SEP can help you avoid penalties and ensure your coverage remains intact. Consider working with a licensed insurance professional to explore your options and help you make informed decisions during challenging times.
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Sources
2023: A historic year of U.S. billion-dollar weather and climate disasters. Climate.gov.
How a Disaster Gets Declared. FEMA.gov.