Understanding and Using the Disaster Special Enrollment Period (SEP)

During the “Government Entity-Declared Disaster or Other Emergency” Special Enrollment Period (SEP) (previously known as the “FEMA-Declared Weather Related Emergency or Major Disaster” SEP), Medicare beneficiaries will have the opportunity to enroll in, disenroll from, or change their Medicare Part D or Medicare Advantage plan coverage.

Find declared disasters now!
Current emergencies (CMS.gov)

This original CMS document shows that a declared disaster causes a Medicare SEP. This allows individuals an SEP to enroll in A or B of Medicare even if they have missed an enrollment.

Disaster SEP FAQs for Medicare Beneficiaries

If an individual lives in a declared disaster area, they may also be granted freedom of provider network restrictions and network pharmacy restrictions. In addition, they may also receive additional supplies of their prescriptions beyond the limit that is normally allowed.

Getting Medical Care & Prescription Drugs in a Disaster or Emergency Area

Getting care in a disaster or emergency (Medicare.gov)

To replace a lost or damaged Medicare card, call 1-800-MEDICARE and contact social security if you temporarily or permanently changed your address. If you have other health insurance, call the plan to replace lost or damaged membership cards.

CMS Requirements for Disaster or Emergency SEPs

A declared Disaster or Emergency Special Enrollment Period (SEP) is only available for beneficiaries who have been prevented from enrolling or disenrolling during an election period due to a declared disaster or emergency.

CMS has fairly strict limitations for when the Disaster or Emergency SEP can be used. Below are three ways to qualify for this type of SEP:

A valid election period must have occurred during the time of the declared disaster or emergency; and
Beneficiary must have been unable to change plans due to said disaster or emergency; and
Individual must live or have lived in the location where the declared disaster or emergency occurred at the time the Disaster or Emergency SEP began. Additionally, CMS states that the enrollee may be eligible for this Disaster or Emergency SEP if they rely on someone who assists with making their health care decisions who lives where the declared disaster or emergency took place during the SEP.

If the above requirements are not met, the individual cannot enroll with this SEP.

This SEP may also NOT be used if the individual has already used another valid election period during the SEP period. As an example, let’s say Mr. Jackson was unable to change plans during an election period due to a declared disaster in the town he lives in. The SEP began on August 1, 2023, and ends on January 31, 2024. During AEP (October 15-December 7) Mr. Jackson chose to change plans. Due to Mr. Jackson changing plans during AEP, he is not allowed to use the Disaster or Emergency SEP to change his plan again.

Start and End Dates for Disaster or Emergency SEPs

A Disaster or Emergency Special Enrollment Period (SEP) begins on:

The day the disaster or emergency was declared; or
The incident start date, as stated in the declaration; or
If these dates are different, whichever date is earlier.

The Disaster or Emergency SEP ends after 2 full calendar months from the end date stated in the declaration, or, if different, the date that the end of the disaster or emergency is announced, whichever is later.

End Date Regulation, Effective January 1, 2025

Per 42 CFR 422.62(b)(18) (i) If the incident end date of an emergency or major disaster is not otherwise identified, the incident end date is 1 year after the SEP start date; or, if applicable, the date of a renewal or extension of the emergency or disaster declaration, whichever is later. The maximum length of this SEP, if the incident end date is not otherwise identified, is 14 full calendar months after the SEP start date or, if applicable, the date of a renewal or extension of the emergency or disaster declaration.

A Disaster or Emergency SEP Timeframe Example

A massive flood has occurred in several counties, so FEMA declares an emergency for said counties on February 4, 2022. The incident start date is January 4, 2022, and the end date is January 6, 2022.

The SEP begins on January 4 (this is the earlier date).
The SEP ends two full calendar months from the announcement date of February 4 (this is the later date).
So the SEP ends on April 30.