Important Update: Changes to the Disaster/Emergency Special Election Period (SEP) for Medicare Plans

As insurance agents in the senior market, staying updated on changes to Medicare regulations is essential for maintaining compliance and providing your clients with accurate guidance. Recently, the Centers for Medicare & Medicaid Services (CMS) released an important update regarding the Special Election Period (SEP) for Individuals Affected by a Government Entity-Declared Disaster or Other Emergency (Disaster/Emergency SEP).

Download CMS Memo

Effective April 1, 2025, this change alters how beneficiaries can make elections using the Disaster/Emergency SEP. Here’s what you need to know and how it impacts your business.

What’s Changing?

Starting April 1, 2025, beneficiaries who wish to utilize the Disaster/Emergency SEP must contact 1-800-MEDICARE directly. This means:

• Medicare Advantage Organizations and Part D sponsors will no longer accept SEP elections directly from beneficiaries.
• Plans will receive Disaster/Emergency SEP elections solely through downloads from the Health Plan Management System (HPMS) Online Enrollment Center Management module.

This change aims to address concerns regarding misuse of the Disaster/Emergency SEP, ensuring that only eligible beneficiaries affected by a declared disaster or emergency can use this election period.

Key Requirements for Insurance Agents and Plans

To comply with this new policy, insurance agents and plans must adapt their processes:

1. Remove the Disaster/Emergency SEP from Enrollment Forms

• Before April 1, 2025, all references to the Disaster/Emergency SEP must be removed from enrollment forms and mechanisms.
• Educate clients that this specific SEP can no longer be directly facilitated through their agent or plan sponsor.

2. Incomplete Applications Using the Disaster/Emergency SEP

• If a client submits an application with an application date on or after April 1, 2025, citing the Disaster/Emergency SEP, the application must be treated as incomplete.
• Agents and plans must:
  • Determine whether the applicant qualifies for another election period.
  • Inform the applicant that they need to call 1-800-MEDICARE to utilize the Disaster/Emergency SEP.

3. Educate Prospective Clients

• Proactively inform clients who may qualify for the Disaster/Emergency SEP that they must directly contact 1-800-MEDICARE (TTY: 1-877-486-2048) to make their election.

4. Monitor Compliance

• CMS will monitor transactions in the HPMS and MARx systems to ensure plans and agents are complying with this change.

Why This Matters to Insurance Agents

This change has significant implications for agents selling Medicare Advantage and Part D plans:

• Streamlined Compliance: By removing the ability to process Disaster/Emergency SEP applications directly, CMS reduces the risk of non-compliance.
• Clarity for Clients: The new process helps ensure that only those genuinely affected by a disaster or emergency can access this SEP, protecting its integrity.
• Educational Opportunities: Agents must take an active role in educating their clients about this change, demonstrating their value as a trusted resource for navigating Medicare complexities.

Pro Tips for Supporting Your Clients

Here are some strategies to manage this transition smoothly:

1. Update Your Marketing Materials: Ensure all enrollment-related materials reflect the new SEP process and remove outdated information.
2. Train Your Team: If you manage a team of agents, provide training on how to explain the changes to clients effectively.
3. Enhance Client Communication: Use newsletters, emails, or webinars to inform your client base about this update and how it affects their enrollment options.
4. Be Proactive with SEP Education: Familiarize yourself with other SEPs that may apply to clients, ensuring you can identify and leverage appropriate alternatives when necessary.
5. Lean on PSM Brokerage: Our team is here to support you with updated training, tools, and resources to help you navigate this change seamlessly.

Partner with PSM Brokerage for Success

Navigating changes like these can be challenging, but you don’t have to do it alone. At PSM Brokerage, we’re committed to providing agents with the expertise, compliance guidance, and tools needed to excel in the Medicare market.

From tailored training sessions to up-to-date enrollment resources, we’re here to help you stay ahead of the curve. Together, we can ensure you’re providing exceptional service to your clients while meeting all compliance requirements.

Have questions? Contact us today to learn how PSM Brokerage can support your Medicare business during this transition and beyond.