Medicare Special Enrollment Periods Announced For Kentucky, Virginia, and West Virginia

Special enrollment periods have been announced for Kentucky, Virginia, and West Virginia.

Special Enrollment Period: Kentucky Emergency Declaration - Severe Flooding in Eastern KY

Please be advised that a state of emergency declaration was extended, impacting individuals in all Kentucky counties. This declaration allows for a one-time Special Enrollment Period (SEP), in the event beneficiaries were unable to make an election during another qualifying election period. Please reference the following guidelines for the incident period. This SEP applies to all counties in Kentucky.

Important Compliance Information

Who is eligible:

This SEP opportunity is ONLY available to beneficiaries who:​

• Reside, or resided at the start of the SEP eligibility period described in this guidance, in an area for which a federal, state or local government entity has declared a disaster or other emergency or they do not reside in an affected area but rely on help making healthcare decisions from one or more individuals who reside in an affected area; and
• Were eligible for another election period at the time of the SEP eligibility period, and;
• Did not make an election during that other valid election period due to the disaster or other emergency.

Details:

Impacted Counties: All Counties

Incident Period: The incident period occurred on July 28, 2022. The declaration was announced on July 28, 2022.

Timeframe: Effective immediately, individuals meeting the requirements listed above can enroll, dis-enroll, or switch MAPD or PDP plans until September 30, 2022.

*Note: Eligible enrollments will be effective the first of the month after the application has been processed.

Reminders:

Agents can accept/submit a Medicare Advantage or Prescription Drug Plan application by the beneficiary’s request through the following steps:

1. Obtain a compliant Consent to Contact (C2C).
2. Capture a compliant Scope of Appointment (SOA).
3. Host a compliant 1:1 appointment.
4. If the beneficiary is prepared to enroll, complete an application noting this SEP, either by selecting the “Emergency or Major Disaster” option or writing "Severe Flooding" in the "Other" option. WARNING! Only select one election type.

Virginia

State declaration: Emergency

SEP incident date: 7/28/2022 - 8/27/2022

This SEP declaration is effective 7/28/2022 - 10/31/2022

Impacted counties for SEP purposes: All

IMPORTANT: Please be aware

• This does not mean that active marketing can occur.
• The SEP is only for the purpose of providing a SEP to impacted individuals who had a valid election during the incident and were unable to make that election due to the emergency.
• This does not mean we initiate waiving of authorization or referral requirements.
• This does not extend waiving of prior authorizations, referrals, etc. 

SEP for Government Entity-Declared Disaster or Other Emergency

42 CFR 422.62(b)(18)

(Rev. 2, Issued: August 12, 2020; Effective/Implementation: 01-01-2021)

An SEP exists for individuals affected by a disaster or emergency declared by a federal, state, or local government entity who were unable to, and did not make an election during another valid election period. This includes both enrollment and disenrollment elections.

Individuals will be considered eligible for this SEP if they: 

• Reside, or resided at the start of the SEP eligibility period described in this guidance, in an area for which a federal, state or local government entity has declared a disaster or other emergency or they do not reside in an affected area but rely on help making healthcare decisions from one or more individuals who reside in an affected area; and
• Were eligible for another election period at the time of the SEP eligibility period; and
• Did not make an election during that other valid election period due to the disaster or other emergency.

The SEP starts as of the date the declaration is made, the incident start date or, if different, the start date identified in the declaration, whichever is earlier. The SEP ends two full calendar months following the end date identified in the declaration or, if different, the date the end of the incident is announced, whichever is later.

Special Enrollment Period: West Virginia Emergency Declaration - Inclement Weather

Please be advised that a state of emergency was declared, impacting individuals in certain West Virginia counties. This declaration allows for a one-time Special Enrollment Period (SEP), in the event beneficiaries were unable to make an election during another qualifying election period. Please reference the following guidelines for the incident period. This SEP applies to the following counties in West Virginia.

Important Compliance Information

Who is eligible:

This SEP opportunity is ONLY available to beneficiaries who:​

• Reside, or resided at the start of the SEP eligibility period described in this guidance, in an area for which a federal, state or local government entity has declared a disaster or other emergency or they do not reside in an affected area but rely on help making healthcare decisions from one or more individuals who reside in an affected area; and
• Were eligible for another election period at the time of the SEP eligibility period, and;
• Did not make an election during that other valid election period due to the disaster or other emergency.

Details:

Impacted County: Fayette, Greenbrier, Logan, McDowell, Mingo, and Wyoming

Incident Period: The incident period occurred from July 26, 2022 through August 25, 2022. The declaration was announced on July 26, 2022.

Timeframe: Effective immediately, individuals meeting the requirements listed above can enroll, dis-enroll, or switch MAPD or PDP plans until October 31, 2022.

*Note: Eligible enrollments will be effective the first of the month after the application has been processed.

Reminders:

Agents can accept/submit a Medicare Advantage or Prescription Drug Plan application by the beneficiary’s request through the following steps:

1. Obtain a compliant Consent to Contact (C2C).
2. Capture a compliant Scope of Appointment (SOA).
3. Host a compliant 1:1 appointment.
4. If the beneficiary is prepared to enroll, complete an application noting this SEP, either by selecting the “Emergency or Major Disaster” option or writing "Inclement Weather" in the "Other" option. WARNING! Only select one election type.

If you have any questions, call us today at 866-568-9649!