As we move out of the Annual Enrollment Period and into ROY (rest-of-year) Medicare enrollment period, it is important to make sure you are using the correct Special Election Period on the Medicare Enrollment Application. There is always a lot of confusion about which SEP Reason and Code to use on the application, and rightfully so since the wrong SEP code can get the application kicked back as incorrect.
Unfortunately, things did not get easier since the Centers for Medicare and Medicaid Services (CMS) have recently published numerous changes to election codes for Plan Year 2019. Yes, you read that correctly! Time to learn more SEP Codes. Luckily, we have already done some leg work reading through the various changes and have summed up the information for you as a cheat sheet.
Important Notes:
- If you are reading this before 1/17/2019, then it is important to note that not all codes updates will have taken place in the electronic applications and you will need to use SEP-OTH and indicate the “reason code” from below if you don’t see an applicable SEP on the list.
- If you are an avid paper application user, then you will notice that not all SEPs are itemized. If you do not see an applicable SEP on the paper application, then you must use SEP-OTH and indicate ‘reason code’ as indicated below.
- Make sure you are using the correct code for Paper vs. Electronic application. They can differ.
Here is the list of changes to SEP for 2019 and their corresponding codes:
SEP for Dual-Eligible Individuals and Other LIS-Eligible Individuals: This is for Medicare Beneficiaries receiving any type of Medicaid assistance, or who qualify for a low-income subsidy (LIS)
- SEP Code: SEP – MDE
- Note: They have eliminated SEP codes LIS, LLS
- This SEP can now only be use once per calendar quarter between 1/1 and 9/30
SEP for Individuals who Gain, Lose or Have a Change in their Dual or LIS-Eligible Status: This is for Medicare beneficiaries who become eligible for any type of Medicaid or LIS, lose eligibility for any type of Medicaid or LIS, or have a change in the level of their Medicaid or LIS.
- Paper Application Code: SEP – MCD
- Electronic Application Code: SEP – MCD (for Medicaid), NLS (for Extra Help/LIS)
- Note: They have eliminated SEP codes LIS, LLS
SEP for individuals Affected by a FEMA-Declared Weather-Related Emergency or Major Disaster: This is for Medicare beneficiaries who were affected by a weather-related emergency or major disaster (as declared by FEMA) and, as a result, were unable to make an enrollment during their election period.
- SEP Code: SEP – DST
SEP for beneficiaries who dropped a Med Supp to choose MA/MAPD for first time (12 month Trial Right) and want to return to Original Medicare and PDP.
- SEP Code: SEP-12G
- changed from MES to 12G
SEP for Individuals who elected a MA/MAPD plan during IEP/ICEP at 65th birthday and dropping it within the first 12 months to return to Original Medicare and PDP.
- SEP Code: SEP – 12J
- Changed from S65 to 12J
SEP (ACC) for beneficiaries who missed an election period due to delayed receipt of Accessibility materials:
- SEP Code: SEP – OTH, and enter “Equal Time for Materials in Accessible Format”
- Beginning 1/1/2019
SEP
(LAW) for Non-U.S. Citizens who become Lawfully Present:
- SEP Code: SEP-LAW
- This SEP begins the month the lawful presence starts and continues for two additional months.
SEPs for beneficiaries who recently returned to the United States after living permanently outside the U.S.
- SEP Code: SEP-RUS
- NOTE: This code changed from MOV to RUS
SEP for beneficiaries released from incarceration.
- SEP Code: SEP-INC
- NOTE: This code changed from MOV to INC
SEP for beneficiaries who involuntarily lose creditable prescription drug coverage
- SEP Code: SEP-LEC
- NOTE: This code changed from LOC to LLC
- The SEP permits enrollment in a MAPD/PDP
SEP for beneficiaries who are in a State Qualified Pharmaceutical Assistance Program (SPAP) or lost eligibility for SPAP
- SEP Code: SEP – PAP
- changed from SPA to PAP
A FULL GUIDE FOR ALL ELECTION PERIODS CAN BE FOUND HERE.
Please feel free to call and speak with one of our friendly broker managers if you are interested in becoming an agent and have any Medicare related questions. CONTACT US HERE!
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