If a plan receives an application using the Disaster/Emergency SEP with an application date on or after April 1st, 2025, the plan should treat the application as incomplete. The plan must reach out to the applicant to determine eligibility for another election period and to inform the applicant that they need to call 1-800-MEDICARE in order to use the Disaster/Emergency SEP. If the applicant is only eligible for the Disaster/Emergency SEP, the plan should deny the application for failure to provide the information to complete the application.

Plans should inform prospective applicants who may be eligible for the Disaster/Emergency SEP that they must call 1-800-MEDICARE in order to make an election under the Disaster/Emergency SEP. TTY users should call 1-877-486-2048.

For MARx submissions, the SEP reason code will remain “01,” however it will be moved to the “CMS approval required” group. For OEC crosswalk purposes, the S reason code via OEC will remain “DST.” Updates to the Plan Communication User Guide (PCUG) and more information from the MA-PD Help Desk will be released in the coming months. Additionally, we will update our model enrollment exhibits and descriptions of the SEP in the Medicare Advantage and Part D Enrollment and Disenrollment Guidance in 2025.

CMS will monitor OEC transactions and plan submissions in MARx to ensure plan compliance with this change.

Read the CMS release HERE.

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