Special Enrollment Periods (SEPs) are allotted times outside the yearly Open Enrollment Periods when you can sign up for health insurance or make changes to your Medicare coverage. You qualify for an SEP under certain special circumstances, such as losing your health coverage, moving, getting married, or having a baby. Each SEP has rules about when you can make changes and the types of changes you can make.

You may also qualify for an SEP under certain extraordinary circumstances when a disaster is declared by the President and your state Governor. This is the case right now.

The Centers for Medicare & Medicaid Services (CMS) have granted an ongoing SEP-DST to multiple counties in Texas. Additionally, there is a new SEP available for all 50 states and all counties. Please reference the following guidelines for this SEP. The timeline of this SEP is January 1, 2021 and runs indefinitely, until the end date is declared.

Who Qualifies for This SEP?

Effective January 1, 2021, an SEP exists for individuals affected by a disaster or other 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 are eligible for this SEP if they:

• Reside, or resided at the start of the SEP eligibility period, 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 (2) 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.

What Does This Mean for Agents?

If an individual wants to enroll and believes they may qualify for this SEP, agents should:

• Ask the beneficiary if they can show proof that they lived/live in an impacted area at the start of the SEP eligibility period.
• If they do not have proof, ask them to verbally attest.
• Confirm that they had another election period available during the time of the incident period.
• Confirm that the beneficiary lived in a county that has been declared an emergency or major disaster or relies on help making healthcare decisions from friends or family members who lived/live in the affected areas.
• Once eligibility has been verified, proceed with the application.
• On applications, use election code SEP DST.  

Enrollments made pursuant to this SEP are effective the first of the month following the receipt of the enrollment request. For enrollment requests where more than one enrollment effective date is possible, agents will need to determine the applicant’s desired effective date.  

This SEP should never be used as a marketing tool to promote MA or PDP sales.  Agents should not be actively marketing this SEP, but rather, be aware that it is available in case they are approached by someone who believes they have missed an election period due to the weather-related incident.

For any updates to eligible counties for FEMA declarations please refer to the FEMA website at: https://www.fema.gov/disasters

Changes from Previous Communication:

New or amended declarations are highlighted in BLUE.

Nationwide (COVID-19 Public Health Emergency) – Secretary of Health and Human Services Declared a Public Health Emergency on January 27, 2020

Incident Period: January 27, 2020 – End Date Not Stated In The Declaration

SEP Start Date: January 27, 2020

SEP End Date: TO BE DETERMINED

Counties: Nationwide

Texas (Significant Flooding and Severe Weather) – Governor Declared a State of Emergency on May 19, 2021

Incident Period: May 19, 2021 – End Date Not Stated In The Declaration

SEP Start Date: May 19, 2021

SEP End Date: TO BE DETERMINED

Counties: Calhoun, Jasper, Jefferson, Kleberg, Newton, and Tyler

Texas (Tropical Storm Nicholas) – Governor Declared a State of Emergency on September 13, 2021

Incident Period: September 13, 2021 – End Date Not Stated In The Declaration

SEP Start Date: September 13, 2021

SEP End Date: TO BE DETERMINED

Counties: Aransas, Brazoria, Calhoun, Chambers, Galveston, Harris, Jackson, Jasper, Jefferson, Liberty, Matagorda, Montgomery, Newton, Nueces, Orange, Refugio, San Patricio, Victoria, Wharton

Texas (Drought With Threat of Wildfire) – Governor Declared a State of Emergency on January 6, 2022

Incident Period: January 6, 2022 – End Date Not Stated In The Declaration

SEP Start Date: January 6, 2022

SEP End Date: TO BE DETERMINED

Counties: Andrews, Baylor, Borden, Brewster, Cameron, Carson, Castro, Childress, Collingsworth, Cottle, Culberson, Dallam, Dallas, Deaf Smith, Dimmit, Fisher, Floyd, Gray, Hansford, Hardeman, Hartley, Haskell, Hemphill, Hidalgo, Howard, Hutchinson, Jones, Knox, Lamar, Martin, Maverick, Midland, Moore, Motley, Ochiltree, Oldham, Pecos, Potter, Presidio, Randall, Roberts, Scurry, Sherman, Stonewall, Terrell, Throckmorton, Upton, Ward, Wheeler, Wichita, Wilbarger, Winkler

Texas (Ice Storm) – Governor Declared a State of Emergency on February 3, 2022

Incident Period: February 3, 2022 – End Date Not Stated In The Declaration

SEP Start Date: February 3, 2022

SEP End Date: TO BE DETERMINED

Counties: Bosque, Dallas, Delta, Denton, Ellis, Fannin, Grayson, Hopkins, Hunt, Johnson, Kaufman, Lamar, Navarro, Rains, Red River, Rockwall, Williamson

Texas (Drought with Risk of Wildfire) – Governor Declared a State of Emergency on February 21, 2022

Incident Period: February 21, 2022 – End Date Not Stated In The Declaration

SEP Start Date: February 21, 2022

SEP End Date: TO BE DETERMINED

Counties: Andrews, Angelina, Archer, Armstrong, Atascosa, Bailey, Baylor, Borden, Bosque, Bowie, Brewster, Briscoe, Brown, Callahan, Cameron, Camp, Carson, Cass, Castro, Cherokee, Childress, Clay, Coke, Coleman, Collin, Collingsworth, Comanche, Cooke, Coryell, Cottle, Crosby, Culberson, Dallam, Dawson, Deaf Smith, Delta, Denton, Dickens, Dimmit, Donley, Duval, Eastland, Erath, Fannin, Fisher, Floyd, Foard, Franklin, Frio, Gaines, Garza, Gray, Grayson, Hall, Hamilton, Hansford, Hardeman, Harrison, Hartley, Haskell, Hemphill, Hidalgo, Hill, Hood, Hopkins, Houston, Howard, Hunt, Hutchinson, Jack, Jeff Davis, Johnson, Jones, Kaufman, Kent, King, Knox, Lamar, Lamb, Lampasas, La Salle, Lipscomb, Live Oak, Loving, Lubbock, Lynn, Marion, Martin, Maverick, McLennan, McMullen, Midland, Mills, Mitchell, Montague, Moore, Morris, Motley, Nacogdoches, Nolan, Ochiltree, Oldham, Palo Pinto, Panola, Parker, Parmer, Pecos, Potter, Presidio, Rains, Randall, Red River, Reeves, Roberts, Rockwall, Runnels, Rusk, San Augustine, San Saba, Scurry, Shackleford, Shelby, Sherman, Somervell, Stephens, Sterling, Stonewall, Swisher, Tarrant, Taylor, Terrell, Terry, Throckmorton, Titus, Upton, Val Verde, Van Zandt, Ward, Webb, Wheeler, Wichita, Wilbarger, Winkler, Wise, Young, Zavala

Texas (Wildfire) – Governor Declared a State of Emergency on March 18, 2022

Incident Period: February 23, 2022 – End Date Not Stated In The Declaration

SEP Start Date: February 23, 2022

SEP End Date: TO BE DETERMINED

Counties: Brooks, Brown, Coleman, Comanche, Eastland, Grayson, Mason, Potter, Randall, Reynolds, Williamson

Texas (Severe Weather) – Governor Declared a State of Emergency on March 22, 2022

Incident Period: March 21, 2022 – End Date Not Stated In The Declaration

SEP Start Date: February 23, 2022

SEP End Date: TO BE DETERMINED

Counties: Bastrop, Cass, Cooke, Grayson, Guadalupe, Houston, Jack, Madison, Marion, Montague, Nacogdoches, Panola, Rusk, Upshur, Williamson, Wise