WHAT'S WAPPENING?

No Medicare SEP Established for COVID-19

Posted by Jean A. Lentsch on 4/13/20 1:55 PM

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Western Asset Protection is dedicated to keeping the agent community and our senior community safe during this COVID-19 crisis, especially when it comes to compliance. Unfortunately, there has been a lot of misinformation and confusion surrounding COVID-19. We have been working closely with our compliance partners to stay up to date on any and all changes in our industry as information is released from Capitol Hill, CMS, FEMA and the Department of Insurance.

One key source of confusion that we’re seeing deals with special enrollment periods (SEPs) and COVID-19.

In recent days, you may have received a few blasts from carriers advertising that a SEP has been implemented for the COVID-19 crisis, due to a FEMA declared emergency. However, as of April 13, CMS has not announced a new SEP, and there is currently no SEP for Medicare due to COVID-19.

The COVID-19 Emergency

COVID-19 has led to emergency declarations.

In March, President Trump declared a national emergency in response to COVID-19. Governors have also declared emergencies in their states, and Health and Human Services Secretary Azar declared a public health emergency on January 31.

The emergency declarations may have significant ramifications for Medicare. According to the proclamation declaring a national emergency, “The Secretary of HHS may exercise the authority under section 1135 of the SSA to temporarily waive or modify certain requirements of the Medicare, Medicaid, and State Children’s Health Insurance programs and of the Health Insurance Portability and Accountability Act Privacy Rule throughout the duration of the public health emergency declared in response to the COVID‑19 outbreak.”

After FEMA declares a weather-related emergency or disaster, CMS will establish a SEP for individuals who were unable to enroll in a plan because of the disaster.

However, at this time, no Medicare SEP has been established in connection to COVID-19. Western Asset has confirmed this with several congressional parties. 

CMS and the COVID-19 Response

CMS has announced multiple changes in response to COVID-19.

These changes include a temporary expansion of telehealth services. This change will help at-risk seniors get medical care without exposing themselves and others to the novel coronavirus.

CMS has also announced that Medicare will cover lab tests for COVID-19 with no out-of-pocket costs, and that Medicare Advantage plans can waive cost-sharing for COVID-19 lab tests.

Stay Tuned

According to NPR, multiple states that operate their own ACA health insurance exchange have established SEPs in response to COVID-19. Additionally, some organizations have voiced the opinion that CMS should create an SEP for COVID-19. For example, the American College of Physicians recently sent a letter to Vice President Pence, Secretary Azar and Administrator Verma urging this.

This is still a developing situation. New announcements may be made as the pandemic continues.

You can check the Medicare & Coronavirus page for new information. We can assure you that Western Asset Protection will blast any new information as it is approved, so watch for our communications.

Topics: COVID-19

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