Easy as SEP
What SEP do you use if caller is moving out of service area?
Move
What SEP do you use if there was a level change in Medicaid 3/1/2026 and it is 4/2/2026
Change in level of Medicaid
Member was termed for non payment on their PDP plan. Member has LIS and has had no level change. Can you use LIS SEP in this case.
No
Member has had Medicare and is turning 65 7/03/2026, Is there an SEP to change plans if so when is the first day SEP can be used?
IEP 2 ( I have had Medicare and will be turning 65 soon)
4/01/2026
Member has a Chronic Condition and wants to join a C-SNP. What SEP would you use?
I want to join a Chronic plan that tailors its benefits to my condition
Member had Original Medicare and a Supplement Plan Before trying there First MAPD plan. Member does not like the MAPD plan and is wanting to go back to Original Medicare and there Supplement Plan. Is there a SEP and what would it be?
Trial Period SEP
What SEP do you use If caller has Chronic Plan but the doctor did not send in the documentation to show they have a Chronic Condition and their plan is ending?
Loss of SNP ( Loss of chronic Condition)
Can you change from PDP to MAPD during OEP?
NO
Caller is enrolled into a Pace program but doesnt like it and wants to drop it to return to aetna. Are we able to enroll caller back into Aetna? If so what is the SEP?
YES, I dropped my coverage in Pace Program.
Caller use to be a member but CMS auto enrolled into a different plan and is wanting back with Aetna. What SEP do you use?
Auto enrolled SEP
Member lives in KY and has full Medicaid( though Sunflower Health). Member is wanting a HIDE dual plan. Is there a SEP if so what is it?
No SEP as they have to apply for Aetna Medicaid first.
Member is calling because she is a snow bird and needs to change address. Current plan is PDP in NJ and is in NJ 6 and a half months of the year. Is there a SEP and if so what is it?
No SEP as they are in a NJ plan and is there more then 6 months out of the year. Transfer to PDP mso to change temporary mailing address.
Members doctor is not going to be taking there plan anymore. They received a letter stating that they will have a SEP to change to a plan the doctors take. Is there an SEP we can use? If so what is the SEP?
There is no SEP we can use for doctors not taking a plan when they receive a letter. Only SEP that can be used per letter is though CMS.
Mr. Smith was released from incarceration on 01/01/26. He enrolled back into Medicare part A on 03/1/26. He calls in 4/2/26 to enroll back into her previous plan. Does he have an SEP
NO, must be enrolled in both Medicare part A&B
Note: They have 2 full calendar months to join a plan after Medicare Part A and/or B coverage starts
Tom turned 65 in March of 2026 and enrolled into a MAPD for the first time that will starts in April. If he doesn't like the plan will he be able to enroll into a different MAPD?
Yes, OEP Newly eligible
Mber was impacted by hurricane and missed AEP season, are you able to process application using FEMA SEP
NO, USE OF FEMA SEP MUST BE REFERRED back to Medicare
Caller is enrolled into a Pace Program but heard about a plan with extra benefits. She wants to keep her Pace Plan and enroll with us as well. Is she able to do so. If so what would the SEP be?
No, You aren't able to have a Pace Program Plan and a MAPD.
Mr. Jones lives in Kentuck and states he was dropped from his Kentucky Pharmacy Assistance Program on 03/31/2026. Is there an SEP, If so which one?
NO, the Kentucky Pharmacy Assistance Program is a discount drug program not an SPAP
Mber was enrolled into X001-015, is there an SEP if so, what SEP would be used
Yes, I was automatically enrolled by CMS or my state into drug coverage
Note: Mber are enrolled into X001-015 when they have Medicaid and LIS and their MAPD plan has ended and they must have prescription drug coverage
EX. Change in Medicaid level and they are no longer qualify for plan but failed to enroll in a new plan
Mrs. Jones is currently enrolled in H3810-023 is she eligible for a SEP
Yes, I am in a low performing plan (star rating less than 3 stars for the last 3 years)
NOTE: can enroll at anytime, CMS only