Scenario
Member moved out of a rehabilitation facility on 3/15/2026 and would like to enroll into a different MAPD plan.
Moved out of a LTC facility SEP
Member moved down the street within the same county. 28040 -> 28160 and currently on H3146-002. Is move SEP valid?
Not valid, moved within the same service area
How often can the Integrated SNP SEP be used?
Monthly
What is the SEP timeframe for Living In, Moved in or Out of a Long term care facility?
SEP is valid as long as you live in the institution and for 2 full months after the month you move out of the institution.
There are two programs called PACE and identifying which it is will determine if you have a SEP. How do you know the difference?
Marx will show the "National PACE" program if they are enrolled. If person lives in the state of PA its likely they are referring to the SPAP PACE instead.
Member has an active MAPD plan, part of the HOOSIER program and would like to switch to a MAPD plan with more dental.
SPAP SEP
Member has PDP plan that is set to terminate on 4/30/2026 due to being out of service area. Member moved in 2024 from NY -> FL and just received a letter notifying them of the termination date. Is Move SEP valid?
Valid, enter today's date as notification date
Marx shows Medicaid level has been QMB ONLY since 2022, no recent change. The plan eligibility requirements no longer list QMB ONLY. Are they eligible for SEP?
Yes, Loss of SNP eligibility SEP
What is the SEP timeframe for Delayed Part B?
3 months before the month you’re first eligible for both Part A and Part B & 2 months after you get both Part A and Part B for the first time to join a plan.
Move SEP is valid the month before you move and 2 months after you move, unless...
This is your first time notifying the plan, the SEP starts the date of notification
Caller enrolled into Part B during a Special Enrollment Period because of an exceptional situation on 2/1/2026 and would like to enroll into a MAPD plan.
Valid for 2 months after signing up for Part A or Part B during a Special enrollment period
Member moved from Los Angeles County CA -> Spartanburg County SC. Marx/Stars shows the updated SC address. Member is currently on plan H4982-001. Is move SEP valid?
Marx shows a recent Copay Level change from 1 to 2 Extra help, are they eligible for a SEP? If so, is it product type specific?
Change in LIS Status SEP (level change, newly eligible, or loss)
Not product type specific, enrollment can be for MAPD or PDP
What is the SEP timeframe for being enrolled into a State Pharmaceutical Assistance Program (SPAP)?
Once per Calendar Year
The Trial Period SEP is valid for 12 months after you join a MA/MAPD plan for the first time. What are you allowed to do with that SEP?
Go back to Medigap policy and join PDP only plan
Caller lost plan S5660-801 on 2/28/26 and would like to enroll into Aetna policy today.
800 Series Retiree plan, loss of employer coverage SEP
Member moved from Broward County FL -> Rutherford County NC. Marx/Stars shows FL address and member is currently on plan H3146-006. Is move SEP valid?
Not valid, member is already on a plan for the correct service area
If a caller has Medicaid and/or extra help, with no recent level changes (not in a HIDE/FIDE state), are they eligible for a SEP? If so, is it product type specific?
Yes, monthly SEP for a PDP only enrollment
What is the SEP timeframe for Change in LIS or Medicaid Status?
3 full months from the notification or effective date of the change, whichever is later.
IEP 2 means eligible for Medicare prior to age 65 and now turning 65. This enrollment is valid 3 months prior, month of, and 3 months after 65th birthday. When can the plan take effect?
First of the following month after enrollment
Member's CSNP plan terminated on 2/28/26 due to doctor not certifying condition. Member would like to re-enroll into CSNP plan.
Chronic SEP
Member moved from Rutherford County NC -> Gaston County NC. Marx/Stars shows updated address for Gaston County. Member is currently on plan H5521-348.
Valid, member has new plan options available in Gaston County if they choose to enroll into one of those.
What are the eligibility requirements for enrollment into the VA or KY FIDE plans utilizing the integrated SNP SEP?
Full Medicaid QMB+, SLMB+, FBDE
Enrolled into Aetna's Medicaid called Aetna Better Health
What is the SEP timeframe for OEP newly eligible?
Within the first 3 months you get Medicare and joined an MA/PD plan
The SEP to enroll into a CSNP plan with a qualifying chronic condition is valid once per calendar year, unless...
you have another chronic condition, you get another SEP to join a different SNP that covers this other condition.