What SEP allows beneficiaries with severe or disabling chronic conditions to enroll in a Chronic Special Needs Plan?

SEP-FiveStar allows beneficiaries to enroll in a 5-Star plan at any time throughout the year, with unlimited changes.

Your client recently moved to a new county, and you found a plan offering a benefit increase for them. Their address is not updated in MARx. What should you do?

Maria was auto-enrolled into a plan through CMS. When reviewing MARx, you see a plan starting with X0001 was a plan they had before being placed on a PDP only. What SEP applies?

Your client says that he was recently let out of jail, and he's had a hard time getting on his feet.  You can us use SEP-INC to enroll in a Medicare Advantage Plan.

While reviewing their DSNP eligibility, you see they are approved for Medicaid, but they have not mentioned any Medicaid changes nor are aware that they have Medicaid. Which SEP will you use?

While reviewing MARx, you notice your client’s LIS level changed from a level 2 in 2024 to a  level1 in 2025. What SEP should you use?

Your client tells you they were recently discharged from a skilled nursing facility after a long recovery. They are interested in switching to a Medicare Advantage plan. What SEP applies?

Your client’s employer just informed them that their prescription drug coverage is no longer considered creditable. They need to enroll in a new plan. What SEP applies?

What SEP allows a client to disenroll from a Part D plan to maintain other creditable coverage, such as VA benefits?

SEP-LEC applies when a client loses employer or union health coverage, allowing them to enroll in a Medicare Advantage or Part D plan.

When can a client use SEP-ICEP if they delayed enrolling in Part B?

A client is newly eligible for Medicare and has never enrolled in a Medicare Advantage or Part D plan. On the MARx todays date is three months before the A& B start date.  What SEP applies?

What SEP applies when a client loses eligibility for a Special Needs Plan (SNP) because they no longer meet the specific special needs status?

A client is enrolled in a State Pharmaceutical Assistance Program (SPAP). What SEP applies?

Your client has full Medicaid and qualifies for a Dual Special Needs Plan (DSNP). You run an eligibility check and see they qualify for a HIDE (Highly Integrated Dual Eligible) plan, and they live in a state where the Managed Care Organization (MCO) is not relevant for using this SEP. What SEP applies?

Your client is moving out of an institution and wants to change their Medicare Advantage plan. What SEP applies?