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SEP Codes: The #1 Misused Code - MDE

Posted by www.psmbrokerage.com Admin on Wed, Aug 09, 2023 @ 11:55 AM

SEP Codes

It has come to our attention that the MDE SEP is the #1 misused SEP. Misusing this SEP may cause CMS to reject the application and can be time consuming for all parties involved. It is very important that agents understand how to use SEP codes correctly to avoid having applications rejected and corrective action issued.

SEP for Dual-Eligible Individuals and Other LIS-Eligible Individuals

Available to:

  • Medicare beneficiaries receiving any type of Medicaid assistance
  • Medicare beneficiaries who qualify for a low-income subsidy (LIS)

What the election can be used for:

If enrolled in:

  • Original Medicare - Then they may enroll into an MA-only, MAPD, or PDP
  • MA-only, MAPD, or PDP - Enroll into a different MA-only, MAPD, or PDP or Disenroll to Original Medicare

When can it be used:

  • Election can only be used once per calendar quarter between 1/1 and 9/30
  • Quarters are January to March, April to June, and July to September (based on enrollment receipt, not requested plan start date)
  • Election cannot be used between 10/1 and 12/31
  • Individuals identified as at-risk or potentially at-risk for abusing certain medications will not have their enrollment/disenrollment accepted by CMS
  • Limitation can last up to 24-months at a time

The effective date of an enrollment request made using this SEP is the first of the month following receipt of an enrollment request.

The disenrollment date will be the end of the month in which the disenrollment request is received.

Note: This SEP is separate from the “SEP for Individuals who Gain, Lose, or Have a Change in Their Dual or LIS-Eligible Status” and the two should not be used interchangeably. SEP Codes by rejectionLearn more about SEP Enrollment periods by viewing our SEP Guide.


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Tags: LIS, SEP

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