SEP Codes

IEP

Initial Enrollment Period
Memory Hook: “3 Before, Month Of, 3 After”
Use When: First time getting Medicare Part A & B together
Window: 7 months total

• 3 months before

• Start month

• 3 months after
  Example: A/B starts 4/1 → Jan-Jul
  Trigger Question: “When does your Medicare Part A and B begin?”

ICEP

ICEP
Initial Coverage Election Period
Memory Hook: “Only BEFORE Part B starts”
Use When: Client delayed Part B while already having Part A
Window: 3 months BEFORE Part B effective date
Ends: Day before Part B starts
Example: Part B starts 4/1 → Use Jan-Mar only
Trigger Question: “Did you delay Part B because of employer coverage?”

OEP-NEW

New to Medicare Open Enrollment

Memory Hook: “One Medicare do-over”
Use When: Client enrolled using IEP/ICEP and wants ONE plan change
Window: First 3 months after Part B starts
Example: Part B starts 4/1 → Apr-Jun
Trigger Question: “Did you recently start Medicare this year?”

CSN

Chronic Special Needs SEP

Memory Hook: “C = Chronic”
Use When: Client has qualifying chronic condition
Examples: Diabetes, CHF, Cardiovascular Disorders
Also Use: If client was denied from a C-SNP after verification
Trigger Question: “Do you have diabetes, heart failure, or cardiovascular disease?”

INT

Integrated Care SEP

Memory Hook: “Duals can switch monthly”
Use When: Client has QMB+ or FBDE and qualifies for FIDE/HIDE SNP
Rule: Can use once per month
Trigger Question: “Do you receive both Medicare and Medicaid?”

MCD

Medicaid Change SEP

Memory Hook: “Medicaid changed”
Use When: Client gained, lost, or changed Medicaid level
Window: 3 months after notice
Required: Client says they received a Medicaid letter
Trigger Question: “Did Medicaid send you a letter saying your benefits changed?”

NLS

New LIS Status SEP

Memory Hook: “Extra Help changed”
Use When: Client gained, lost, or changed Extra Help/LIS
Window: 3 months
Important:

• UHC/HealthSpring = applying may qualify

• Aetna/Humana/Devoted = must be approved
  Trigger Question: “Have you recently applied for or received Extra Help?”

MOV

Moving SEP

Memory Hook: “New ZIP, New Plans”
Use When: Client moved outside or within service area and has new options
Must Be: New ZIP code or county
Trigger Question: “Have you moved within the last year?”

LEC

Loss of Employer Coverage

Memory Hook: “Retired = LEC”
Use When: Lost employer, union, or COBRA coverage
Window: 3 months after coverage loss/Part B start
Big Clue: Part A & B dates are different
Trigger Question: “Did you recently retire or lose employer coverage?”

LCC

Loss of Creditable Coverage

Memory Hook: “Lost drug coverage”
Use When: Client lost prescription coverage through no fault of their own
Does NOT Include: Non-payment
Window: 3 months
Trigger Question: “Did you recently lose prescription drug coverage?”

SNP

Loss of Special Needs Status

Memory Hook: “Lost special status”
Use When: Client no longer qualifies for D-SNP, C-SNP, or I-SNP
Examples: Lost Medicaid or chronic condition
Trigger Question: “Has your Medicaid or health condition changed recently?”

5STAR

5-Star SEP

Memory Hook: “Switch to best-rated plan”
Use When: 5-star plan available in area
Rule: Can switch into a 5-star plan
Trigger Question: “Would you like to see if there’s a 5-star plan available nearby?”

PAP

State Pharmaceutical Assistance Program SEP

Memory Hook: “State prescription help”
Use When: Client receives state prescription assistance
Rule: Usually once per year
Trigger Question: “Do you receive state help paying for prescriptions?”

CDC

Creditable Drug Coverage SEP

Memory Hook: “Using VA/TRICARE instead”
Use When: Client has VA, TRICARE, or employer drug coverage
Usually: MAPD → MA-only
Trigger Question: “Do you receive prescriptions through VA or another drug program?”

DST

Disaster SEP

Memory Hook: “Missed enrollment because of disaster”
Use When: FEMA/state disaster caused client to miss OEP or AEP
Required: Client verbally confirms they were affected
4 DST Steps:

1. Check disaster area

2. Confirm missed enrollment

3. Confirm client affected

4. Use today’s SEP date
   Trigger Question: “Were you affected by the disaster during enrollment?”