SEP & OEP Election Codes
All codes verified against CMS Chapter 2 MA Enrollment & Disenrollment Guidance (2025). IHS is NOT a SEP.
⚠ CMS Rule
Applications denied with incorrect election codes. Always document and verify the correct EP before every enrollment submission.Enrollment Period Hierarchy
CMS priority order. Use the highest applicable period. Always document the correct EP before submitting.
⚠
Incorrect EP = application denial or disenrollment.D-SNP — Dual Special Needs Plans
Medicare Advantage plans for individuals with both Medicare and Medicaid. SEP-INT is FBDE ONLY.
D-SNP Eligibility Verification
Use these carrier-specific tools to verify dual eligibility before enrolling. Always confirm Medicaid is active before submitting.How to Confirm CMS Enrollment Source Code
- Run a Medicare report on Humana site
- Check the Current Enrollment Source Code
- Look for:A Part D Auto Enrolled by CMSJ State-Submitted Passive EnrollmentK CMS-Submitted Passive Enrollment
Key Rule
If you see A, J, or K — you can use the CMS SEP. ONE change within 3 months of the effective date of the assignment or notification, whichever is later.MAT Integration by State & Alignment Checklist
SEP-INT requires FBDE status, affiliated Medicaid MCO enrollment, and plan on CMS Integrated D-SNP list.
How to Use
Green: FIDE/HIDE SNPs — SEP-INT may apply. Yellow: MAT process applies. Red: CO D-SNPs only — SEP-INT not available.CMS 2026 Integrated D-SNP List
Yellow / Red States Only
Complete all 9 steps before logging. Green state clients use SEP-INT directly.Client Information
MAT Alignment Steps
✓ All MAT Steps Complete
All 9 steps verified. Click below to log to Firebase and Deal Tracker.
MAT Alignment Log
Live from Firebase — sorted current to future by estimated completion. All agents visible to manager.| Date | Agent | Client | State | Carrier | Plan | Lead ID | Est. Complete | Status |
|---|
No MAT deals logged yet.
C-SNP — Chronic Special Needs Plans
Plans for individuals with severe or disabling chronic conditions. EP code: CSN. ONE-time use per lifetime, per condition.
⚠ Critical Reminders
Eligibility determined by qualifying questions — NOT by medications. Pre-Diabetes, high blood pressure, heart murmur do NOT qualify alone. Prep client to expect Verification of Chronic Condition form (80 days).Prescription Indicators
- How many prescriptions do you take?
- What type of medications do you take?
- How much do you pay monthly for prescriptions?
- What is your most expensive medication?
Doctor Eligibility Indicators
- How many doctors do you currently have?
- How often do you see your PCP?
- Do you have a specialist? If so, what kind?
Shop Plans Indicators
"In your area we do offer Chronic Special Needs Plans. These are plans specifically designed for anyone who has been diagnosed with Cardiovascular Disorders, Chronic Heart Failure, and/or Diabetes. Would you like to hear more about these plans?"
EP Timeframe — CSN
Once per lifetime, per condition.
Caution
CSN is ONE-time use per condition, NOT per year. Chronic Pulmonary / Lung Disorder Plans
Qualifying Conditions
COPD • Chronic Lung Disorders • Emphysema • Chronic Bronchitis • Pulmonary FibrosisRequired Verbatim Qualifying Questions
1. Have you been diagnosed by a doctor with COPD, emphysema, chronic bronchitis, or any other chronic lung condition?
Listen for: yes/diagnosed/doctor told me/been on inhalers for years
2. Are you currently being treated for a chronic lung or pulmonary condition — for example, do you use an inhaler, nebulizer, or oxygen?
Listen for: oxygen, nebulizer, inhaler, breathing treatments, pulmonologist
3. How often do you see a doctor or specialist for your lung condition?
A qualified candidate typically has regular ongoing treatment
4. Have you been hospitalized or had emergency care due to your lung condition in the past 12 months?
Frequent hospitalizations indicate severity qualifying for C-SNP
"In your area, we offer Chronic Special Needs Plans specifically designed for individuals diagnosed with chronic lung disorders such as COPD, emphysema, or chronic bronchitis. Based on what you've shared, you may qualify. Would you like to hear more?" (Yes/No)
Carrier Notes
Humana / Aetna / UHC: Condition must be on the plan qualifying condition list in the SOB. Provider verification form sent within 80 days of enrollment.❤ Chronic Cardiovascular Disease / Chronic Heart Failure Plans
⚠ Critical CMS Reminder
Heart-related issues do NOT always qualify on their own. Pre-Diabetes, high blood pressure, and heart murmur do NOT qualify by themselves.Qualifying Conditions
Cardiovascular Disorders • Chronic Heart Failure (CHF) • Coronary Artery Disease • Peripheral Artery Disease • Atrial FibrillationRequired Verbatim Qualifying Questions
1. Have you been diagnosed by a doctor with heart failure, coronary artery disease, atrial fibrillation, or any other chronic heart or cardiovascular condition?
Listen for: CHF, heart failure, A-fib, cardiomyopathy, stents, bypass surgery
2. Are you currently being treated or taking medications for a chronic heart or cardiovascular condition?
Listen for: cardiologist, beta-blockers, blood thinners, diuretics, pacemaker
3. How often do you see a cardiologist or heart specialist?
Regular ongoing specialist care is required
4. Have you had a cardiac event, hospitalization, or emergency related to your heart condition in the past 12 months?
Documents severity and ongoing nature of the condition
"In your area, we offer Chronic Special Needs Plans specifically designed for individuals diagnosed with cardiovascular disorders or chronic heart failure. Would you like to hear about the options available in your area?" (Yes/No)
💧 Chronic Dialysis / ESRD Plans
Qualifying Conditions
End-Stage Renal Disease (ESRD) • Chronic Kidney Disease requiring dialysis • Kidney transplant recipientsRequired Verbatim Qualifying Questions
1. Have you been diagnosed with End-Stage Renal Disease (ESRD) or chronic kidney disease requiring dialysis?
Listen for: dialysis, kidney failure, ESRD, on the machine, three times a week
2. Are you currently receiving dialysis treatment? If so, how often and where?
Hemodialysis 3x/week or peritoneal dialysis daily are common
3. Have you had a kidney transplant, or are you on a transplant waiting list?
Post-transplant patients may qualify for specific plan types
4. Who is your nephrologist or kidney specialist?
Verifies ongoing specialist care and treatment relationship
"In your area, there are Chronic Special Needs Plans specifically designed for individuals with End-Stage Renal Disease or who are on dialysis. These plans can include transportation to dialysis, specialized drug coverage, and additional benefits. Would you like to learn more?" (Yes/No)
Special Supplemental Benefits for the Chronically Ill (SSBCI)
What is SSBCI?
SSBCI allows C-SNP and D-SNP plans to offer additional non-primarily health-related benefits: healthy food, grocery allowances, transportation, pest control, air quality equipment, and more.SSBCI Carrier Verification Requirements
Humana
Condition must match qualifying condition list in SOB. Provider verification form within 80 days. Client must confirm qualifying condition verbally on enrollment call.
UnitedHealthcare (UHC)
Requires eligible diagnosis code OR provider attestation. SSBCI food/utility benefits require one of 23 specified chronic conditions.
Aetna
Condition must be listed in C-SNP SOB. Sends Verification of Chronic Condition form (80-day window). Doctor and carrier must verify condition prior to policy approval.
WellCare / Centene
Qualifying chronic condition must match plan designated condition. Client may not receive SSBCI benefits until condition is confirmed.
Elevate / Zing / Other
Refer to carrier current plan SOB for qualifying conditions and SSBCI benefit details. Always check SOB before promising any supplemental benefit.
FEMA / DST — Disaster & Emergency SEP
SEP: AA / DST. Do NOT actively market this SEP.
⚠ DST SEP Eligibility Discovery — Effective 5.12 (CMS Required)
Prior to ALL DST enrollment submissions, agents are required to adhere to the following process / talking points:1. Exhaust all other election period opportunities.
2. Use these talking points to fact find about DST eligibility BEFORE pitching a plan.
3. Do NOT wait until the enrollment transfer or wrap-up script to read the following statements.
4. If it is determined that there is no impact, but the client INDEPENDENTLY revisits DST utilization, the agent must follow these same DST talking points as applicable.
⚠ As of 4/18 — Required Wrap-Up (ALL DST Sales)
Verbatim:
"As discussed, you are eligible for [carrier/plan name] using Fema Disaster as the elective period based on your location, impact, and having missed a prior election period. Is that correct? (yes/no)"All DST conversations monitored by CX & SQAT.
Missed EPs for FEMA
- MA-OEP January 1 to March 31
- OEP-New — new to Medicare
- EOC — 1/1 to 2/28 if they lost their plan
- Last day of missed EP: 12/31/25
Steps for Verifying SEP-DST Eligibility
- Ask for documentation — beneficiary lived/lives in an impacted area
- Request Verbal Attestation — verbal attestation is acceptable if written proof unavailable
- Confirm a Missed Enrollment Opportunity — beneficiary missed an enrollment period during the FEMA incident
- Confirm the Incident Prevented Enrollment — did not make an election during that period
- Confirm Residency or Dependent Support — beneficiary lives in declared county OR relies on Authorized Rep or POA who lives/lived in the impacted area
CMS Required Discovery Script (Eff. 5.12)
Read verbatim BEFORE pitching any plan:
"You may not know this, but Medicare allows people to only change their plans at certain times. So, [Customer Name], before we go any further, I want to check something that might apply to you. The government has issued a Special Enrollment Period for your area due to a recent disaster or emergency. This means if you missed an earlier opportunity to change your plan specifically because of [disaster/emergency], you may be able to change your plan today. If that event directly impacted your ability to enroll in a Medicare plan earlier due to things like financial strain, stress or needing to move, you might qualify to change plans now. Did [event] prevent you from changing your Medicare plan at that time?" (Yes/No)
If client says NO:
"Okay. Thank you. Looks like you are not eligible for a new plan at this time, because while the event impacted your area, it did not impact your personal ability to enroll in a Medicare plan. Client is not eligible for the DST election period. Since you should have confirmed all other election opportunities are not available, please follow standard no sale processes (UTT, AEP Rep Appt, etc.). Do not continue DST discussion."
What Agents CAN Say
"I know your area has gone through some challenges recently. How have things been for you over the past few months?"
"Have you faced any situations recently that might have prevented you from reviewing or changing your Medicare plan?"
"Have you faced any situations recently that might have prevented you from reviewing or changing your Medicare plan?"
What Agents CANNOT Say
"We can change your plan because there was a FEMA in your area." X
"This is the only way we can enroll you." X
Pressuring or reframing the question is not allowed. X
"This is the only way we can enroll you." X
Pressuring or reframing the question is not allowed. X
Sales Scripts
Click to expand. Keep questions conversational and open-ended.
Portals, Carrier Tools & Informational Sites
All links verified. Carrier agent portals require appointment/login credentials.
CMS & Government
MA / MAPD Carrier Agent Portals
Medicare Supplement / Medigap Portals
Qualifying Prospects — D-SNP & Dual Eligibility
Prospect must have active Medicare AND active Medicaid. FBDE only qualifies for SEP-INT.
Key rule
Medicaid must be active at submission — not pending, not lapsed.Deal & Sales Tracker
Live Firebase sync — all agents see shared data in real time. Manager sees all. Agents see their own.
| Date | Agent | Client | Carrier | Type | Lead ID | Premium | SEP/EP | Status | Notes |
|---|
No deals logged yet.
ⓘ Auto-Calculated from Deal Log
Totals pull directly from your approved deals in the Deal Log. Set your bonus per sale below — everything else calculates automatically.0
Approved Sales
$0
Total Bonus
Total Premium / MRC
$0
Total Earnings Est.
Bonus Per Sale Setting
Enter your bonus amount per sale. Totals above update automatically as deals are approved in the Deal Log.
Approved Deals Breakdown
| Date | Client | Carrier | Plan Type | SEP/EP | Premium | Bonus |
|---|
No approved deals yet. Set a deal status to Approved in the Deal Log to see it here.
🔒 Manager View — All Agent Data (Live Firebase)
Active Agents
All Agent Deals
| Date | Agent | Client | Carrier | Type | Lead ID | Premium | SEP | Status |
|---|
No deals yet.
All Agent MAT Submissions
| Date | Agent | Client | State | Carrier | Lead ID | Est. Complete | Status |
|---|
No MAT submissions yet.
Agent Pre-Enrollment Checklist
Complete all steps before submitting any SEP or D-SNP enrollment.
🔒 Manager Dashboard
Manager Only
This section is only visible to manager access.Live Agent Activity
Switch to Deal & Sales Tracker > Manager View for full deal and MAT reports.