How SPAPs and Their SEPs Can Bring You New Business

It may be the lock-in period, but that doesn’t mean you have to put your business on lock-down.

Unlock more sales during Medicare’s nearly 10-month off-season by working with beneficiaries in state pharmaceutical assistance programs (SPAPs) and their qualifying Special Enrollment Periods (SEPs).

In a 2024 study, the U.S. Centers for Disease Control and Prevention reported that nearly 88.6 percent of Americans age 65 and over took a prescription medication. For the roughly 95 percent of older individuals who suffer from at least one chronic condition, the ability to receive prescription medications can mean the difference between life and death. But, with limited incomes, paying for prescription drugs or Part D coverage can be tough.

The good news is those over 65 years old who meet certain income and resource parameters may be eligible for Extra Help in the form of a low income subsidy (LIS) from Medicare or an SPAP that can help them pay for their prescriptions. Working with seniors in SPAPs is an excellent way to solve the dilemma of how to make sales during lock-in. But before we delve into why they’re valuable right now, let’s define what they are.

What Is an SPAP?

An SPAP is a state-operated program that offers prescription drug assistance to seniors with low incomes. Funded by the individual states, these programs may pay for qualifying seniors’ Part D coverage completely or simply lower the cost of their prescription drugs. Depending on the state, these programs may also cover qualifying seniors’ Medicare Part D monthly premiums, deductibles, and/or copays.

Working with seniors in SPAPs is an excellent way to solve the dilemma of how to make sales during lock-in.

SPAPs vary by name, eligibility, and details. Furthermore, some states provide programs which help people with specific illnesses. For instance, there are states that offer End-Stage Renal Disease (ESRD) drug assistance programs and/or HIV/AIDs drug assistance programs (ADAPs).

Why Are SPAPs Important Right Now?

Medicare beneficiaries who qualify for Extra Help or a qualified SPAP are eligible for an SEP. They’re given a window of opportunity outside of the Open Enrollment Period during which they can make changes to their health insurance.

Since so many Americans may qualify for Extra Help or SPAPs, it’s important that you are aware of your clients’ special enrollment options.

When a client qualifies for Extra Help, they can join, switch, or drop Medicare Part D coverage with their SEP. Additionally, as long as they keep qualifying for Extra Help, they can utilize a monthly SEP to join, switch, or drop their Part D plan. That’s a lot of opportunity for agents!

Those who qualify for SPAPs can join or switch an MA or Part D plan once per calendar year.

Find Your State’s SPAP

Help your clients find their SPAP or find out if they qualify by calling their local State Health Insurance Assistance Program (SHIP). Use the online directory to locate their program or call 877-839-2675 (and say “Medicare” when prompted). Helping your clients in this way can be a great service and a way for them to reduce their drug costs.

How Can SPAPs and SEPs Benefit Your Clients?

Besides the fact that SPAPs can help your clients afford prescription drug coverage, their SEP can also help your clients save even more on an MA or prescription drug plan (PDP). This is crucial considering that the average Social Security monthly benefit for retirees was only $1,976 in January 2025. Additionally, 67 percent of older adults relied on Social Security for 51 to 99 percent of their income in 2024, according to The Senior Citizens League.

With Extra Help or SPAP eligibility, your clients may have multiple opportunities throughout the year to swap their current plan for a more affordable one.

How Can SPAPs and SEPs Benefit You?

If you’re working in the Medicare-eligible market, you already know the Annual Enrollment Period (AEP) is the busy season. However, AEP occurs only 54 days out of the 365-day calendar year. Working with beneficiaries in SPAPs and those with SEPs can help you bring in new business during the long off-season.

Don’t be locked out during lock-in. Go out and build a bigger, better business with your improved understanding of SPAPs and their SEPs.

Since so many Americans may qualify for Extra Help or SPAPs, it’s extremely important that you are aware of your clients’ special enrollment options. As you know, your clients’ needs can change without notice. By being a resource for their different enrollment options, you can show your clients your professional knowledge, prove you have their best interest in mind, and build client loyalty.

Don’t be locked out during lock-in. Go out and build a bigger, better business with your improved understanding of SPAPs and their SEPs.