New Medicare Special Enrollment Periods for Low Income and Dual-Eligible Beneficiaries
What's new with Medicare and Medicaid? And are you prepared?
Published: 06.25.2025
Recent regulatory changes have introduced significant updates to Special Enrollment Periods (SEPs) for Medicare beneficiaries, particularly affecting those with low income, dual eligibility and specific life events.Starting January 1, 2025, two new Special Enrollment Periods became available for dual-eligible individuals and individuals eligible for Extra Help, also known as Low-Income Subsidy (LIS).
Information on these new SEPs can be found below.
Medicare Special Enrollment Period (SEP) Updates 2025
1. Integrated Care SEP for Full-Benefit Dual Eligibles:
Effective January 1, 2025, a new Special Enrollment Period (SEP) was introduced for full-benefit dual eligibles.This Integrated Care SEP will allow full-benefit dual eligibles (those receiving both Medicare and Medicaid benefits) a once-per-month opportunity to enroll in a Dual Special Needs Plan (D-SNP) aligned with their Medicaid managed care plan. This SEP is particularly relevant for those in Medicaid programs like NJ FamilyCare.
2. Transition from Quarterly to Monthly SEP for Dual-Eligible / LIS Beneficiaries:
Effective January 1, 2025, a new monthly Special Enrollment Period (SEP) was introduced to allow low-income subsidy individuals and dual-eligibles to:
- Switch from a Medicare Advantage plan to Original Medicare and enroll in a standalone Prescription Drug Plan (PDP).
- Change from one standalone PDP to another.
Key Considerations and Additional Details
- Enrollment Deadlines: It's crucial for beneficiaries to adhere to these new SEP timelines to avoid coverage gaps or delays.
- Plan Restrictions: Some SEPs have limitations on the types of plan changes allowed; beneficiaries should review these carefully.
- Effective Dates: Changes made using these SEPs generally take effect on the first day of the following month after the plan receives the enrollment request.
- Existing Medicare Special Enrollment Periods: These two new SEPs do not affect the other existing Medicare Special Enrollment Periods. Beneficiaries can continue to use these as applicable.
Do you have questions regarding these changes to Medicare enrollment periods?
Our dedicated team of Medicare experts is ready to help you better understand Medicare SEPs and determine who qualifies to make changes to their current Medicare coverage.If you have questions or would simply like to discuss coverage options, reach out to our team today.
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