Duals and SEPs, oh my!
Q.
Dear Taryn,
Can we enroll dual-eligible Beneficiaries every month in 2025?
Sarah
A.
Dear Sarah,
Yes and no! The opportunities to enroll in a Dual Special Needs plan (DSNP) each month depend on the state where they live. Under the Dual/LIS SEP 1, individuals may make a monthly election between Original Medicare and a standalone Prescription Drug plan (PDP). Integrated care SEP allows for a monthly election into a fully integrated Dual Eligible Special Needs plan (FIDE SNP), highly integrated Dual Eligible Special Needs plan (HIDE SNP), or an Applicable Integrated plan (AIP).
Taryn
Q.
Dear Taryn,
What is a Dual/LIS SEP 1?
Jack
A.
Dear Jack,
According to the CMS website: “The Dual/LIS SEP1 will allow full-benefit dually eligible individuals (QMB+, SLMB+, FBDE), partial-benefit dually eligible individuals (QMB, SLMB, QI, QDWI), and Extra Help-only eligible individuals to make a once-per-month election into Original Medicare and a standalone Prescription Drug plan (PDP). It will also allow a once-per-month election to switch between standalone PDPs. This replaces the quarterly Dual/LIS SEP”.
Taryn
Q.
Dear Taryn,
What is the new rule for disaster SEPs in 2025?
Gabriel
A.
Dear Gabriel,
Exciting news! The expected Disaster SEP changes on April 1, 2025 have been withdrawn!
On March 20, 2025, CMS announced a pivotal retraction. The current SEP process remains in place, and plans should continue to accept applications using the Disaster/Emergency SEP. Read the official memo here.
Happy Medicaring!
Taryn
Taryn Mott, Director of Provider Referral Operations and Training and long-time licensed insurance agent