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Help your Dual-Eligible Clients During AEP

Special Election Period (SEP) options for Dual-Eligible Beneficiaries

As of 2019, LIS/Dual eligible individuals are no longer allowed unlimited SEP changes
throughout the year. Instead they will be limited to one SEP change per quarter during
the first 3 quarters of the year.

Since there’s no Quarterly SEP for Dual-Eligible beneficiaries during the last quarter of
the year, they can only use the AEP period from October 15th- December 7th to change
their plans for a January 1st start date.

Below are some SEPs that are always available: 

  • Recently gained/lost Medicaid
  • Recently moved
  • New to Medicare (ICEP) because of Age or Disability
  • Recently gained/lost/had a change in their Dual or LIS coverage
  • Recently moved into or out of an institution like a skilled nursing facility or long-term care hospital
  • Recently left employer or union coverage
  • Recently released from incarceration

 

What does this mean for you as an agent during the 4th quarter?

  • Understand your client’s eligibility (Medicare only or also Medicaid) to determine the best plan fit for January 1st
  • Educate your DSNP clients that they can only switch during AEP for January 1st
  • After December 7th be familiar with other SEPs that could apply to your clients

 

Want to learn more about SEPs? A quick list here and every possible SEP listed here

Questions? Call us at 855-888-8326.

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