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
Questions? Call us at 855-888-8326.
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