Individuals who are entitled to Medicare Part A and Medicare Part B - and receive any type of assistance from the Title XIX (Medicaid) program (including full-benefit dual eligible individuals and those eligible only for the Medicare Savings Programs) are entitled to a Special Enrollment Period (SEP
) while they are dual eligible.
(Please note: the term "Special Election Period" is the same as Special Enrollment Period.)
A Special Enrollment Period
(SEP) allows a person to join or change their Medicare Part D or Medicare Advantage plan outside of the Annual Open Enrollment Period (or AEP).
This Special Enrollment Period (SEP) begins
when the individual becomes dually-eligible and continues
as long as they receive Medicaid benefits.
Evidence of SEP needed:
− Termination of Medicaid notice from State Medicaid agency.
− Proof that beneficiary is in the State’s Medicaid eligibility database, which the beneficiary may obtain by contacting their State’s Medicaid office.
To view other Special Enrollment Period situations, click here
, if you are eligible for the Medicare Part D Extra Help program
, you will be granted a quarterly Special Enrollment Period (SEP
) so that you have the option to change enrollment to another Medicare Part D or Medicare Advantage plan that provides more affordable health and prescription coverage. (Please note, starting in 2019
, the LIS Special Enrollment Period will allow only one plan change per quarter
up through the third-quarter of the year.)