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). 

Evidence needed to use this SEP:

− 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.

The rules for using the dual eligible / Extra Help SEP to change plans during the year have changed.

Beginning in 2025, the SEP for people qualified for both Medicare and Medicaid - or the Medicare Part D Extra Help program is different depending on your plan type:

• People enrolled in a stand-alone Medicare Part D plan (PDP) and eligible for the Medicare Part D Low-Income Subsidy (LIS) or Extra Help program will have a monthly opportunity to change their PDP. 
  
  
• Most Medicare beneficiaries enrolled in a Medicare Advantage plan (MA, MAPD, or SNP), and eligible for Extra Help will no longer be granted a Special Enrollment Period (SEP) to join or change Medicare Advantage plans.
  
  
• However, an Extra Help recipient will be granted a Special Enrollment Period to drop their Medicare Advantage plan, return to Original Medicare and join a stand-alone Medicare Part D plan.
  
  
• And, people who are dual-eligible for Medicare/Medicaid and enrolled in an integrated Medicare Advantage D-SNP (FIDE D-SNP, HIDE D-SNP, or AIP) will be able to change each month to another qualifying integrated D-SNP.
  
  
• LIS recipients can still use the MAOEP or other SEPs to change Medicare Advantage plans.

Your newly selected Medicare plan coverage will start on the first day of the month after you enroll in a new plan.

To view other Special Enrollment Period situations, click here.