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.
Remember, 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.)