There have been some important Medicare SEP changes in 2025 that both agents and enrollees need to be aware of. These regulations were put into effect by the CMS. We will explain those changes and how to navigate them. We’ve summarized the changes and how they could impact your clients.
SEPs for D-SNPs & LIS enrollees
As of January 1, 2025 CMS eliminated the quarterly SEP that let dual eligible individuals or those with LIS make MA/MAPD Medicare Advantage plan changes once each quarter during the first 3 quarters.
What replaced the quarterly SEP for D-SNP & LIS enrollees
Instead of a quarterly SEP, CMS has provided a monthly SEP (Code DEP). This allows DSNP and LIS beneficiaries to disenroll from their MAPD plan and enroll in Original Medicare and a standalone PDP. The SEP also allows LIS members to switch their current PDP coverage to another PDP plan.
There is also a monthly integrated SEP (INT-SEP). This SEP allows only full dual eligible beneficiaries to switch to or from one integrated D-SNP with aligned Medicaid plan to another.
Monthly INT SEP details
Full Dual Beneficiaries can use the INT-SEP once per month. The effective date of the new plan will be the first day of the following month.
Plans that are eligible for the INT-SEP include:
- FIDE SNP: Fully Integrated Dual Eligible Special Needs Plan
- HIDE SNP: Highly Integrated Dual Eligible Special Needs Plan
- AIP: D-SNP is an Applicable Integrated Plan
Although dual eligible plan enrollees can change plans monthly, staying in their current plan allows them to avoid disruptions to their coordinated care plan.
Disaster (DST) SEPs
CMS has also changed the SEP (DST-SEP). The DST SEP is for those affected by an event that results in a government declared disaster or other emergency. The election process will change as of April 1, 2025.
Medicare beneficiaries who miss a valid election period due to a government declared disaster or emergency must follow these guide lines:
Beneficiaries who qualify for the DST SEP must submit applications directly through CMS by calling 1-800-MEDICARE or TTY 1-877-486-2048 to submit an application.
In other words, CMS will not accept broker assisted DST applications.
Despite the changes to these SEPs, full and partial dual eligible beneficiaries can continue to use other SEPs, if they are eligible (AEP, OEP, move, loss/gain of eligibility, etc.).
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