4Q LIS/Medicaid SEPs

SEP for Dual-eligible Individuals  or Individual that receive extra help (L Election):

There is an SEP for individuals who are entitled to Medicare and receive any type of assistance from the Title XIX (Medicaid) program or receive extra help. This SEP is valid as long as the member receives Medicaid benefits or extra help and has not had a change. This SEP allows an individual to enroll in, or disenroll from, a plan once per calendar quarter from January 1st to September 30th.

SEP for Dual-eligible Individuals  or Individual that receive extra help that have recently gained, have lost, or had a change in status (U Election):

This SEP is valid as long as the member receives Medicaid benefits or extra help and has recently gained, have lost, or had a change in status. This SEP allows an individual to enroll in, or disenroll from, an MA plan.

Individuals new to LIS and Individuals who Lose LIS or have a change in status of LIS (U Election):

Individuals who newly qualify for LIS, lose LIS, or have a change in status of LIS have an SEP. The SEP allows the individual one opportunity to make an election within three months of any of these events, or notification of such a change, whichever is later. This SEP allows an individual to enroll in, or disenroll from a plan at any time. NOTE: Use of this SEP does not count towards the once per calendar quarter limitation that applies to SEP MDE.

Individuals Who Lose Special Needs Status (S Election):

CMS will provide an SEP for individuals enrolled in a SNP who are no longer eligible for the SNP because they no longer meet the specific special needs status. This SEP begins the month the individual’s special needs status changes and ends the earlier of when the beneficiary makes an enrollment request or three months after the expiration of the period of deemed continued eligibility

This is neither legal nor accounting advice. If you have questions, please consult a lawyer or accountant. The information included in this post was provided by the entity referenced herein.

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