This reality sheet covers Medicare adjustments beginning January 2025: The introduction of two new Medicare Particular Enrollment Durations (SEPs) that may affect when low-income people can be part of, change, or go away Medicare Benefit Plans or Prescription Drug Plans.
Becoming a member of, Switching, or Leaving Medicare Benefit Plans
A Medicare enrollee can select to get their well being care by way of Unique Medicare (often known as Conventional) or a Medicare Benefit plan. Throughout sure time durations, enrollees can be part of a Medicare Benefit plan from Unique Medicare, change from one Medicare Benefit plan to a different, or drop their Medicare Benefit plan for Unique Medicare.
Medicare Enrollment and Disenrollment at a Look
People have the chance to be part of a Medicare Benefit plan throughout their Preliminary Enrollment Interval, which is a seven-month interval across the time an individual first turns into eligible for Medicare. Additionally they have a possibility to change or drop that protection inside a short while interval after choice. Throughout the Annual Election Interval from October 15 to December 7 annually, Medicare enrollees have the chance to be part of, change, or drop their Medicare Benefit plan, efficient the next January. Throughout the Medicare Benefit Open Enrollment Interval from January 1 – March 31 annually, Medicare enrollees have the chance to change or drop their Medicare Benefit plan. Throughout varied Particular Enrollment Durations, Medicare enrollees might have the chance to be part of, change, or drop their Medicare Benefit plan exterior of different enrollment durations beneath qualifying circumstances. For extra data on enrollment durations, see CMS, Becoming a member of a Plan.
In April 2024, the Facilities for Medicare and Medicaid Providers (CMS) issued a remaining rule for 2025 Medicare Benefit Plans and Prescription Drug Plans (“Half C/D Rule” or “Closing Rule”). The Closing Rule makes adjustments to Particular Enrollment Durations for people who’ve Medicaid or the Low-Revenue Subsidy (LIS). For extra data on these adjustments, see Justice in Growing older’s transient Upcoming Modifications for Dually Enrolled People: The Closing 2025 Medicare Benefit Rule and webinar.
There are two adjustments to Medicare Particular Enrollment Durations for Medicare enrollees with low revenue:
- New Month-to-month SEP
- New Built-in Care SEP
New Month-to-month SEP for Dually Eligible People and Low-Revenue Subsidy Recipients
For folks enrolled in a Medicare Benefit plan, the brand new “Month-to-month SEP” will permit people enrolled in Medicaid and/or who obtain help by way of the Low-Revenue Subsidy to drop their Medicare Benefit plan, return to Unique Medicare, and enroll in a brand new standalone Prescription Drug Plan on a month-to-month foundation. For people already in Unique Medicare, the Month-to-month SEP can even permit people to change from one Prescription Drug Plan to a different. The SEP can’t be used to enroll into one other Medicare Benefit plan.
This Month-to-month SEP can be utilized to:
- Drop a Medicare Benefit plan with Half D prescription protection (MAPD), be part of Unique Medicare, and enroll in a standalone Half D Prescription Drug Plan.
- In Unique Medicare, change standalone Prescription Drug Plans.
Who can use this Month-to-month SEP?
- All dually eligible people—folks with Medicare and Medicaid advantages—together with people who’re enrolled in Medicare Financial savings Applications however not full-scope Medicaid (additionally known as partial-benefit dually eligible).
- All people enrolled within the Low-Revenue Subsidy (LIS), additionally known as Further Assist.
What number of occasions can the Month-to-month SEP be used?
As soon as per 30 days. Plan adjustments will probably be efficient the primary of the next month. For instance, in February 2025, Maria is in Prescription Plan A and needs to change to Prescription Plan F. Maria could make the change in February and she or he will probably be disenrolled from Prescription Plan A and enrolled in Prescription Plan F efficient March 1, 2025.
How is this feature altering in 2025 in comparison with 2024?
Previous to January 1, 2025, people may make adjustments to their Medicare Benefit and Prescription Drug Plans on a quarterly foundation. Beginning in 2025, people will have the ability to make adjustments on a month-to-month foundation. Nevertheless, the month-to-month SEP can’t be used to affix a Medicare Benefit plan. This SEP can solely be used to disenroll from a Medicare Benefit plan with prescription drug protection or to change to standalone Prescription Drug Plans. There’s an exception for full profit dually eligible people who want to be part of sure built-in D-SNPs. See beneath for extra data on this new enrollment interval.
The final time the Quarterly SEP might be used was in September 2024.
Built-in Care Particular Enrollment Interval
There’s a subset of Medicare Benefit plans known as a Twin Eligible Particular Wants Plan (D-SNP). D-SNPs are plans accessible to people who’re dually enrolled in Medicare and Medicaid.
Beginning in 2025, the “Built-in Care SEP” will permit some dually eligible people to be part of or change to particular sorts of D-SNPs on a month-to-month foundation. This SEP is slim. It solely permits enrollment in a D-SNP that’s thought of to be: (1) Aligned and (2) Built-in.
What does it imply to enroll in an aligned plan?
The Built-in Care SEP solely applies if the person is enrolled, or within the strategy of enrolling, within the Medicaid plan that’s aligned with the D-SNP. An aligned Medicaid Managed Care Group (MCO) is described within the federal regulation as a Medicaid MCO that operates beneath a contract with the state and (a) the D-SNP; (b) the D-SNP’s guardian group; or (c) one other entity that’s owned and managed by the D-SNP’s guardian group.
What does it imply to enroll in an built-in plan?
The SEP solely applies if the D-SNP meets CMS’s description of built-in—that means that it’s a Absolutely Built-in D-SNP (FIDE-SNP), Extremely Built-in D-SNP (HIDE-SNP), and/or an Relevant Built-in Plan (AIP).
The Built-in Care SEP can be utilized to:
- Be part of an built-in D-SNP that’s aligned with the person’s Medicaid plan
- Swap from one other Medicare Benefit plan to an built-in D-SNP that’s aligned with the person’s Medicaid plan
Who can use the Built-in Care SEP?
- Full dually eligible people with full-scope Medicaid and enrolled, or enrolling in, the D-SNP’s aligned Medicaid MCO
Who can’t use the Built-in Care SEP?
- Partial profit dually eligible people in Medicare Financial savings Applications, however not full scope Medicaid
- Low-income subsidy people with out full scope Medicaid
What number of occasions can the Built-in Care SEP be used?
As soon as per 30 days. Plan adjustments will probably be efficient the primary of the next month.
What’s new in 2025 in comparison with 2024?
Previous to January 1, 2025, full and partial profit dually eligible people, and LIS enrollees, may change their Medicare Benefit enrollment quarterly. This quarterly choice was eradicated and partial profit and LIS recipients should wait till one other enrollment interval in the event that they need to change their Medicare Benefit selection.
The creation of those two new SEPs don’t affect the opposite present Particular Enrollment Durations. Individuals can proceed to make use of different relevant Particular Enrollment Durations.
Abstract of New Particular Enrollment Durations Efficient January 2025
|
Particular Enrollment Interval |
Full Dually Eligible |
Partial Dually Eligible |
Low-Revenue Subsidy |
Change |
|
Month-to-month SEP for Medicaid and LIS recipients |
Sure |
Sure |
Sure |
Accessible month-to-month somewhat than quarterly; can’t be used to enroll into or change MA plans |
|
Built-in Care SEP |
Sure |
No |
No |
Restricted to enrollment into built-in and aligned D-SNPs |
