2019 Change for Dual Eligible Enrollments

January 2, 2019

Special Enrollment Period for Low Income Subsidy or Dual Eligible Beneficiaries (LIS/Dual SEP)

The Center for Medicare and Medicaid Services (“CMS”) implemented a significant change to the LIS/Dual Special Enrollment Period.  Beginning January 1, 2019, beneficiaries eligible for the LIS/Dual SEP will be permitted to make a coverage change one time per quarter during the first nine months of the year:

• January – March
• April – June
• July – September

The LIS/Dual SEP may not be used during the fourth quarter of the year (October – December).

The effective date of the enrollment into the new plan will be the first of the month following the receipt of an enrollment request.  Per CMS guidelines, the SEP is considered “used” based on the month in which the election was made.  Using their example, if an election is made in March with an April effective, the first quarter use of the SEP would be considered “used” not the second quarter. 

An SEP for Individuals who gain, lose or have a change in their Dual or LIS eligibility, have a one time opportunity to make an election within three months of the change or notification of the change, whichever is later.

As always, we thank you for your support and cooperation. For questions or comments, please email us at Compliance@NSGACommunications.com or you may call the toll-free number listed below.

FOR AGENT USE ONLY. NOT FOR USE WITH CONSUMERS.

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