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D-SNP Plan Enrollment Changes
Attention Valued Partner,
As communicated in the 2025 CMS Final Rule, Special Enrollment Period (SEP) changes will be implemented regarding how and when dual-eligible beneficiaries can enroll in Medicare Advantage plans. To provide the best guidance to your beneficiaries for Plan Year 2025 (PY2025), please take a few moments to review important information regarding the changes.
Highlights of 2025 Changes
- Beginning in PY2025, dual-eligible and low-income beneficiaries’ ability to enroll into Medicare Advantage plans quarterly throughout the year will change.
- Mid-year movement is only allowed for fully integrated dual-eligible beneficiaries if currently enrolled in a Medicaid MCO and enrolling into the same parent company’s aligned D-SNP through a new integrated D-SNP SEP.
- The 2025 Wellcare Aligned Markets are Arizona, California, Florida, Hawaii, Iowa, Kansas, Kentucky, Nebraska, New Jersey, New York, Oregon, Pennsylvania, Washington, and Wisconsin.
- If a beneficiary resides in a service area where aligned D-SNPs are not available, the new SEP will not apply. Beneficiaries will only be able to change plans during AEP, OEP, ICEP, and other valid election SEPs.
Dual-eligible and Low-Income Subsidy (LIS) beneficiaries may select either a non-aligned or aligned D-SNP (or TMA product) during AEP or other valid election periods. Dual-eligible and LIS beneficiaries can disenroll from their Medicare Advantage coverage in favor of Fee-for-Service (FFS) and a standalone Prescription Drug Plan (PDP) at any time.
Key Changes by Beneficiary Type
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