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Changes to DSNP Election in 2025

Written by Rachel Brammeier

What are the Dual Special Needs Plan (DSNP) Elections in 2024?

  • Dual and Low Income Subsidy (LIS) Eligible (Maintaining Dual or LIS status)
    • 1 election per calendar quarter (first three quarters of the year, 4th quarter use the Annual Enrollment Period (AEP))
      • Q1: January – March
      • Q2: April – June
      • Q3: July – September
      • Q4: AEP election only
    • Election code: SEP: Dual LIS Maintaining
    • Available for Medicare Advantage and Part D
  • Loss, Gain, or Change in Dual LIS Status
    • 1 election effective the 1st day of the month following receipt of election
    • SEP allows an opportunity to make an election within 3 months of any gain, loss, or change in Dual/LIS level or notification of such a change, whichever is later
    • Election can be used anytime throughout the year
    • Election code: SEP: Change in Dual/LIS Status
    • Available for Medicare Advantage and Part D

What Changes are Coming in 2025?

  • Nothing will change for the Loss, Gain, or Change in Dual LIS Status election in 2025
  • The Dual and LIS Eligible (maintaining Dual or LIS Status) will ONLY be available to individuals who live in a state with an integrated dual plan
    • In states with an integrated plan, an SEP will be available to enroll in that plan anytime during the year if the client is maintaining the Dual or LIS Status and they are not currently enrolled in the integrated plan.
  • An integrated Medicare Advantage plan means that both the state and federal government have approved a plan and can be Fully Integrated Dual Eligible special needs plan (FIDE) or Highly Integrated Dual Eligible special needs plan (HIDE).

What Caused the Election to Change?

  • The change in enrollment elections was part of the 2024 Final Rule. These policies advance the goals of the White House Competition Council and executive order, signed in July of 2021, by promoting choice and facilitating improved access to an array of Medicare coverage options for individuals with low incomes. The following goals are;

    • To expand access to integrated materials, unify appeal processes across Medicare and Medicaid, and to continue Medicare services during an appeal.

    • To reduce the number of plans that can enroll dually eligible individuals outside AEP.

    • To reduce aggressive and confusing marketing tactics towards dually eligible individuals throughout the year.

What Opportunities do Agents Have to Enroll DSNP Clients?

  • In 2024, it’s important to take care of and meet with all your maintaining dual clients during AEP (October 15 – December 7) since many will lose access to make changes using their dual status in 2025.

  • In 2025, check to see if your state has an integrated DSNP plan(s) available to your maintaining dual clients. If they do, you will have a 1-time election per integrated plan available to enroll them.

  • In 2025, many Medicare Advantage plans have expanded or added Chronic Special Needs Plans (CSNP). If that is the case, you may see if your client may qualify for a CSNP plan based on certain health conditions.

  • In 2025, check to see if there are 5-star plans that may be available in your client’s area and could be a good fit for them.

  • To find any additional elections your client may qualify for, use our Election Period Assistant!

For more information, please call us today at (800) 689-2800!

Sources:

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