Understand the Special Election Period for dual-eligible and LIS eligible clients

Dual-eligible and other LIS eligible individuals can enroll in, or disenroll from, an MA plan once per calendar quarter through a Special Election Period (SEP). Here's what you need to know about this SEP:

  • The SEP begins the month the individual becomes dually-eligible and exists as long as the prospect receives Medicaid benefits; however there are limits in how often it can be used.
  • This SEP allows an individual to enroll in, or disenroll from, an MA plan once per calendar quarter during the first nine months of the year.
  • The SEP is considered used based on the month in which the individual makes the election (i.e., application date of the enrollment request). If the election occurs in March (which would be effective April 1st), this counts as using the SEP for the 1st quarter, not the 2nd quarter.
  • The effective date of an enrollment request made using this SEP is the first of the month following receipt of an enrollment request.
     
  • This SEP can be used once during each of the following time periods:
    • January – March
    • April – June
    • July – September
  • The election period is not available during the 4th quarter of the year (October – December).