A New Monthly Integrated Care Sep For Calendar Year 2025 To achieve this the rule a revises the current Part D quarterly special enrollment period SEP for dually eligible and other Part D low income subsidy LIS enrolled individuals to a once per month SEP to enroll in a standalone prescription drug plan and b creates a new integrated care SEP to allow dually eligible individuals to elect
Starting in January 2025 two new Medicare Special Enrollment Periods SEPs will impact when low income individuals can join switch or leave Medicare Advantage Plans or Prescription Drug Plans Creates a new monthly integrated care SEP to facilitate aligned enrollment in integrated D SNPs and affiliated Medicaid managed care organizations MCO for full benefit dually eligible individuals pp 755 793
A New Monthly Integrated Care Sep For Calendar Year 2025
A New Monthly Integrated Care Sep For Calendar Year 2025
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Starting January 1 2025 CMS will split the current quarterly Part D SEP for dually eligible and other low income subsidy LIS enrollees into two separate SEPs A revised monthly SEP for enrollment in stand alone prescription drug plans PDPs Effective January 1 2025 this quarterly SEP is eliminated In place of the quarterly SEP CMS created a new SEP for dually eligible individuals and LIS only individuals to make changes to their MAPD and Prescription Drug Plan enrollment on
Create a new integrated care SEP to allow dually eligible individuals to elect to enroll in an integrated D SNP on a monthly basis pp 286 296 Limit enrollment in certain D SNPs to those who are also enrolled in an affiliated Medicaid managed care plan Monthly meetings Lead Work Group MMI Finalized without modifications effective 1 1 2025 Integrated Care SEP Creates a new integrated care SEP to allow dually eligible individuals to elect an integrated DSNP on a monthly basis which would allow enrollment in any month into FIDE SNPs HIDE SNPs and AIPs for those dually eligible individuals
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Dually eligible beneficiaries will have an opportunity to enroll in an integrated D SNP monthly under a new integrated care special enrollment period SEP CMS is lowering the D SNP look alike threshold from 80 percent to 70 percent for plan year 2025 and to 60 percent for plan year 2026 and into the future In addition effective January 1 2025 a new Integrated Care SEP will allow full benefit dually eligible individuals to elect an integrated dual eligible special needs plan D SNP in any month to align coverage with a Medicaid managed care organization
We are proposing interconnected proposals to a replace the current quarterly special enrollment period SEP with a one time per month SEP for dually eligible individuals and others enrolled in the Part D low income subsidy program to elect a standalone PDP b create a new integrated care SEP to allow dually eligible individuals to elect an IMPACTS OF 2025 FINAL RULE CHANGES FOR D SNPS Full benefit duals provided with additional opportunities to enroll in an aligned D SNP More members will have access to D SNPs that are aligned integrated with their Medicaid coverage
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To achieve this the rule a revises the current Part D quarterly special enrollment period SEP for dually eligible and other Part D low income subsidy LIS enrolled individuals to a once per month SEP to enroll in a standalone prescription drug plan and b creates a new integrated care SEP to allow dually eligible individuals to elect
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Starting in January 2025 two new Medicare Special Enrollment Periods SEPs will impact when low income individuals can join switch or leave Medicare Advantage Plans or Prescription Drug Plans
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A New Monthly Integrated Care Sep For Calendar Year 2025 - New monthly integrated care SEP allows dually eligible individuals to elect an integrated D SNP e g FIDE HIDE or AIP with the same parent Medicaid MCO as the D SNP plan CMS clarified that they are finalizing a narrower scope for the integrated care SEP than in the proposed rule to facilitate aligned enrollment
