Special Enrollment Periods for Dual-Eligible and LIS Beneficiaries: What You Need to Know
If you’re someone who qualifies for both Medicare and Medicaid—or if you receive Extra Help through the Low-Income Subsidy (LIS) program—you’re in a unique position when it comes to Medicare coverage. Unlike most people who can only switch Medicare Advantage or Part D plans during certain times of the year, dual-eligible individuals and LIS beneficiaries often have more flexibility. In fact, you may be able to make changes monthly thanks to something called a Special Enrollment Period (SEP).
Let’s break it down in plain English.
Normally, people with Medicare have to wait for the Annual Enrollment Period (October 15 through December 7) to make changes to their Medicare Advantage or prescription drug plans. There are also other limited windows, like the Medicare Advantage Open Enrollment Period (January 1 to March 31), but these opportunities come and go quickly. For most folks, missing these dates means being stuck with their current plan until the next year.
But for those who are dual-eligible—meaning you qualify for both Medicare and Medicaid—or who receive Extra Help paying for Medicare drug coverage, the rules are different. You have access to Special Enrollment Periods that allow you to change your Medicare Advantage or Part D plan once during each calendar quarter for the first three quarters of the year. That means:
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January through March
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April through June
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July through September
From October through December, you can still make changes, but those won’t take effect until January 1 of the following year.
Why is this such a big deal? Because plans can vary in their costs, coverage, and provider networks—and for those managing chronic health issues or on limited incomes, being locked into the wrong plan can lead to unnecessary stress and out-of-pocket expenses. The monthly flexibility means that if you find a plan with better coverage for your prescriptions, lower premiums, or a more convenient doctor network, you don’t have to wait a year to switch. You can make a change that fits your needs much sooner.
Now, you might be wondering: how do I know if I qualify? Dual eligibility typically means you’re enrolled in some form of Medicaid while also being covered by Medicare. LIS, or Extra Help, is a program that assists with Part D prescription drug costs, including premiums, deductibles, and co-pays. You might qualify for Extra Help even if you don’t get Medicaid. If you’re not sure where you stand, it’s worth checking with your local Medicaid office or calling Medicare directly.
Another point to keep in mind: you don’t need to use every Special Enrollment Period. Just because you can switch plans each quarter doesn’t mean you have to. But it’s comforting to know the option is there if your needs or circumstances change. Maybe your doctor retires, or a new medication isn’t covered the way you thought it would be—having the flexibility to make a change without penalty can make a real difference.
Finally, any plan change made through a Special Enrollment Period typically goes into effect on the first day of the following month. So, if you switch plans in May, your new coverage starts on June 1. That gives you some breathing room to prepare for the change and ensure a smooth transition.
Navigating Medicare can feel overwhelming, especially when you’re juggling multiple programs and eligibility criteria. But Special Enrollment Periods offer a little breathing room—and a chance to make smarter, more responsive choices throughout the year.
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