NEW Monthly Enrollment Option for Medicare-Medicaid Recipients

If you qualify for both Medicare and Medicaid, or receive the Low-Income Subsidy (LIS), there’s a new monthly enrollment option you need to know about.

Unpacking The New Monthly Enrollment Option

As of January 1, 2025, the Centers for Medicare and Medicaid Services (CMS) replaced the quarterly Dual/LIS Special Enrollment Period (SEP) with a new monthly enrollment option. This change gives dual eligible beneficiaries and LIS recipients more flexibility to adjust their prescription drug coverage as their needs change.

Dual eligible & Low-Income Subsidy (LIS) Recipients

The term “Dual eligible” refers to someone who is enrolled in both Medicare and Medicaid. LIS recipients are people who receive a Low-Income Subsidy (LIS) to help pay for prescription drugs. Before 2025, dual eligible beneficiaries and LIS recipients could only change their prescription drug plans once per quarter during the first nine months of the calendar year.

Making Prescription Drug Coverage More Accessible

While helpful, the old rule was limiting, and it often left people stuck in the wrong plan for months after their health and medication needs shifted. Now, eligible individuals can make one plan change per month, all year long. That’s up to 12 opportunities a year to:

• Enroll in a standalone Prescription Drug Plan (PDP)
• Leave a Medicare Advantage (MA or MAPD) plan and return to Original Medicare with a PDP

Medications can change quickly and so can health circumstances. This new monthly enrollment option means you won’t have to wait months to adjust your coverage. For some, it could also mean returning to Original Medicare for more predictable care and nationwide access to doctors.

Removing Healthcare Hurdles

For those on fixed incomes, prescription drug costs can be a heavy burden. This change gives eligible beneficiaries the flexibilty to:

• Adjust coverage when prescriptions change mid-year
• Avoid paying for drug plans that no longer meet their needs
• Maintain continuous access to needed medications without gaps in coverage

Unsure if you qualify for the new monthly enrollment option? Contact your state’s Medicaid office or speak with a trusted AMAC Medicare advisor who can walk you through your options.

Stay Informed with AMAC

AMAC is your reliable Medicare resource. We provide clear updates on Medicare policy changes and real help understanding your options. If you qualify as dual eligible or receive the LIS benefit, knowing about this monthly SEP could help you save money and get the coverage that truly fits your needs.

For help with Medicare plans – or any questions you may have about Medicare – contact AMAC’s Medicare Advisory Service at 1-855-611-4856 or request a coverage review below.