Dual Special Needs Plan enrollment changes - what you should know

In April 2024, the Centers for Medicare & Medicaid Services (CMS) introduced enrollment changes to Medicare Dual Special Needs Plans (D-SNPs) for the 2025 plan year. As a part of the broader Medicare Advantage and Part D Final Rule, the goal is to expand access to member resources, reduce costs and improve the coordination of care for Medicare beneficiaries.

The following details highlight key enrollment changes for Dual Special Needs plans, or Medicare Advantage plans for individuals who have both Medicare and Medicaid, beginning in 2025.

Previously, a quarterly Dual Special Enrollment Period (SEP) allowed full and partial dual eligible individuals as well as Low Income Subsidy (LIS) or Extra Help recipients to enroll in or disenroll from a Medicare Advantage (MA) plan, Special Needs Plan (SNP) or Prescription Drug Plan (PDP) once per calendar quarter from January to September. Per CMS guidelines, this quarterly Dual SEP will no longer be in effect starting in 2025.

Beginning on January 1, 2025, integrated care SEPs allow monthly enrollment in select Dual Special Needs Plans (D-SNPs) and Medicaid plans under one insurer. This new SEP is only available to those who are eligible for Medicare and have full Medicaid benefits. 

While this new integrated enrollment period is only available to a select number of individuals and plan types, all dual-eligible beneficiaries can still enroll during the Annual Enrollment Period (AEP) and the Medicare Special Enrollment Period with a qualifying life event.

Additional information related to these plan types can be found by visiting CMS. Availability of these plan types vary by county and insurance provider, therefore verification of plan options with a D-SNP provider, such as UnitedHealthcare, is recommended for full duals interested in enrolling.

These changes are a critical part of improving experiences and are designed to facilitate aligned enrollment while continuing to enhance care coordination and benefit options for dual-eligible members.

From choosing a plan to using your plan, you can count on UnitedHealthcare to help you every step of the way. For more information and resources related to the new integrated SEP, view our D-SNP enrollment changes FAQs article.