Special Election Period Changes for Dual Eligibles & Others with Extra Help, Starting in January 2019

Special Election Period Changes for Dual Eligibles & Others with Extra Help, Starting in January 2019

Currently people who have both Medicare and full Medi-Cal coverage and others who have the Extra Help are allowed to change their Medicare Advantage (MA) and/or Part D prescription drug plan (PDP) during any month of the year. They have what’s called a continuous special election period (SEP). This is different from other beneficiaries without Medi-Cal or the Extra Help who only have two times each year to change their coverage: once during Medicare’s annual open enrollment period from Oct 15 – Dec 7, and another during the Medicare Advantage Open Enrollment period from Jan 1- Mar 31 of each year. As of January 1, 2019, however, people with both Medicare and full Medi-Cal and the Extra Help will lose this continuous SEP and only be able to switch plans once a quarter for the first three quarters of the year, and then once during Medicare’s annual open enrollment period, also referred to as annual election period. Having the option to change coverage at any time has been an important protection for these beneficiaries, ensuring they are never locked into a plan that doesn’t meet their needs.

There is, however, one exception to this new rule. The Department of Health Care Services (DHCS) applied for and received a waiver from the Centers for Medicare and Medicaid Services (CMS) for a continuous SEP for dual eligibles to enroll into or disenroll from Cal MediConnect plans in the seven counties offering these plans. This waiver is only for Cal MediConnect plans and does not apply for any other Medicare Advantage or Part D plans.

Our blogger Karen J. Fletcher is CHA's publications consultant. She provides technical expertise, writing and research on Medicare, health disparities and other health care issues. With a Masters in Public Health from UC Berkeley, she serves in health advocacy as a trainer and consultant. See her current articles.