Understanding 2025 SEPs: Focus on LIS No Longer Being Quarterly

Understanding 2025 SEPs: Focus on LIS No Longer Being Quarterly

Understanding 2025 SEPs: Focus on LIS No Longer Being Quarterly

The landscape of Medicare is constantly evolving, and it is essential for Agents to stay informed about the latest changes to better serve their clients. One significant change for the 2025 plan year is the modification of Special Enrollment Periods (SEPs) concerning the Low-Income Subsidy (LIS), also known as Extra Help. At Advocate Health Advisors, we aim to provide you with the information you need to navigate these changes effectively. This blog will focus on the new rules for SEPs and the impact of LIS no longer being quarterly. 

What is Low-Income Subsidy (LIS)?

The Low-Income Subsidy (LIS) program, also known as Extra Help, assists Medicare Beneficiaries with limited income and resources in paying for their Medicare prescription drug plan costs. This includes assistance with premiums, deductibles, and copayments, making prescription drugs more affordable for eligible individuals.

 Key Change: LIS SEP No Longer Quarterly

Previously, Medicare Beneficiaries who qualified for LIS were granted a Special Enrollment Period (SEP) once every calendar quarter for the first three quarters of the year. This allowed them to change their Medicare Advantage or Part D plan outside of the Annual Enrollment Period (AEP). However, starting in 2025, this quarterly SEP will no longer be available. Here’s what you need to know about the new SEP rules:

Annual SEP for LIS Beneficiaries

Beginning in 2025, LIS Beneficiaries will now have one SEP per year instead of the quarterly option. This change aims to streamline the enrollment process and reduce the administrative burden on both Beneficiaries and plan providers. Here’s how it works:

  1. One-Time Annual SEP: LIS Beneficiaries will have one Special Enrollment Period each year to change their Medicare Advantage or Part D plan.
  2. Timing: The timing of this SEP will align with the calendar year, providing Beneficiaries with a clear window for making changes outside of the AEP.
  3. Impact on Beneficiaries: This change requires careful planning and consideration for Beneficiaries to ensure they choose the best plan for their needs during their available SEP.

 Benefits of the New SEP Rule

While the shift from quarterly to annual SEP may seem limiting, it offers several benefits:

  1. Stability in Coverage: Reducing the frequency of plan changes can lead to more stable coverage for Beneficiaries, allowing them to better manage their healthcare needs without frequent disruptions.
  2. Simplified Process: The new rule simplifies the enrollment process, making it easier for Beneficiaries to understand their options and make informed decisions.
  3. Administrative Efficiency: Streamlining SEPs reduces the administrative workload for both Medicare and plan providers, potentially leading to improved service delivery.

How Agents Can Assist Beneficiaries

As Agents, it is crucial to support your clients through this transition. Here are some ways you can assist LIS Beneficiaries:

  1. Educate Clients: Inform your clients about the new SEP rule and its implications. Ensure they understand that they will now have one annual opportunity to change their plan.
  2. Review Current Plans: Conduct a thorough review of their current plan to ensure it still meets their needs. Consider factors such as coverage, costs, and network providers.
  3. Plan: Encourage Beneficiaries to plan and evaluate their healthcare needs for the upcoming year. This proactive approach will help them make the most informed decision during their SEP.
  4. Provide Ongoing Support: Offer continuous support and guidance throughout the year. Keep your clients informed about any other changes in Medicare that may affect their coverage.

 The shift to an annual SEP for LIS Beneficiaries is a significant change for the 2025 plan year. By understanding and effectively communicating these new rules, you can better serve your clients and help them navigate their healthcare choices. Advocate Health Advisors is here to support you with the resources and expertise needed to succeed.