• Home
  • /
  • Blog
  • /
  • Understanding the Changes in Medicare for Dual Eligible Special Needs Plans in 2025
October 24, 2024

In an effort to enhance the integration of Medicaid and Medicare services for dually eligible individuals, the Centers for Medicare & Medicaid Services (CMS) has introduced transformative changes set to take effect in 2025. These changes aim to streamline care coordination, accessibility, and affordability for enrollees, benefiting both CMS and dual-eligible beneficiaries.

Positive Aspects of the Changes:

  1. Improved Care Coordination: By encouraging beneficiaries to obtain Medicare and Medicaid benefits from either a fully integrated D-SNP or highly integrated D-SNP, care coordination is set to significantly improve. This alignment ensures that enrollees receive comprehensive and efficient healthcare services.
  2. Enhanced Affordability: With a focus on decreasing costs through exclusively aligned enrollments, both CMS and beneficiaries stand to benefit financially. This approach not only optimizes resource allocation but also promotes cost-effective care delivery.
  3. Better Outcomes: The shift towards integrated D-SNP plans promotes better health outcomes for enrollees. With streamlined services and increased accessibility to essential healthcare resources, beneficiaries can expect improved health and wellness outcomes.

Challenges and Considerations:

  1. Limited Selection Options: The restriction on enrolling in any D-SNP of choice on a monthly or quarterly basis may limit the flexibility and choice available to dual-eligible individuals. This constraint could affect the ability of beneficiaries to select plans that best suit their unique healthcare needs and preferences.
  2. State Disparities: Individuals residing in states without integrated plans may face restrictions in enrollment options and access to the new monthly SEP. This disparity could lead to uneven opportunities for beneficiaries across different regions, impacting the equity of healthcare access.

Conclusion: Navigating the Future of Dual Eligible Special Needs Plans

As we anticipate the implementation of these Medicare changes in 2025, it is crucial for dual-eligible individuals to stay informed and prepared for the evolving landscape of healthcare services. While the new integrated-care SEP offers opportunities for enhanced care coordination and affordability, it is important to consider the potential limitations in choice and availability of plans based on individual circumstances.

By understanding the positives and challenges associated with these changes, beneficiaries can make informed decisions to ensure they receive optimal healthcare coverage aligned with their specific needs and preferences. Stay engaged, seek guidance where needed, and embrace the transformations that aim to elevate the quality of care for dual-eligible enrollees in the years to come.

Get Help

Compare Medicare coverage options with the help of one of our agents:

Talk to us: (833) 265-9655 

What to Do With Medicare When You Move

Moving to a new state? This guide explains how relocating affects your Medicare coverage—whether you have Original Medicare, Advantage, Part D, or Medigap—and what steps to take to avoid gaps, missed deadlines, or surprise costs.Medicare Starts Here™by Lehigh Partners Senior Benefits What Happens to Medicare If I Move to Another State? Thinking about moving—or already

Read More

Medicare Supplement Enrollment Periods

This guide explains Medicare Supplement Enrollment Periods—Open Enrollment, Guaranteed Issue, and state-specific rules—so you can enroll with confidence and avoid costly mistakes.Why Medicare Supplement Enrollment Rules Matter More Than You ThinkIf there’s one thing that frustrates me more than anything in this industry, it’s the amount of confusing or flat-out wrong information people get when

Read More

Can You Use a Prescription Discount Card with Medicare?

Can You Use Drug Coupons or Discount Cards Instead of Part D Benefits?If you’ve ever stood at the pharmacy counter, wondering why your Medicare Part D plan is charging more than what you saw online with a discount card like GoodRx, you’re not alone. As a licensed Medicare agent who’s helped hundreds of people through

Read More

Medicare Advantage vs Supplement — Which One Fits You Best?

The Medicare Decision That Matters More Than You ThinkIf you’re turning 65 soon, I don’t need to tell you that your mailbox has probably turned into a war zone of Medicare ads. Shiny brochures. Friendly-looking seniors. Confusing charts. And somehow… nobody’s giving you a straight answer. Here’s what I’ve learned after helping people with Medicare for over

Read More

Medicare Plan G Explained Simply (2025 Update)

When it comes to Medicare Supplement plans, it’s easy to feel overwhelmed by all the choices.If you’ve heard about Plan G but aren’t sure exactly what it covers – or whether it’s the right fit – you’re in the right place. Medicare Plan G is a popular Medicare Supplement plan in 2025 because it covers most

Read More

Medicare brokers such as Lehigh Partners get paid by the insurance companies they represent. And you pay exactly the same rate for your insurance if you use a Medicare consultant (broker). There is no extra fee or cost for enrolling through a broker. You will never pay a fee for our help.


Find a Plan

Shop for coverage online. Safe, Secure, & Confidential

Call us

Call Lehigh Partners at 1-833-265-9655

Licensed insurance agents are available to help you through enrollment and beyond.

Need Help?

Get in touch with a licensed sales agent now by filling out the form - no obligations!

Get Our FREE Medicare Checklist.

Download our complimentary Medicare checklist and conveniently access all the necessary information in one place, ensuring you never miss a crucial number, deadline, or date again.

Tags


Medicare Advantage vs Supplement — Which One Fits You Best?

The Medicare Decision That Matters More Than You ThinkIf you’re turning 65 soon, I don’t need to tell you that your mailbox has probably turned into a war zone of Medicare ads. Shiny brochures. Friendly-looking seniors. Confusing charts. And somehow… nobody’s giving you a straight answer. Here’s what I’ve learned after helping people with Medicare for over

Read More

Turning 65 Medicare: Avoid Costly Mistakes Now

Turning 65 Medicare: Choosing between Medicare Advantage and Medigap Plan G is a pivotal decision for individuals approaching 65. This guide aims to clarify both options, helping you make an informed choice tailored to your healthcare needs and financial situation.Medicare Plan Comparison Example: Meet Jane, Age 65If you’re turning 65 and trying to make sense

Read More

Decoding the 4 Parts of Medicare

Compare Medicare Advantage plans. See plans in my area Navigating healthcare can be complicated, but knowing about Medicare can help you make informed decisions. Medicare is a federal health insurance program with four parts: Part A, Part B, Part D, and Part C. Understanding these parts can help you plan for healthcare, choose the right

Read More

Does Medicare Cover Transportation?

Medicare is a crucial resource for many individuals, providing essential healthcare coverage for various medical needs. However, when it comes to transportation, there may be some confusion regarding what Medicare covers and what it does not. In this comprehensive guide, we will delve into the specifics of Medicare coverage for transportation, including the role of

Read More

Decoding Medicare: Making Informed Choices for Your Healthcare Coverage

Are you ready to navigate the maze of Medicare options but unsure about whether a Medicare supplement or a Medicare Advantage plan is the best fit for you? In this comprehensive guide, we’ll unravel the intricacies of Medicare coverage, empowering you to make informed decisions that align with your healthcare needs and preferences.Understanding Your OptionsWhen

Read More

Not satisfied with your Medicare Advantage? Open Enrollment Options

The Medicare Open Enrollment Period holds significant importance for beneficiaries, offering a crucial window of opportunity to review and modify your Medicare coverage. In light of the dynamic healthcare landscape, this enrollment period takes on added significance, as it presents individuals with the chance to assess their plans and make adjustments that better align with

Read More

Ready to talk to an agent about your Medicare coverage?