SEP changes that impact you in 2025

Learn about the SEP changes that impact you in 2025

Cigna is here to help you navigate the Special Enrollment Period (SEP) changes in 2025 from the Centers for Medicare & Medicaid Services (CMS). The changes that impact you and your customers have been summarized below, but it is recommended you take some time to review the Cigna SEP Booklet for more details (login to CignaForBrokers required).

Reach out to your local Broker Manager team if you have questions.

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Dual Special Needs Plan (D-SNP) / Low-Income Subsidy (LIS) SEPs

Starting this year, CMS eliminated the quarterly SEP (code MDE) that allowed dual eligible customers and anyone with LIS to make Medicare Advantage (MA) plan changes on a quarterly basis (quarters 1-3).

The quarterly SEP was replaced by:

• A monthly SEP (code DEP) allowing all dual eligible customers and/or customers that qualify for LIS to leave their Medicare Advantage Prescription Drug (MAPD) plan for Original Medicare and join a standalone Prescription Drug Plan (PDP) or switch to a different PDP.
• A monthly integrated SEP (INT-SEP) allowing only full-benefit dual eligible customers to switch to/between integrated D-SNPs with aligned Medicaid plans. See more details below.

Despite this change, full and partial dual eligible customers can continue to use other SEPs, if available, and leverage other non-dual SEPs (i.e., new move, loss/gain of eligibility, etc.) as they do today.

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More details on the monthly INT-SEP

The INT-SEP can be used once per month with an effective date the first of the following month for full-benefit dual eligible individuals. Eligible plans for the INT-SEP include:

• FIDE SNP: Fully Integrated Dual Eligible Special Needs Plan
• HIDE SNP: Highly Integrated Dual Eligible Special Needs Plan
• AIP: D-SNP that is an Applicable Integrated Plan

As a HIDE SNP, Cigna's TotalCare Plus HMO-DSNP (H5410) in Florida is the only Cigna Healthcare^SM plan eligible for the monthly INT-SEP. This means that you can accept enrollments using this monthly INT-SEP for Florida customers that are eligible for this plan.

Please note that effective with sales written on and after March 1, 2025, Cigna will no longer pay commissions on the TotalCare Plus HMO-DSNP (H5410-49) plan in Miami-Dade, Broward, and Palm Beach counties in Florida.

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Navigating these changes with your customers

While dual eligible customers have the option to change plans throughout the year as listed above, Cigna encourages you to remind your customers about the benefits associated with remaining on their MA D-SNP plans. By remaining on their Cigna Healthcare plan, they will avoid disrupting the coordinated service, model of care, and benefits that they already have.

Here is some more information that you can share with your customers regarding the benefits of their Cigna Healthcare D-SNP:

• D-SNPs include rich benefits such as lower cost-shares and larger allowances for supplemental benefits like dental, over-the-counter (OTC) items, groceries, utilities, and transportation.
• The Cigna team supports D-SNP customers with case management, care planning, appeals and grievances, and other needs.

To ensure you're ready to answer your customers' questions, please review the following resources from CignaForBrokers.com:

• 2025 Cigna Medicare D-SNPs & Dual/LIS SEP Changes
• 2025 D-SNPs State Specific Guide

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Disaster (DST) SEPs

Per direction from CMS, the SEP for Individuals Affected by a Government Entity-Declared Disaster or Other Emergency (also known as the DST-SEP) election process will change effective April 1, 2025.

These changes will impact both you, broker partners, and customers. Please take some time to review the this link to learn more about these changes to ensure you stay in compliance with the new CMS guidelines throughout the year.

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