If a beneficiary enrolled in a MAPD plan wants to switch to a plan with no premiums after qualifying for Medicaid, what applies?

When a beneficiary qualifies for Medicaid and wishes to switch from a Medicare Advantage Plan with Prescription Drug coverage (MAPD) to a plan with no premiums, the rules around enrollment periods become significant. Specifically, those eligible for both Medicare and Medicaid have special regulations that allow them to change their plan based on their changing eligibility status.

The correct timeframe for switching plans in this scenario is within three months of qualified Medicaid eligibility. This is due to the coordinated benefits that are available for individuals who are dually eligible. The three-month allowance provides them with ample opportunity to evaluate their options for coverage that may better suit their needs, especially given that their financial situation has changed with the approval of Medicaid.

Remaining in the current plan or not needing to change plans does not take into consideration the potential benefits of a zero-premium option, which could provide more sustainable coverage for the individual now that their financial circumstances have altered.

Therefore, the correct option regarding the ability for a beneficiary to switch plans effectively in relation to new eligibility under Medicaid supports the notion that they can make use of the three-month window following eligibility to transition to a more favorable plan that incurs no premiums.