What qualifies an eligible consumer to use the Integrated Care SEP?

• A. Must be a Full Dual-Eligible consumer who lives within the Integrated plan service area and is enrolling in an Integrated plan.
• B. Any Medicare beneficiary can use it.
• C. Only those with Medicare Advantage Open Enrollment.
• D. Not applicable to Integrated plans.

Answer: (A)

The key idea is that the Integrated Care Special Enrollment Period is limited to people who have both Medicare and Medicaid (full dual-eligibles) and who live in the area where the Integrated plan is offered, and who are enrolling in that integrated plan. This focus ensures that only those whose benefits are coordinated through Medicaid and Medicare—and who can access the integrated product in their location—use this SEP. Being a full dual-eligible means you qualify for both sets of benefits, which is necessary because the integrated plan coordinates those benefits under one product. The service area requirement ensures the plan is actually available where you live, and the enrollment in an Integrated plan confirms you’re joining the specific integrated Medicare-Medicaid option.

The other statements don’t fit because they either apply too broadly to all Medicare beneficiaries, reference a different enrollment window (Medicare Advantage Open Enrollment), or state that integrated plans aren’t eligible for this SEP, which contradicts the purpose of the integrated option.