When can a Medicaid member change plans and how many times?
Medicaid/LIS-eligible individuals have two separate SEPs, and their scope differs: one lets a full-benefit dual or other LIS-eligible individual switch stand-alone Part D plans once per month, and a second lets them make an election within three months of a gain, loss, or change in their Medicaid or LIS status.
What the rule says
Monthly SEP (standalone PDPs only):
“(i) Except as provided in paragraph (ii) of this section, the individual is a full-subsidy eligible individual or other subsidy-eligible individual as defined in § 423.772, who is making a one-time-per month election into a PDP.”
The guidance clarifies this SEP does not reach MA-PD plans:
“The SEP for low-income subsidy eligible individuals is a Part D SEP that allows a "full-benefit dual eligible individual" or "partial-benefit dual eligible or other low-income subsidy (LIS) eligible individual" (see § 10) to enroll once per month into any standalone prescription drug plan but does not permit enrollment into MA-PD plans or changes between MA-PD plans.”
This SEP is unavailable to at-risk or potential at-risk beneficiaries:
“An individual described in paragraph (i) is not eligible for this special enrollment period if he or she has been notified that he or she has been identified as a "potential at-risk beneficiary" or "at-risk beneficiary" as defined in § 423.100 and such identification has not been terminated in accordance with § 423.153(f)).”
SEP for a change in Medicaid/LIS status:
“The individual is making an election within 3 months after a gain, loss, or change to Medicaid or LIS eligibility, or notification of such a change, whichever is later.”
The guidance notes these two SEPs are independent of each other:
“NOTE: Use of this SEP does not count towards the SEP for subsidy-eligible individuals described in § 30.6.7.”
This answer relies partly on the CY 2027 enrollment guidance, which applies to enrollment requests received on or after January 1, 2027 (and may be applied by plans to AEP enrollments effective 1/1/2027).
The deciding facts here are whether the member wants an MA-PD or a standalone PDP, and whether their situation is an ongoing dual/LIS status (monthly SEP) versus a recent change in that status (3-month SEP).
Carrier and FMO rules are often stricter than CMS rules. This tool reports what CMS sources say and is not legal advice. Enrollment guidance shown is the CY 2027 version. Regulation text reflects the CY 2027 marketing rules, which apply to marketing beginning October 1, 2026.
This answer was generated by mapdbot from the sources listed below on September 23, 2026 and checked against them. Regulation text: eCFR as of 09/15/2026. It is for licensed insurance agents, is not legal advice, and does not cover carrier or FMO rules.
Sources cited
Related questions
- How often can a dual eligible client change plans?
- Which Special Enrollment Period applies, and what documentation do I need?
- How does someone sign up for a stand-alone Part D plan?
- My client moved to a new county. What election period can they use?
- What SEP does my client qualify for, and do I need proof? They just moved to another county.