Medicare 2026

A Monthly Chance to Change Course: The Special Enrollment Period for People With Medicaid or Extra Help

If you have Medicaid, qualify for a Medicare Savings Program, or get the Extra Help program that lowers your drug costs, Medicare gives you more flexibility than most people to change your drug or health coverage during the year. Since January 1, 2025, that flexibility comes in the form of two monthly Special Enrollment Periods. They replaced the older quarterly window that used to apply, and they are designed to help you fix mismatched coverage without waiting for fall Open Enrollment.

Here is a plain-English guide to how these two monthly windows work, who qualifies, and what they can — and cannot — be used for.

Who these Special Enrollment Periods are for

The first window is often called the "dual/LIS" Special Enrollment Period. Under federal rules at 42 CFR 423.38(c)(4), it is available to:

• Full-benefit dual eligibles (people with both Medicare and full Medicaid).
• Partial-benefit dual eligibles — people enrolled in the Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), Qualifying Individual (QI), or Qualified Disabled and Working Individuals (QDWI) programs.
• People who receive only the Extra Help (Low-Income Subsidy, or LIS) program that helps pay for Part D.

If you fit any of these descriptions, once a month you can either leave Medicare Advantage and return to Original Medicare paired with a stand-alone Part D drug plan, or switch from one stand-alone drug plan to another.

The second window is the "integrated care" Special Enrollment Period, under 42 CFR 423.38(c)(35). It is narrower: it is only for full-benefit dual eligibles, and it can only be used to enroll in an integrated D-SNP — specifically a fully integrated D-SNP, a highly integrated D-SNP, or an "applicable integrated plan" — in order to line your Medicare up with your Medicaid managed care plan. Not every D-SNP is integrated, so if you want to know which plans in your area qualify, you can call 1-800-MEDICARE for a list.

If you are in fee-for-service Medicaid or in a Medicaid managed care plan that is not aligned with an integrated D-SNP, the integrated care Special Enrollment Period is not available to you. You can still use the dual/LIS Special Enrollment Period to move to Original Medicare with a stand-alone drug plan or to change stand-alone drug plans.

When your change takes effect

Both Special Enrollment Periods follow the same timing rule: whatever you choose this month takes effect the first day of the next month. That makes it easier to plan around a pharmacy change, a new prescription, or a move between providers.

What these windows do not do

A common point of confusion: these monthly windows do not let you hop between regular Medicare Advantage plans. You cannot use them to enroll in a Medicare Advantage plan that is not a D-SNP, or to switch from one non-D-SNP Medicare Advantage plan to another.

If you want to make that kind of change, you still have the standard opportunities everyone on Medicare has: your Initial Enrollment Period when you first become eligible, the fall Open Enrollment Period (October 15 – December 7, 2026, for coverage starting January 1, 2027), the Medicare Advantage Open Enrollment Period in the first quarter of the year, and any other Special Enrollment Period you qualify for based on life events.

One important exception

The dual/LIS Special Enrollment Period is not available if your Part D plan has notified you that it identified you as a "potential at-risk" or "at-risk" beneficiary under a Part D drug management program (these programs focus on safe use of certain medications, like opioids). If that applies to you, the plan will send you a letter. The Special Enrollment Period becomes available again once that identification has ended.

Original Medicare with a drug plan, or an integrated D-SNP?

If you qualify for both options, it is worth understanding the trade-offs — without anyone telling you which is "better," because that depends on your doctors, your medications, and your preferences.

• Original Medicare with a stand-alone Part D plan gives you broad access to any provider in the country who accepts Medicare, and your drug coverage is separate. Many people pair this with a Medigap policy to help with out-of-pocket costs, though Medigap availability and pricing vary.
• An integrated D-SNP bundles Medicare and Medicaid together. By federal design, members get one ID card for both programs, a single health risk assessment, a care coordinator or case manager, and one combined appeals and grievance process for any Medicare or Medicaid issue. The trade-off is that you use the plan's network and rules.

Neither option is universally better. The right fit depends on your situation.

A few national program facts for 2027

Regardless of which path you choose, some Part D numbers are set nationwide for 2027:

• The Part D out-of-pocket cap will be $2,400 (up from $2,100 in 2026).
• The most any Part D plan may charge as a deductible is $700.
• The Part D base beneficiary premium is $41.33, a national figure used to calculate the late-enrollment penalty; actual plan premiums are set plan by plan.

Social Security also announced a 3.6 percent cost-of-living adjustment for benefits payable beginning January 2027. The 2027 Part B standard premium and deductible, and the IRMAA income brackets, have not yet been announced; CMS typically releases those figures in the fall.

Where to go next

For plan comparisons in your area, personalized cost estimates, and help confirming you qualify for Medicaid or Extra Help, visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227), available 24 hours a day, 7 days a week. Those are the official sources for enrollment rules and plan details.