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Revised 02/02/2011 1 Low Income Subsidy & Enrollment Assistance Creating Special Election Periods through the Medicare Part D Low-Income Subsidy (LIS)

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Presentation on theme: "Revised 02/02/2011 1 Low Income Subsidy & Enrollment Assistance Creating Special Election Periods through the Medicare Part D Low-Income Subsidy (LIS)"— Presentation transcript:

1 Revised 02/02/ Low Income Subsidy & Enrollment Assistance Creating Special Election Periods through the Medicare Part D Low-Income Subsidy (LIS)

2 Revised 02/02/2011 Learning Objectives At the end of this training you will be able to : Explain why we should assist with LIS Define Low Income Subsidy (LIS) qualifications Understand the options for apply for LIS Determine if LIS, or other state pharmaceutical program, is the best option for the consumer (DE, MD, NJ and PA only) Apply the knowledge to grow your business 2

3 Revised 02/02/2011 Why should you assist with LIS? Consumers enrolled into LIS have a continuous Special Election Period (SEP) that can be used to enroll consumers during Lock-In Enhances both the agents and Bravos value with the consumer Its the right thing to do 3

4 Revised 02/02/2011 What is the LIS Program? LIS is a Federal program administered by the Social Security Administration (SSA) for Medicare consumers who have limited income & resources. The program pays* for prescription drug related costs: – Monthly premium – Yearly deductible – Prescription coinsurance and copayments – Assistance to cover RX drugs for $ $6.50 – Eliminates the Part D late enrollment penalty – Provides coverage in 2012 Coverage gap is $3, * The LIS service is estimated to be worth an average of $34,000 per year. This is determined by the Social Security Administration. (source: Did You Know? LIS is also known as Extra Help

5 Revised 02/02/2011 Income Limits Income is the earnings you receive. Examples are: wages, Social Security income, Railroad Retirement, and Veterans benefits 5 IncomeIndividualMarried Yearly$16,335$22,065 Monthly$1,361.25$1, *Income limits may vary for Alaska & Hawaii. Additionally income limits may be higher with additional dependents. Did You Know? Beginning January 1, 2010, the help received regularly from someone else to pay household expenses (food, mortgage, rent, heating fuel or gas, electric, water and property taxes) will not count as income. 150% of Poverty level in 2011*

6 Revised 02/02/2011 Resources Limits Resources are the value of things you own Resources include money in a checking or savings account, stocks, bonds, mutual funds, and Individual Retirement Accounts (IRAs). 6 IndividualMarried Resources$12,640$25,260 Did You Know? Resources dont include your home, car, household items, burial plot, up to $1,500 for burial expenses (per person), or life insurance policies.

7 Revised 02/02/ LIS Overview 7

8 Revised 02/02/2011 LIS – Low Take Up Rate A national survey of seniors indicates that lack of awareness particularly among low-income seniors of color. Medicare beneficiary counselors report that the most common reasons beneficiaries do not apply for the LIS are that they do not have the information they need; They are not aware that a subsidy is available; They do not know how to apply for the subsidy; They think they are ineligible for financial reasons. Some Medicare beneficiaries are reluctant to ask for help or to share personal financial information. 8 Did You Know? The Henry J. Kaiser Family Foundation has created The Medicare Part D Low-Income Subsidy Program. org/medicare/u pload/8094.pdf The Henry J. Kaiser Family Foundation has created The Medicare Part D Low-Income Subsidy Program. org/medicare/u pload/8094.pdf

9 Revised 02/02/2011 LIS – Low Take Up Rate cond Others are confused about the two step process required for low-income beneficiaries to apply for the LIS and enroll in a Part D drug plan. Furthermore, the asset test for the LIS is a source of complexity related to the application process. Beneficiaries may not understand what information is required; they may have difficulty obtaining the information; and the need to verify the information can be time-consuming.

10 Revised 02/02/2011 Automatic Qualification Some consumers are automatically eligible for the low-income subsidy: Full benefits dual eligibles – Consumers and/or members receiving benefits from both Medicare and Medicaid but do not have to pay Part A premiums, in some case Part B premiums and full Medicaid benefits Partial subsidy eligible individual – State programs that help pay consumers Medicare expenses like premiums, deductibles and co-insurance – Four Medicare Savings Programs: Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), Qualifying Individual (Q1 or QI-1), Qualified Disabled & Working Individual (QDWI) Supplemental Security Income (SSI) recipients with Medicare – Federal income supplement program – Designed to help aged, blind disabled people who have little or no income 10 Did You Know? Non-deemed consumers are REQUIRED to reapply for LIS every calendar year. The Social Security Administration sends notices to consumers in October encouraging them to reapply.

11 Revised 02/02/2011 Why an Agent Should Assist? Agent Assistance Application SubmissionApplication completed immediately LIS Award LetterAverage Award letter is produced within 10 – 14 business days Program UnderstandingCan ask questions of the agent to understand the benefits Value RecognitionConsumer relates value of assistance with you and Bravo Health Consumer ExperienceConsumer has a relationship with agent and feels more comfortable talking about financial situation and any concerns they have 11

12 Revised 02/02/2011 LIS Application Assistance LIS can be applied for with a paper application. GOOD GOOD LIS can be applied for with an online application. BETTER BETTER LIS can be applied for with a telephone application. BEST BEST 12 Did You Know? That when applying for LIS a consumer DOES NOT have to submit documents verifying their income and resources.

13 Revised 02/02/2011 LIS Application Assistance 1.Apply via the telephone at Social Security Administration (SSA): –SSA at (TTY ) 2.Paper forms can be requested at: –SSA at (TTY ) 3.Online forms available at: – 4.Additional information is available at: – 13 Did You Know? Completing the LIS application starts the process for a Medicare Savings Program. Information is sent to the state and they will contact the consumer to help apply for a Medicare Savings Program

14 Revised 02/02/2011 What info is needed to complete application? Social Security card Bank account statements: checking, savings, certificates of deposit Investment information: Individual Retirement Accounts (IRAs), stocks, bonds, savings bond, mutual fund, other investment statements Tax returns Payroll slips Most recent Social Security benefits award letters Railroad retirement benefits Veteran benefits Pensions Annuities 14 Did You Know? The Social Security Administration created a guide titledApplication for Extra Help with Medicare Prescription Drug Plan Costs ialsecurity.gov/ prescriptionhel p/SSA-1020B- OCR-SM- INST.pdf The Social Security Administration created a guide titledApplication for Extra Help with Medicare Prescription Drug Plan Costs ialsecurity.gov/ prescriptionhel p/SSA-1020B- OCR-SM- INST.pdf

15 Revised 02/02/2011 If completing a paper application...follow these tips Use black ink in because application is scanned at SSA and black ink scans better Enter name and number exactly as it appear on your SS Card or Railroad Retirement Card Dont mark the yes and no boxes in any section If you are single (divorced, widowed, not living with spouse) do not complete any sections that ask for spousal information Return entire packet and not just the page signed Do not send other documents (e.g. doctor bills, Rx info, IRS info, etc) Do not used a photocopied, faxed or downloaded form – use the original paper form or apply online DO NOT complete question 15 if you want help from the Medicare Savings Program 15 Did You Know? Applying for LIS with a paper application adds 10 business days to the determination process.

16 Revised 02/02/2011 What is the Alabama SenioRx Partnership for Medication Access ? Alabamas SenioRX Partnership for Medication Access administered by the Department of Senior Services through 13 Area Agencies on Aging. Eligible individuals who have at least 55 years of age or you are deemed disabled by Social Security and in the 24 month gap for Medicare coverage. – No prescription drug coverage. – Have a chronic medical condition. – In the Medicare Part D Gap. – Legal resident of the state of Alabama. 16 Did You Know? The SeniorRX Partnership that provides assistance with applying for drug assistance programs provided by pharmaceutical manufacturers.

17 Revised 02/02/2011 SenioRX Income Limits Income is the earnings you receive. – Examples are: wages, Social Security income, Railroad Retirement, and Veterans benefits There is no Resource test for SenioRX. 17 IncomeIndividual*Married Yearly$21,660$29,140 Monthly$1,800$2,482 Did You Know? If a consumer exceeds the income limits they still may qualify for DPAP if they have prescription costs exceeding 40% of their income.

18 Revised 02/02/2011 SenioRX Application Assistance Contact AGE-LINE ( ) to request an application. Applicants will need to include the following: – Social Security – Medicare Card – Medicaid Card (if applicable) – Supplemental Card (if applicable) – Medicare Part D Prescription Card (if applicable) – Veterans Benefit, pension, earnings, interest on savings and/or investments, and cash given to you or any other income must be reported. – List of all medications from a pharmacist – List of all monthly bills 18

19 Revised 02/02/2011 SenioRX vs. LIS 19 SenioRXLIS Income Limit200% of FPL150% of FPL Resource LimitNOYES DocumentationYESNO Processing7 business days10 – 21 business days RX BenefitNo set benefit. Application assistance with pharmaceutical manufacturers drug programs $2.50 – $6.50 RX PremiumNOVaries based on LIS level Coverage GapNOYES Which program is more beneficial for the consumer?

20 Revised 02/02/2011 What is the Delaware Prescription Assistance Program? Delawares Prescription Assistance Program (DPAP) is a State program administered by the Delaware Health and Social Services for provides up to $3,000 per individual in each calendar year for eligible clients. Eligible individuals who have no prescription insurance other than Medicare Part D, and whose income is at or below 200% of the Federal Poverty Level (FPL), or whose prescription costs exceed 40% of their income. DPAP program pays for prescription drug related costs: – Assistance to cover RX drugs 5.00 or 25%, whichever is greater 20 Did You Know? DPAP was funded by the tobacco settlement.

21 Revised 02/02/2011 DPAP Income Limits Income is the earnings you receive. Examples are: wages, Social Security income, Railroad Retirement, and Veterans benefits There is no Resource test for DPAP. *If one spouses' income(social security and or pension etc.) exceeds the annual income then that spouse doesn't qualify 21 IncomeIndividual*Married Yearly$21,780n/a Monthly$1,815n/a *Income limits may vary for Alaska & Hawaii. Additionally income limits may be higher with additional dependents. 200% of Poverty level in 2011 Did You Know? If a consumer exceeds the income limits they still may qualify for DPAP if they have prescription costs exceeding 40% of their income.

22 Revised 02/02/2011 DPAP Application Assistance DPAP can only be applied for with a paper application and require the following documentation to be submitted with the application: – Social Security – Social Security Disability Benefit – Veterans Benefit, pension, earnings, interest on savings and/or investments, and cash given to you or any other income must be reported. Individuals needing assistance the DPAP application can call , Option 2, then Option 1 to reach a representative. 22 Did You Know? The DPAP paper application is located online at: ss.delaware.go v/dss/files/dpa papplication.pd f The DPAP paper application is located online at: ss.delaware.go v/dss/files/dpa papplication.pd f

23 Revised 02/02/2011 DPAP vs. LIS 23 DPAPLIS Income Limit200% of FPL150% of FPL Resource LimitNOYES DocumentationYESNO Processing7 business days10 – 21 business days RX Benefit$5.00 or 25%$2.50 – $6.50 RX PremiumNOVaries based on LIS level Coverage GapYES Which program is more beneficial for the consumer?

24 Revised 02/02/2011 Florida Florida does not have a state prescription assistance program for Medicare recipients. Some Florida counties offer Pharmaceutical Prescription Assistance Programs for individuals who cannot afford their prescriptions. Florida does offer the Florida Discount Drug Card is designed to lower the cost of prescriptions for Florida residents without drug insurance coverage. Enrollees save an estimated 5 to 40 percent on Rx purchases. More information can be found at heet.pdf heet.pdf 24

25 Revised 02/02/2011 Georgia Georgia does not have a state prescription assistance program for Medicare recipients. 25

26 Revised 02/02/2011 What is Illinois Care RX? Illinois Care RX BASIC plan covers prescription drugs for the treatment of Alzheimers disease, arthritis, cancer, diabetes, glaucoma, heart and blood pressure problems, HIV/AIDS (if eligible for Medicare), lung disease and smoking related illnesses, multiple sclerosis, osteoporosis and Parkinsons disease. Illinois Care RX PLUS plan covers all classes of medically necessary drugs Enrollees in either plan will pay: – $2.50 for generic drugs, $6.30 for preferred brand name drugs – $15 for specialty and non-preferred brand name drugs, – 20% plus the applicable co-pay after $2,700 in drug benefits have been paid on your behalf. After – $6,440 of total drug costs, enrollees pay 5% co-insurance and Medicare pays 95% of the drug costs. 26

27 Revised 02/02/2011 Care RX Income Limits Income is the earnings you receive. – Examples are: wages, Social Security income, Railroad Retirement, and Veterans benefits There is no Resource test for Care RX. 27 IncomeIndividual*Married Yearly$21,78036,635 Monthly$1,815$3,052 Did You Know? In order to enrollee in Care RX an individual must apply for Medicare Part D Extra Help even if they do not meet Extra Help qualifications.

28 Revised 02/02/2011 Care RX Application Assistance Care RX can be applied for at: https://cbrx1.aging.illinois.gov/app/cbci/ https://cbrx1.aging.illinois.gov/app/cbci/ Paper applications can be obtained by: – df df – Calling the Senior Help Line at – Calling the Senior Health Insurance Program at

29 Revised 02/02/2011 Care RX vs. LIS 29 SPDAPLIS Income Limitof FPL150% of FPL Resource LimitNOYES DocumentationYESNO ProcessingOnline Application: 6 Weeks Paper Application: 4 months 10 – 21 business days RX Benefit$ $15.00$2.50 – $6.50 RX Premium-Varies based on LIS level Coverage GapYES Which program is more beneficial for the consumer?

30 Revised 02/02/2011 What is the Maryland Senior Prescription Drug Assistance Program? Marylands Senior Prescription Drug Assistance Program (SPDAP) is a State program administered by the Maryland Health Insurance Plan and provides financial assistance to moderate-income Maryland residents who are eligible for Medicare and are enrolled in a prescription drug plan. SPDAP pays for prescription drug related costs: – $35 per month towards the cost of their monthly Medicare Rx or Medicare Advantage Prescription drug premiums – Will pay 95% of the drug costs for consumers during the coverage gap 30 Did You Know? In order to be eligible for the Coverage Gap Subsidy the consumer MUST be enrolled in an approved plan.

31 Revised 02/02/2011 SPDAP Income Limits Income is the earnings you receive. – Examples are: wages, Social Security income, Railroad Retirement, and Veterans benefits There is no Resource test for SPDAP Couples must complete separate applications if both are applying for the benefit 31 IncomeIndividualMarried Yearly$ 32,670$ 44,130 Monthly$2,722.50$3, % of Poverty level in 2011 Did You Know? To enroll into SPDAP a consumer CANNOT be enrolled in LIS.

32 Revised 02/02/2011 SPDAP Application Assistance SPDAP can only be applied for with a paper application and require the following documentation to be submitted with the application: Proof of at least six months of Maryland residency Copy of your most recent federal income tax return 32 Did You Know? The SPDAP paper application is located online at: rylandspdap.co m/Portals/1/Do cs_MarylandSP DAP/SPDAP%20 Application%20 Revised% %20approv ed.pdf The SPDAP paper application is located online at: rylandspdap.co m/Portals/1/Do cs_MarylandSP DAP/SPDAP%20 Application%20 Revised% %20approv ed.pdf

33 Revised 02/02/2011 SPDAP vs. LIS 33 SPDAPLIS Income Limit300% of FPL150% of FPL Resource LimitNOYES DocumentationYESNO Processing10 business days10 – 21 business days RX Benefit95% during the Coverage Gap $2.50 – $6.50 RX PremiumUp to $35 for partner plans Varies based on LIS level Coverage GapYES Which program is more beneficial for the consumer?

34 Revised 02/02/2011 Mississippi Mississippi does not have a state prescription assistance program for Medicare recipients. 34

35 Revised 02/02/2011 What is the New Jersey Pharmaceutical Assistance to the Aged and Disabled Program? New Jerseys The Pharmaceutical Assistance to the Aged and Disabled (PAAD) is a State program administered by the Department of Health and Senior Services and provides financial assistance to residents who are eligible for Medicare and are enrolled in a prescription drug plan. PAAD pays for prescription drug related costs: – Assistance to cover RX drugs $5.00 (generic) or $7.00 (name brand) – Contribute up to the regional benchmark amount towards the prescription portion of the total premium. 35 Did You Know? If a Medicare Part D plan does not pay for a medication because the drug is not on its formulary, PAAD beneficiaries will have to switch to a drug on the Part D plan's formulary

36 Revised 02/02/2011 PAAD Income Limits Income is the earnings you receive. – Examples are: wages, Social Security income, Railroad Retirement, and Veterans benefits There is no Resource test for PAAD 36 IncomeIndividualMarried Percentage of FPL225%205% Yearly$24,432$29,956 Monthly$2,0362,496 Percentage varies between individual& married Did You Know? The application for PAAD also includes information to apply for the Lifeline Utility Credit/ Tenants Lifeline Assistance Program.

37 Revised 02/02/2011 PAAD Application Assistance PAAD can only be applied for with a paper application and require the following documentation to be submitted with the application: Verification of date of birth (birth certificate, Social Security record, baptismal certificate, Railroad Retirement record) 37 Did You Know? The PAAD paper application is located online at: te.nj.us/health/ forms/ap-2.pdf The PAAD paper application is located online at: te.nj.us/health/ forms/ap-2.pdf

38 Revised 02/02/2011 PAAD vs. LIS 38 PAADLIS Income Limit> 200% of FPL150% of FPL Resource LimitNOYES DocumentationYESNO Processing business days10 – 21 business days RX Benefit$5.00 & $7.00$2.50 – $6.50 RX PremiumUp to the regional benchmark for the RX portion of the premium Varies based on LIS level Coverage GapYES Which program is more beneficial for the consumer?

39 Revised 02/02/2011 What is the Pennsylvanias Prescription Assistance? Pennsylvanias Prescription Assistance (PACE) is a State program administered by the Department of Health and Senior Services and provides financial assistance to residents with prescription costs. 39 Did You Know? That PACEPLUS Medicare includes PACE & PACENET PACEPACENET RX Benefit$6.00 & $9.00, potentially lower based on income level $8.00 & $15.00 Premium BenefitCovers the premium if RX plan is a partner plan No premium benefit

40 Revised 02/02/2011 PACE Income Limits Income is the earnings you receive. – Examples are: wages, Social Security income, Railroad Retirement, and Veterans benefits There is no Resource test for PACE 40 IncomeIndividualMarried Percentage of FPL133%120% Yearly$14,500$17,700 Monthly$1,208$1,470 Percentage varies between individual& married Did You Know? That a consumer is not enrolled into a Part D Plan at the time of enrollment in PACE or PACENET the Department of Health and Senior Services may provide recommendati ons.

41 Revised 02/02/2011 PACENET Income Limits Income is the earnings you receive. – Examples are: wages, Social Security income, Railroad Retirement, and Veterans benefits There is no Resource test for PACENET 41 IncomeIndividualMarried Yearly$23,500$31,500 Monthly$1,958$2, % of the FPL in 2010 Did You Know? That a consumer does not have to enroll in Part D to enjoy the benefits of PACE or PACENET; however they will be responsible for a PACE or PACENET monthly deductible of $32.09

42 Revised 02/02/2011 PACE & PACENET Application Assistance PACE & PACENET can be applied for with a paper or online application and require the following documentation to be submitted with the application: Verification of date of birth (birth certificate, Social Security record, baptismal certificate, Railroad Retirement record) 42 Did You Know? The PACE paper application is located online at: ortal/server.pt/ community/pac e___pacenet_a pplications/ The PACE paper application is located online at: ortal/server.pt/ community/pac e___pacenet_a pplications/179 45

43 Revised 02/02/2011 PACE/PACENET Application Assistance PACE/PACENET applications DO NOT require supporting documentation. Applications can be submitted in the following: 1.PACE/PACENET paper application is available at: _pacenet_applications/ _pacenet_applications/ PACE/PACENET online application is located at: _pacenet_applications/ _pacenet_applications/

44 Revised 02/02/2011 PACE & PACENET vs. LIS 44 PACEPACENETLIS Income Limit133% & 120% of FPL 216% of FPL150% of FPL Resource LimitNO YES DocumentationNO Processing10 business days 10 – 21 business days RX Benefit $6.00 & $9.00$8.00 & $15.00$1.00 – $6.30 RX PremiumCovers the premium if RX plan is a partner plan NOVaries based on LIS level Coverage GapYES Which program is more beneficial for the consumer?

45 Revised 02/02/2011 Tennessee Tennessee does not have a state prescription assistance program for Medicare recipients. 45

46 Revised 02/02/2011 Texas Texas does not have a state prescription assistance program for Medicare recipients. 46

47 Revised 02/02/2011 Washington D.C. Washington D.C. does not have a state prescription assistance program for Medicare recipients. Residents of the Washington Metropolitan Area now have access to a FREE discount prescription drug card program. DC Rx Card will provide savings of up to 75% on prescription drugs at over 50,000 pharmacies across the country. More information can be found at 47

48 Revised 02/02/2011 West Virginia West Virginia does not have a state prescription assistance program for Medicare recipients. 48

49 Revised 02/02/2011 Assistance – Is there a Need? Needs Analysis Ask questions about their prescription needs How many medications do you take each month? How much do you spend on your medications each month? Do you not get all your prescriptions filled each month because of the cost? Have you ever applied for state or federal programs that could help lower your prescription costs? Would you like some assistance in applying for these programs to help lower your prescription costs? Listen for keywords that indicate need. 49 Sales Tip When discussing a consumers current coverage, inquire about what they pay for prescriptions, if the costs are lower than the plan benefits they may be on LIS.

50 Revised 02/02/2011 Assistance – Position a Solution Position Acknowledge the consumers needs Mrs. Johnson, I appreciate your sharing your answers with me… Mr. Johnson, thank you for helping me to understand your current situation in regards to prescriptions… I understand your situation, many of my customers face similar conditions… Propose a solution – Ms. Smith, did you know that there is a program called Extra Help that could lower your prescription co-pays? – Mr. Smith, could I tell you about a program that I have helped my other customers in that reduced their prescription co-pays? 50 Sales Tip Prior to assisting a consumer with either LIS or a state pharmaceutical program review the application to ensure it can be completed easily.

51 Revised 02/02/2011 Assistance – Position a Solution cond Position Outline the program Mrs. Frank, Extra Help is a program by the Social Security Administration and it helps beneficiaries lower their prescription costs. Mr. Frank, The Department of Heath and Senior Services has a program called Pharmaceutical Assistance to the Aged and Disabled…. Determine if they qualify Mrs. Adams, would you mind if I ask you a few questions about your finances to see if you qualify? Mr. Adams, is your annual income less than a certain amount? 51 Sales Tip When trying to determine if a consumer meets the program qualifications always ask if they make less than the maximum amount.

52 Revised 02/02/2011 Assistance – Position a Solution cond Position Complete the application Mrs. Washington, in order to complete the application Id like to ask you a few detailed financial questions. Are you comfortable with that? Mr. Washington, once youve answered a few questions we can submit the application to lower your prescription costs. Follow-up Mrs. Jones, you will be receiving a letter in about 14 business days that will indicate if youve been enrolled in the program. When you get that letter will you please call me? Mr. Jones, if you dont mind Id like to give you a call back in two weeks to see if youve been accepted into the program. 52 Sales Tip Request brochures from the Social Security Administration and state departments that outline the programs. The brochures will validate your discussion.

53 Revised 02/02/2011 Assistance Dos Donts DODONT Encourage the consumer to contact the Social Security Administration, or state agency if they have any questions about the LIS or the state programs. Guarantee that by completing the application the consumer will automatically be eligible for the program. Inform the consumer that eligibility is determined by Social Security Administration or a state agency, and not the health plan. Imply that the consumer will receive exemption from the Medicare Part D premium. Inform the consumer that the LIS, or state programs, benefit does not impact their current medical coverage. Imply that enrolling into a Bravo Health plan means the consumer is automatically eligible for the additional prescription benefits. Inform the consumer that in order to use the prescription benefit they must be enrolled a Medicare Advantage Plan or stand alone Prescription Drug Plan. Imply that the prescription benefit is unique to Bravo Health plans. 53

54 Revised 02/02/2011 Question & Answers What questions do you have? 54


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