Low Income Subsidy / Extra Help and Enrollment Assistance

Transcription

1 Low Income Subsidy / Extra Help and Enrollment Assistance

2 Objectives After actively participating in this session, agents will: Identify the value of assisting LISeligible consumers. Identify features and benefits of the Low Income Subsidy (LIS) program. Recognize general criteria that may qualify consumers for LIS. Assist consumers in seeking candidacy for LIS. Use bconnected to track consumers LIS enrollment (if applicable). 4

3 LOW INCOME SUBSIDY / EXTRA HELP Introduction 5

4 Terminology Low Income Subsidy LIS Extra Help 6

5 What is LIS / Extra Help? A federal subsidy program that helps low-income Medicare-eligible consumers save money on their prescription costs. 7

6 Plan Enrollment Opportunities SEP LIS LIS-qualified? consumers have a continuous election period and can change their plan at any time! 8

7 ROLES Program Administration and Consumer Assistance 9

8 Who administers the program?? LIS Program 10

9 Who administers the program? Social Security Administration (SSA) LIS Program 11

10 Consumer Considerations SSA LIS Program The SSA decides who qualifies The SSA determines the benefit level The SSA processes LIS applications 12

11 Who administers the program? SSA LIS Program Who qualifies Benefit level LIS applications 13

12 Your Sales Role Help consumers understand how the LIS program may work for them. Assist consumers in completing their LIS application. Consider that consumers may have unique plan needs based on their limited income and resources. Explain that a change in the consumer s status may change their eligibility for LIS. 14

13 LIS PROGRAM Features and Benefits 15

14 Program Benefits Medicare Part D plan premium Annual deductible Prescription coinsurance and copayments Assistance to cover prescription costs Coverage in the gap Assistance with Medicare Part D Late Enrollment Penalty costs Benefit levels vary by consumer, as determined by the SSA. 16

15 Program Benefits Medicare Part D plan premium Annual deductible $ How does the subsidy help cover a consumer s plan premium and/or deductible? 17

16 Program Benefits Prescription coinsurance and copayments Assistance to cover prescription costs Coverage in the gap What prescription cost savings may apply for an eligible consumer? 18

17 Program Benefits How does LIS eligibility impact the Late Enrollment Penalty? Assistance with Medicare Part D Late Enrollment Penalty costs 19

18 LIS Qualifications 20

19 Qualifications Medicare consumers who are or will be enrolled in a Medicare Part D plan Based on the consumer s income and resources U.S. resident (includes 50 states and District of Columbia) 21

20 Automatic Qualification Full Benefit Dual Eligibles (i.e. Medicare and full Medicaid coverage) Supplemental Security Income (SSI) Recipients with Medicare Medicare Savings Programs Participants 22

21 Requalification What actions do automatically-qualified consumers need to take? No action required for consumers who receive the purple letter LIS reapplication required for consumers who lose their Medicaid status Social Service Coordinators (SSC) will contact identified consumers Medicare Savings Program (MSP)-eligible consumers must reapply for their state MSP annually 23

22 Qualification Wages Social Security Income Income Annuities (as income) Support from other family members & Resources Real estate Bank accounts Cash Stocks and bonds Mutual funds Annuities (as investments) Individual Retirement Accounts (IRAs) 24

23 Qualification Levels Income Levels 150% of Federal Poverty Level (2012)* Individual Married Yearly Gross Income $16,755 $22,695 Monthly Gross Income $1, $1, *Income limits may vary for Alaska & Hawaii. Additionally income limits may be higher with additional dependents. Resource Levels 150% of Federal Poverty Level (2012) Individual Married Resources $13,070 $26,120 25

24 Qualification Levels Income Levels 150% of Federal Poverty Level (2012)* Individual Married Yearly Gross Income $16,755 $22,695 Monthly Gross Income $1, $1, *Income limits may vary for Alaska & Hawaii. Additionally income limits may be higher with additional dependents. Resource Levels 150% of Federal Poverty Level (2012) Individual Married Resources $13,070 $26,120 Consumers Mary and Bob Annual income of $21,400 Total resources of $26,800 Marginally exceed limits; submit application in case other circumstances. 26

25 Qualification Levels Income Levels 150% of Federal Poverty Level (2012)* Individual Married Yearly Gross Income $16,755 $22,695 Monthly Gross Income $1, $1, (Within $20) Resource Levels 150% of Federal Poverty Level (2012) Individual Married Resources $13,070 $26,120 Consumer Ellen Monthly gross income of $1,400 Total resources of $12,000 Yes Submit the application. 27

26 Scenario Assist Carlos in understanding his potential eligibility for Extra Help 28

27 Scenario Income Wages Social Security Income Annuities (as income) $1,000 monthly Support from other family members Support for household expenses $200 monthly $200 monthly Total Income: $1,200 Individual Limit Monthly Gross Income $1,

28 Scenario Income Wages Social Security Income Annuities (as income) Support from other family members Support for household expenses $1,000 monthly Total Income: $1,200 Individual Limit Monthly Gross Income $200 monthly $200 monthly $1, Resources Real estate $5,000 Bank accounts $400 Cash $100 Stocks and bonds $2,000 Mutual funds Annuities (as investments) IRAs $5,000 Home value $120,000 Vehicle $500 Personal property $2,000 Life insurance $2,500 Total Resources: $12,500 Individual Limit Resources $13,070 30

29 Resources Where can you find the current LIS qualification levels? Agent Resource Portal (site names may vary) SSA website UHCMedicareSolutions.com website medicare-education/cost-of-healthinsurance/prescription-drug-costs.html 31

30 SALES CONVERSATION Determining Needs for LIS Consumers 32

31 Conversation Triggers What might a consumer say to indicate they may be a candidate for LIS? 33

32 Recognizing Financial Concerns Social Security constituted 90% or more of the income received by 35% of all Social Security beneficiaries Seniors average $4,605 in out-of-pocket expenses, an increase of 57% since Seniors spend an average of 12.5% of their income on healthcare, more than twice spent by all consumers (5.9%) Seniors living alone were much more likely to be poor (17.1%) than those living with family The highest poverty rates were experienced by Hispanic women (43.1%) and African American women (34.7%) About 3.7 million seniors (9.7%) were below the poverty level in 2008: 7.6% are Caucasians 20% are African-Americans 11.1% are Asians 19.3% are Hispanics Older women have a higher poverty rate than older men Higher than average poverty rates were found in seniors who lived in principal cities (12.6%), outside metropolitan areas (11.2%), and in the South (11.2%) Another 2.4 million seniors are classified as near poor with incomes between the Federal Poverty Level (FPL) and 125% of the FPL * A Profile of Older Americans: 2009 Administration on Aging U.S. Department of Health and Human Services 34

33 Mentioning Extra Help How do you mention Extra Help as a possible option for appropriate consumers? 35

34 Already-Eligible Consumers What do you do if the consumer has already qualified for LIS assistance? 36

35 Need Dialogue What should you cover in the Need Dialogue for LIS candidates? 37

36 Plan Options What should you consider in determining and positioning a plan for consumers who may be eligible for LIS? 38

37 ASSISTING THE CONSUMER The LIS Application 39

38 Application Assistance Methods Agent Assist SSC Assist Preferred option! 40

39 AGENT ASSIST The LIS Application 41

40 Accessing the LIS Application Apply through the Social Security Administration (SSA): Complete and submit the application Application is reviewed by SSA Letter will notify the consumer if qualified Paper Form / SSA Assistance: SSA at (TTY ) Online Form: prescriptionhelp/ 42

41 Medicare Savings Program Application Submitting the LIS application starts the application process for the Medicare Savings Program in the consumer s state, when available. 43

42 Information for the LIS Application Government-based Information: Social Security card Letters from Medicare Most recent Social Security benefits award letters Railroad retirement benefits Veteran benefits Personal Financial Information: Tax returns Payroll slips Bank account statements: checking, savings, certificates of deposit Investment information: IRAs, stocks, bonds, savings bond, mutual fund, other investment statements Pensions Annuities 44

43 Application Tips To help avoid delays in application processing, follow these tips: Use the original paper form or apply online Enter consumer s name and number exactly as it appears on official documents The consumer s Social Security or Railroad Retirement Board number must be included Do not mark off both the Yes and No boxes in any section Paper Applications Only: Use black ink Return the entire application package Do not send other items such as physician bills, prescription lists, Internal Revenue Service forms, etc. 45

44 Application Details Paper 1. Contact Information

45 Application Details Paper 2. Spouse Information

46 Application Details Paper 3. Income

47 Application Details Paper 4. Resources

48 Application Details Paper Burial Expenses, Real Estate, Relatives Supported

49 Application Details Paper Other Income

50 Application Details Paper Wages

51 Application Details Paper 15. Medicare Savings Program

52 Application Details Signatures Note: The electronic Extra Help application does not require a consumer s signature

53 LIS Award Letter The SSA will send a notice of approval / denial to the consumer. For electronic applications, the notice will be sent in business days. For paper applications, the notice will be sent in business days

54 TRACKING - AGENT bconnected 56

55 bconnected Agent Assist Contact Screen Select Edit Contact

56 bconnected Agent Assist Contact Screen In the SSC Consent Received field, select YES In the LIS Application Field, select Agent Assist

57 bconnected Agent Assist Contact Screen Select Save Contact Schedule Callback for business days for electronic LIS applications or business days for paper LIS applications

58 TRACKING - SSC bconnected 60

59 bconnected SSC Assist Contact Screen: Select Edit Contact

60 bconnected SSC Assist Contact Screen: In the SSC Consent Received field, select Yes. In the LIS Application Field, select Submit to SSC

61 bconnected SSC Assist Contact Screen: Select Save Contact. Schedule Callback for business days for electronic LIS applications

62 bconnected SSC Assist Contact Screen: Verify LIS status LIS Status Submitted Not Qualified/Income Not Qualified/Assets Not Interested No Answer Do Not Call SSC submitted LIS application to SSA Consumer exceeded LIS income requirements Consumer exceeded LIS asset requirements Consumer not interested in receiving help from SSC SSC is not able to contact with consumer (6 attempts were made) Consumer does not want SSC to contact them

63 WRAP-UP 65

64 Objectives Identify the value of assisting LISeligible consumers. Identify features and benefits of the Low Income Subsidy (LIS) program. Recognize general criteria that may qualify consumers for LIS. Assist consumers in seeking candidacy for LIS. Use bconnected to track consumers LIS enrollment (if applicable). 66

65 Questions? 67