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SEP Opportunities. Learning Objectives. At the end of this training you will be able to : Identify SEP opportunities Explain why we should assist with LIS Define Low Income Subsidy (LIS) qualifications Educate consumers on assistance available to
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Learning Objectives • At the end of this training you will be able to : • Identify SEP opportunities • Explain why we should assist with LIS • Define Low Income Subsidy (LIS) qualifications • Educate consumers on assistance available to • Guide consumers on how to complete the LIS application
Why should you assist with LIS? • Consumers enrolled into LIS have a continuous • Special Election Period (SEP) • that can be used to enroll consumer during Lock-In
What is the LIS Program? • Program for Medicare consumers who have limited income & resources • • Helps pay* for prescription drug costs: • – Monthly premium • – Yearly deductible • – Prescription coinsurance and copayments • – Assistance to cover Rx drugs for little or no cost ($1.10 - $6.30) • • Provides coverage in the gap • 2011 Coverage gap is $ ??? • * The LIS service is estimated to be worth an average of $3,900 per year. This is determined by the Social Security Administration. (source: www.socialsecurity.gov)
Income • Income is the earnings you receive. • Examples are: wages, social security income, support from other family members • 150% of Poverty level in 2010* 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. *Income limits may vary for Alaska & Hawaii. Additionally income limits may be higher with additional dependents.
Resources • Resources are the value of things you own • Examples are: Real estate, bank accounts, cash, stocks, bonds, mutual funds, • Individual Retirement Accounts (IRAs) • DOES NOT include the home consumer lives in, vehicles, personal possessions, burial plots, • irrevocable burial contracts or back payments from Social Security or Supplemental Security • Income (SSI). • 150% of Federal Poverty Level 2010
Who Qualifies for LIS? • Enrolled in a prescription drug plan • and • Have Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance) • and • Live in one of the 50 states or the District of Columbia • and • Monthly income is less than 150% of the Federal Poverty Level (FPL) • $16,245 if single or not living with spouse • $21,855 if married and living with spouse • and • Combined savings, investments, and real estate* are not worth more than: • $12,510 if single or not living with spouse. • $25,010 if married and living with spouse • Note: Consumers who are enrolled into Medicare Part D Low Income Subsidy (LIS) can enroll during Lock-In.
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 • Has income less than 150% of the Federal Poverty Level (FPL) applicable to the consumer’s family size • Supplemental Security Income (SSI) recipients with Medicare • Federal income supplement program • Designed to help aged, blind disabled people who have little or no income • Medicare Savings Program participants • 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
Knowledge Check • Should Kenny apply for LIS benefits? • Single • Life Insurance worth $1000 • Resources of $10,900 • Total yearly income of $16,240 • Answer: Yes • Total resources are below $12,510 • Total income is below $16,245
Knowledge Check • Should Fred and Ginger apply for LIS? • Married and live together • Life insurance worth $2500 • Resources of $24,000 • Total yearly income of $21,000 • Answer: Yes • Total resources are below $25,010 • Total income below $21,855
Knowledge Check • Should Fred and Wilma apply for LIS? • Married and living together • Son pays $2400/month in rent for couple • Resources of $23,000 • Total yearly income of $20,900 • Answer: Yes • Total resources are below $25,010 • Total income below $21,855
LIS Consumer Profile • Low income • • Enrolled in Prescription Drug program • • Have Medicare Part A (Hospital Insurance) • and/or Medicare Part B (Medical Insurance) • • Financial worries
LIS Application Assistance • Apply through Social Security Administration (SSA): • • Complete and submit the application • • Application is reviewed by SSA • • Letter will notify if qualified for LIS • Paper forms or help obtained from: • • SSA at 1-800-772-1213 (TTY 1-800-325-0778) • Online forms available at: • • http://www.ssa.gov/prescriptionhelp/ • Help with other Medicare costs may also be available from the state • under the Medicare Savings Programs: • • 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 (unless you indicate not to on the LIS application)
What info is needed to complete application? • Documents that may help complete application and determine • qualification: • • 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
What are some tips for completing Application? • To avoid delays in processing your 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 • Don’t 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
Burial Expenses (Section 5)Real Estate (Section 6)Relatives Supported (Section 7)
LIS Election Application • Remember the electronic LIS application does not require a signature
Bravo Select (Central PA) • Members must have full PA state Medicaid for maximum benefits • $0 Monthly Premium • $0 co-pay for most covered medical services • $1.10/$3.30 co-pay for Rx • $0 co-pay for preventive dental • $800/year allowance for comprehensive dental • Bravo Care Pack - $52 monthly allowance • Forever Fit gym membership benefit
Bravo Achieve – PA • Diabetic SNP • $0 monthly premium • $0 PCP co-pay • $5 co-pay for preferred generic diabetic drugs • No coverage gap for diabetic drugs • $0 co-pay for diabetic supplies
Bravo Web Tools • E-agent (https:\\broker.bravohealth.com) • Track application submissions • Download CMS approved literature • My Bravo Store (www.mybravostore.com) • Order customized cards • Create customized mailers
Q & A • What questions do you have?
