Low Income Subsidy

1
Low Income Subsidy Enrollment
Assistance Creating Special Election Periods
through the Medicare Part D Low-Income Subsidy
(LIS)
2
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

3
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

4
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 2.50 - 6.50
• Eliminates the Part D late enrollment penalty
• Provides coverage in 2012 Coverage gap is 3,608.

The LIS service is estimated to be worth an
average of 34,000 per year. This is determined
by the Social Security Administration. (source
www.socialsecurity.gov)
5
Income Limits
150 of Poverty level in 2011
Income Individual Married
Yearly 16,335 22,065
Monthly 1,361.25 1,838.75

• Income is the earnings you receive.
• Examples are wages, Social Security income,
  Railroad Retirement, and Veterans benefits

Income limits may vary for Alaska Hawaii.
Additionally income limits may be higher with
additional dependents.
6
Resources Limits
Individual Married
Resources 12,640 25,260

• 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).

7
2012 LIS Overview
8
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.

9
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
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

11
Why an Agent Should Assist?
Agent Assistance
Application Submission Application completed immediately
LIS Award Letter Average Award letter is produced within 10 14 business days
Program Understanding Can ask questions of the agent to understand the benefits
Value Recognition Consumer relates value of assistance with you and Bravo Health
Consumer Experience Consumer has a relationship with agent and feels more comfortable talking about financial situation and any concerns they have
12
LIS Application Assistance

• LIS can be applied for with a paper application.
• GOOD
• LIS can be applied for with an online
  application.
• BETTER
• LIS can be applied for with a telephone
  application.
• BEST

13
LIS Application Assistance

• Apply via the telephone at Social Security
  Administration (SSA)
• SSA at 1-800-772-1213 (TTY 1-800-325-0778)
• Paper forms can be requested at
• SSA at 1-800-772-1213 (TTY 1-800-325-0778)
• Online forms available at
• http//www.ssa.gov/prescriptionhelp/
• Additional information is available at
• http//www.socialsecurity.gov/pubs/10525.html

14
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

15
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

16
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.

17
SenioRX Income Limits
Income Individual Married
Yearly 21,660 29,140
Monthly 1,800 2,482

• Income is the earnings you receive.
• Examples are wages, Social Security income,
  Railroad Retirement, and Veterans benefits
• There is no Resource test for SenioRX.

18
SenioRX Application Assistance

• Contact 1-800-AGE-LINE (243-5463) 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

19
SenioRX vs. LIS
SenioRX LIS
Income Limit 200 of FPL 150 of FPL
Resource Limit NO YES
Documentation YES NO
Processing 7 business days 10 21 business days
RX Benefit No set benefit. Application assistance with pharmaceutical manufacturers drug programs 2.50 6.50
RX Premium NO Varies based on LIS level
Coverage Gap NO YES
Which program is more beneficial for the consumer?
20
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

21
DPAP Income Limits
200 of Poverty level in 2011
Income Individual Married
Yearly 21,780 n/a
Monthly 1,815 n/a

• 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

Income limits may vary for Alaska Hawaii.
Additionally income limits may be higher with
additional dependents.
22
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 1-800-996-9969, Option 2,
  then Option 1 to reach a representative.

23
DPAP vs. LIS
DPAP LIS
Income Limit 200 of FPL 150 of FPL
Resource Limit NO YES
Documentation YES NO
Processing 7 business days 10 21 business days
RX Benefit 5.00 or 25 2.50 6.50
RX Premium NO Varies based on LIS level
Coverage Gap YES YES
Which program is more beneficial for the consumer?
24
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 http//www.floridadiscountdrugcard.com/pd
  fs/AboutFactSheet.pdf

25
Georgia

• Georgia does not have a state prescription
  assistance program for Medicare recipients.

26
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.

27
Care RX Income Limits
Income Individual Married
Yearly 21,780 36,635
Monthly 1,815 3,052

• 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.

28
Care RX Application Assistance

• Care RX can be applied for at https//cbrx1.aging
  .illinois.gov/app/cbci/
• Paper applications can be obtained by
• http//www.state.il.us/aging/1rx/cbrx/forms/il1363
  .pdf
• Calling the Senior Help Line at 1-800-252-8966
• Calling the Senior Health Insurance Program at
  1-800-548-9034.

29
Care RX vs. LIS
SPDAP LIS
Income Limit of FPL 150 of FPL
Resource Limit NO YES
Documentation YES NO
Processing Online Application 6 Weeks Paper Application 4 months 10 21 business days
RX Benefit 2.50 - 15.00 2.50 6.50
RX Premium - Varies based on LIS level
Coverage Gap YES YES
Which program is more beneficial for the consumer?
30
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

31
SPDAP Income Limits
300 of Poverty level in 2011
Income Individual Married
Yearly 32,670 44,130
Monthly 2,722.50 3,677.50

• 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

32
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

33
SPDAP vs. LIS
SPDAP LIS
Income Limit 300 of FPL 150 of FPL
Resource Limit NO YES
Documentation YES NO
Processing 10 business days 10 21 business days
RX Benefit 95 during the Coverage Gap 2.50 6.50
RX Premium Up to 35 for partner plans Varies based on LIS level
Coverage Gap YES YES
Which program is more beneficial for the consumer?
34
Mississippi

• Mississippi does not have a state prescription
  assistance program for Medicare recipients.

35
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.

36
PAAD Income Limits
Percentage varies between individual married
Income Individual Married
Percentage of FPL 225 205
Yearly 24,432 29,956
Monthly 2,036 2,496

• Income is the earnings you receive.
• Examples are wages, Social Security income,
  Railroad Retirement, and Veterans benefits
• There is no Resource test for PAAD

37
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)

38
PAAD vs. LIS
PAAD LIS
Income Limit gt 200 of FPL 150 of FPL
Resource Limit NO YES
Documentation YES NO
Processing 10 - 14 business days 10 21 business days
RX Benefit 5.00 7.00 2.50 6.50
RX Premium Up to the regional benchmark for the RX portion of the premium Varies based on LIS level
Coverage Gap YES YES
Which program is more beneficial for the consumer?
39
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.

PACE PACENET
RX Benefit 6.00 9.00, potentially lower based on income level 8.00 15.00
Premium Benefit Covers the premium if RX plan is a partner plan No premium benefit
40
PACE Income Limits
Percentage varies between individual married
Income Individual Married
Percentage of FPL 133 120
Yearly 14,500 17,700
Monthly 1,208 1,470

• Income is the earnings you receive.
• Examples are wages, Social Security income,
  Railroad Retirement, and Veterans benefits
• There is no Resource test for PACE

41
PACENET Income Limits
216 of the FPL in 2010
Income Individual Married
Yearly 23,500 31,500
Monthly 1,958 2,625

• Income is the earnings you receive.
• Examples are wages, Social Security income,
  Railroad Retirement, and Veterans benefits
• There is no Resource test for PACENET

42
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)

43
PACE/PACENET Application Assistance

• PACE/PACENET applications DO NOT require
  supporting documentation. Applications can be
  submitted in the following
• PACE/PACENET paper application is available at
  http//pa.gov/portal/server.pt/community/pace___pa
  cenet_applications/17945
• PACE/PACENET online application is located at
  http//pa.gov/portal/server.pt/community/pace___pa
  cenet_applications/17945

44
PACE PACENET vs. LIS
PACE PACENET LIS
Income Limit 133 120 of FPL 216 of FPL 150 of FPL
Resource Limit NO NO YES
Documentation NO NO NO
Processing 10 business days 10 business days 10 21 business days
RX Benefit 6.00 9.00 8.00 15.00 1.00 6.30
RX Premium Covers the premium if RX plan is a partner plan NO Varies based on LIS level
Coverage Gap YES YES YES
Which program is more beneficial for the consumer?
45
Tennessee

• Tennessee does not have a state prescription
  assistance program for Medicare recipients.

46
Texas

• Texas does not have a state prescription
  assistance program for Medicare recipients.

47
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 http//dcrxcard.com

48
West Virginia

• West Virginia does not have a state prescription
  assistance program for Medicare recipients.

49
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.

50
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?

51
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?

52
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.

53
Assistance Dos Donts
DO DONT
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.
54
Question Answers

• What questions do you have?