LIS

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Welcome
LIS LIR SEP Training 2011
Low Income Subsidy Low Income Resources
Special Enrollment Period Training 2011
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Do you enjoy working in the Medicare Advantage
marketplace?
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Do you want to sell Medicare Advantage year round?
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If your answer was YES, then this is the right
opportunity for you!

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Training Goals

• Identify Individuals who qualify for a Special
  Election Period Enabling them to enroll in a
  Medicare Approved health plan outside of the
  annual Open Enrollment Period.
• Determination of which programs to enroll these
  qualified people in
• Electronic application process to avoid decrease
  in comp due to paper application

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Important Note

• This presentation and PowerPoint is an overview
  of the process only.
• Please see the Agent Training and Resource manual
  for complete information

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Who Qualifies For A SEP?

• SEP Special Election Period
• Anyone that has recently moved into a service
  area and their current plan is no longer
  available.
• Qualification or Disqualification for LIS, Low
  Income Subsidy and or LIR, Low Income Resources.

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Who Qualifies For an SEP?

• Someone who moves into or out of a institution,
  such as an assisted living home.
• Qualification or Disqualification for a SPAP
  (State Pharmacy Assistance Program).
• Note These are only a few of the examples of
  SEP Qualification. See LIS Training and Resource
  Manual for complete listing

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When is an SEP Created?

• An SEP is created anytime there is a
  qualifying event outside the Annual Open
  Enrollment Period.

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What Is LIS?

• LIS Low Income Subsidy
• This assistance helps eligible people with their
  Medicare prescription drug costs, including
  premiums, deductibles, and coinsurance costs.

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Who Should Apply?

• People with Medicare who have limited incomes
  should apply. People with both Medicare and
  Medicaid will automatically be eligible and do
  not need to apply as CMS considers these
  individuals automatically deemed LIS eligible.

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How to help your client apply for LIS?

• People should apply through the Social Security
  Administration (SSA) using SSA - 1020 paper
  application or at SSAs website WWW.SSA.GOV.
• A fillable PDF version of the application is in
  the resource section of the training manual.
  Photocopies of applications are not permitted

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How Is LIS Eligibility Determined?

• SSA will determine eligibility based on a
  persons income, assets and family size. There
  are three levels of assistance based on a
  persons income and assets.

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How Does SSA Define Income?

• Income includes the income of the person
  applying, their spouse and any other family
  member living in the household. Some examples of
  income that is counted are
• Benefits such as social security benefits,
  railroad retirement
• Earnings
• Money from investments and pensions and
• Rental income.

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How Does SSA Define Assets?

• Assets include
• Liquid assets (Those that can be converted to
  cash within 20 days)
• Real estate, excluding the applicants primary
  residence
• Cash and savings accounts.

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What Are Eligibility Requirements And Benefits?

• The first group is for those individuals who
  receive Medicaid (help through the state) and
  whose income is at or below 100 of Federal
  Poverty Level (FPL, See page 52 of Training
  Manual for FPL limits).
• People in this group are known as QMB
  (Qualified Medicare Beneficiary)
• This eligible group
• Does not pay a premium or deductible,
• Does pay 1.10 for generic drugs and 3.30 for
  name brand drugs
• Note People in this group do not need to apply
  for the assistance. They are already deemed
  eligible.

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What Are Eligibility Requirements And Benefits?

• The second group is for people whose income is
  between 100 and 135 FPL and whose assets are
  below 6,680 for an individual and 10,020 for a
  married couple or people with Medicaid with
  incomes above 100 of FPL. People in this group
  are known as QI (Qualified Individuals) SLMB
  (Specified Low-Income Medicare Beneficiary
  Program).
• This eligible group
• Does Not pay a premium or deductible,
• Does pay 2.50 for generic drugs and 6.30 for
  name brand drugs.

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What Are Eligibility Requirements And Benefits?

• The third group includes households with
  incomes between 135 FPL and 150 FPL, with
  assets at or below 8,180 12,640 for an
  individual and 13,020 - 25,260 for a married
  couple. This group can be either Full or Partial
  LIS pays
• A sliding scale premium based on income (Partial
  LIS)
• A 63.00 annual deductible ( Partial LIS)
• 15 of all other drug costs up to 4,550 (Partial
  LIS)
• 2.50 for generic drugs and 6.30 for name brand
  drugs after reaching the 4,550 (Partial LIS)
• Note IF 135 FPL which is Full LIS, Then NO
  deductible and member pays 2.50 generic and
  6.30 brand

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What Is LIR?

• Low Income Resources or LIR is commonly
  referred to as Medicaid.
• Medicaid is designed for individuals who have
  among other eligibility qualifications, LIR.
• Most people think Medicaid is only for those
  who have limited resources however, this is not
  true.
• Many groups of people are covered by
  Medicaid. Even within these groups, though,
  certain requirements must be met. These may
  include your age, whether you are pregnant,
  disabled, blind your income and resources (like
  bank accounts, real property, or other items that
  can be sold for cash) and whether you are a U.S.
  citizen or a lawfully admitted immigrant.

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What Are Eligibility Requirements And Benefits?

• The first level of assistance for LIR is
  known as full subsidy or QMB and receives Payment
  of Medicare Part A monthly premiums (when
  applicable).
• This eligible group
• Does Not Pay Medicare Part B monthly premiums
  and annual deductible.
• Does Not Pay co-insurance and deductible amounts
  for services covered under both Medicare Parts A
  and B.
• Receives reduction in Medicare Part D
  prescription drug copayments on Tier 1, Tier 2,
  Tier 3 and specialty drugs. Regardless of Tier
  the QMB pays 1.10 generics and 3.30 brand

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What Are Eligibility Requirements And Benefits?

• The second level of LIR assistance is known
  as a partial subsidy or SLMB (Specified
  Low-Income Medicare Beneficiary Program).
• This eligible group
• Does Not Pay of the Medicare monthly Part B
  premium
• Receives 100 of the monthly Medicare Part D
  premium up to the premium subsidy amount through
  LIS benefits. CMS and SSA consider every SLMB
  deemed eligible for LIS and are automatically
  enrolled in LIS.
• Receives reduction in Medicare Part D
  prescription drug copayments on Tier 1, Tier 2,
  Tier 3 and specialty drugs. Regardless of Tier
  the SLMB pays 2.50 generics and 6.30 brand

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What Are Eligibility Requirements And Benefits?

• The third level of LIR assistance is known as
  QI (Qualified Individual Program) - Limited
  Expansion of SLMB Program.
• The QI program provides the following
  benefits
• A portion of the Medicare monthly Part B premium
  is covered, this amount varies by client and
  benefit level.
• 100 of the monthly Medicare Part D premium up to
  the premium subsidy amount through LIS benefits.
  CMS and SSA consider every QI deemed eligible
  for LIS and are automatically enrolled in LIS.
• Reduction in Medicare Part D prescription drug
  copayments on Tier 1, Tier 2, Tier 3 and
  specialty drugs. Regardless of Tier the QI pays
  2.50 generics and 6.30 brand

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What Plan Do I Enroll My Client In?

• QMB Full Subsidy In order to ensure 100
  Coordination of benefits, all full dual eligible
  individuals should be enrolled in a plan that
  caters to this particular market such as the UHC
  Evercare Plan DH SNP.
• In the event you enroll a dual eligible
  individual into a traditional or standard
  Medicare approved health plan you WILL run into
  coordination issues as well as leaving the member
  responsible for certain copays and or coinsurance
  amounts.
• QMB beneficiaries should never be enrolled in
  a plan that is not specifically designed to
  coordinate benefits with Medicaid.

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What Plan Do I Enroll My Client In?

• SLMB QI Partial Subsidy While both of
  these individuals enjoy some level assistance
  they do not qualify for full subsidy.
• As discussed earlier these individuals
  receive all or a portion of their Medicare Part B
  premium and assistance on their Part D
  premium.Since neither of these levels of
  benefits includes assistance with healthcare
  needs you would do a disservice to the client if
  you placed them on a Dual Eligible plan.
  (Typically Dual Eligible plans mimic traditional
  Medicare while enhancing services like
  preventative care, number of doctor visits and
  transportation.)
• SLMB and QIs should be placed on regular
  Medicare Approved Health Plans such as the AARP
  Medicare Complete by Secure Horizons.

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What Plan Do I Enroll My Client In?

• These plans will coordinate with the level
  of benefits and assistance your client receives
  while allowing the member to experience more
  robust formularies, reduced drug cost, affordable
  and predictable copays, no deductibles and most
  importantly an out-of-pocket max that traditional
  Medicare does not have.
• The only exception to this rule is if your
  client qualifies for a SNP (Special Needs Plan)
  that specializes in specific conditions like
  COPD, Heart trouble and or Diabetes, some plans
  put more than one condition in an SNP.
• In the event they qualify for such a plan we
  would recommend using a plan like Care
  Improvement Plus also known as CIP.

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What Plan Do I Enroll My Client In?

• Low Income Subsidy
• Typically your best option for this group of
  beneficiaries is to use a traditional Medicare
  Approved Health Plan such as AARP Medicare
  Complete by Secure Horizons. If the client
  qualifies another alternative would be a
  specialized SNP such as CIP.
• Someone who receives LIS only regardless of
  benefit level should never be placed on a Dual
  Eligible plan.

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Enrollment Form Completion

• Applications are available from each carrier.
• They may be paper or fillable PDF
• Please use only black or blue ink to complete
  enrollment application
• Please print using block letters only
• Make sure all areas have been completed
• Even if the information box does not apply please
  put N/A in the box
• Ensure mailing address and physical address are
  completed if different.

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Enrollment Form Completion

• Double check Medicare Claim number which should
  normally have a letter as last character.
• Complete Medicare A B effective dates
• For SEP reason and correct code please see pg.
  130 in the resource manual
• Please remember if the application is illegible
  and the processors cannot accurately determine
  information, the enrollment may not be processed
  and may delay compensation.
• Please slow down and fill the application out
  carefully and accurately.

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LIR Verification Call

• UHC / Secure Horizons requires a new
  verification process to ensure your client is
  Medicaid eligible for all plan sales on their
  Evercare DH plan.
• Agent must call at time of enrollment
• Call The Producer Help Desk at 888-381-8581
• Your client must be present and able to get on
  the phone
• Hours Monday Friday from 7AM 7PM CST
• See page 126 of the resource manual for more
  details

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New Business Submission Non Electronic

• If you do not submit your business
  electronically UHC/Secure Horizons may reduce
  your compensation.
• Please follow the below steps to submit paper
  applications which will be converted to an
  electronic enrollment for you at no additional
  charge.

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New Business Submission Non Electronic

• Be sure that the client has signed the
  application and that it is dated
• Fax application daily to 336-474-8945 for
  processing. Please fax them individually with a
  cover sheet indicating the agent name, client
  name and number of pages. You do not need to mail
  the original application if you fax them.
• IF YOU CAN NOT FAX APPLICATIONS CAN BE MAILED TO
  THE ASSURANCE GROUP, 5035 PROSPECT ST, ARCHDALE,
  NC 27263.
• IF YOU MAIL APPLICATIONS WE MUST RECEIVE THEM
  WITHIN 48 HOURS OF THE SIGNATURE DATE. DO NOT
  HOLD APPLICATIONS UNTIL THE END OF THE WEEK TO
  TURN IN.

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More Questions??

• If have additional questions or are just unsure
  of the proper process please email
• Rob Casey
• Chief Compliance Officer
• rgcasey_at_assuregrp.com

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.
LIS Enrollment Lead Program
TAG has a relationship with Leads 2 Success,
one of the largest lead generation companies in
the nation. By virtue of your being contracted
you are eligible for the LIS Enrollment Lead
Program! Please note this program may change or
terminate at any time.
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Leads 2 Success A Division Of the Assurance
Group
Printing Mailing Area
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Does this look like you?
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Leads

• The Assurance Group and Leads2Success have
  developed a carrier approved lead piece that is
  sure to make your sales skyrocket.

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Direct Mail Leads Designed Especially For LIS
Enrollment Opportunities
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Jump Start Lead Program

• 325 per 1000 mailed, 1st 2000 Pieces will be
  only 315 for 1st time orders only
• This limited time price is an unbelievable
  Value this is 35 off our everyday price of
  500.00 per 1000 . Best of all there is only a
  1000 piece minimum order!

• 5 day turnaround from completed order to drop.

• Leads delivered to you via paper or
  electronically.

Please see your Upline for ordering details
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Closing Thought

• To be winners and leaders we must be Agents
  of Change. If we are willing to learn and grow,
  together we can accomplish anything.

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Good Luck!

• Thank You For Taking The Time To Complete The
  Online Portion of the LIS Training.
• Please Be Sure to Read The Training Manual.
  It Is Full Of Useful Tools, Resources, Tips and
  Tricks.
• If you have further questions please contact
  your upline for more detailed support.