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LIS (Extra Help)

 

     LIS

 

What is the Medicare Low-Income Subsidy?

Eligible beneficiaries, who have limited income, may qualify for a government program that helps pay for

 

     Medicare Part D prescription drug costs.

 

LIS only helps clients with Pard D costs,  NOT  Medicare Cost Sharing or Part A or B premium.

If the client is eligible for LIS – it does not mean that he is ALSO eligible for Medicaid!  LIS and Medicaid are 2 separate and

unrelated assistance programs. 

-LIS is through Social Security and Medicaid is through individual states. 

-If a client Has Some Medicaid Level – he will definitely have LIS.

-Not the same the other way around- a client can be eligible for LIS and not be eligible for Medicaid

It will show you if somebody is JUST LIS or Dual Eligible or Not Enrolled into LIS program. Also, by asking how much the client

pays for Rx, you can get an idea

of LIS status (if $1.25 or $3.75 or any other amount that’s not an even number)- that would usually indicate some LIS status.

If the client does not qualify for LIS then you need to explain how part D works and explain PART D Late Enrollment Penalty if one

applies:

 

     Part D costs  

     Part D LEP Calculator

Since there are different LIS levels (based on income), sometimes the client will get enrolled into the wrong LIS level. You can fix

it by having a client call LIS

program directly Or call the Insurance company that is providing Part D or MAPD for the client.

LIS is governed by the same rules, no matter what state the client lives in. MEDICAID varies widely between different states.

If the client is ONLY eligible for the LIS, then you can enroll him into any MAPD plan. The only exception is – they ARE NOT eligible

for the Dual SNP plan because

it requires some level of Medicaid.

Since LIS will cover MAPD cost up to the individual state’s limit, but NOT any of the Medical cost-sharing – on average, client can

benefit from the enrollment

into an MAPD plan – since his cost for Emergencies, Hospital, Doctor visits will be much more manageable and he will get Max out

Of Pocket (not available under the original Medicare). Also with some plans- dental, vision, etc.

LIS will cover Part D AND MAPD  premium up to certain limit:

 

     How much premium LIS covers 

 

  (varies from state to state). 

LIS will lower the cost of prescription drugs:

 

     LIS Rx drugs copays

 

LIS Gives you: 

 

 

     Special Enrollment Period (SEP)

 

once per calendar quarter during the first nine months of the year to enroll in a Part D/MAPD  plan or to switch between plans. Same

as Full or Partial Dual

SEP  (You cannot use the Extra Help SEP during the fourth calendar quarter of the year (October through December).

You should use 

 

      AEP 

 

 

 during this time to make Prescription drugs coverage changes).  NO SEP Full Dual/Partial Dual in the last quarter. Everyone needs

to use AEP election period,

unless special circumstances apply: SEP Move, SEP Loss Of Employer Group Plan, etc.

Medicare beneficiaries receiving the low-income subsidy (LIS) get assistance in paying for their

• Part D monthly premium

• annual deductible

• coinsurance

• copayments.

Also, individuals enrolled in the Extra Help program do not have a gap in prescription drug coverage, also known as the coverage

gap, or the

 

 

      Medicare “dougnut hole” (Coverage Gap)

 

The amount of subsidy depends on the individual’s income compared to the Federal Poverty Level and resource limitations set by

the Social Security Act. 

 

     LIS  Guidelines

 

LIS will pay Part D late enrollment Penalties for delayed enrollment into Part D:

 

     Part D LEP

 

If you are enrolled in Medicaid, Supplemental Security Income (SSI), or a Medicare Savings Program (MSP), you 

 

 

      Automatically qualify for Extra Help 

 

regardless of whether you meet Extra Help’s eligibility requirements. You should receive a purple-colored notice from the Centers

for Medicare & Medicaid

Services (CMS) informing you that you do not need to:

     Apply for Extra Help

 

 

APPLY for LIS online:

 

 

     LIS Application

 

Remember that Extra Help is not a replacement for Part D or a plan on its own: You must still have a Part D plan to receive

Medicare prescription drug coverage

and Extra Help assistance. If you do not choose a plan, you will in most cases be automatically enrolled in one.

LIS will apply to any part D or MAPD plan client chooses to be in. So, by switching a client to MAPD, the client will pay the same

copays for Rx as before.

 

Medicare Extra Help eligibility

 

When calculating eligibility for the low-income subsidy, Medicare does not count resources such as your home (or primary

residence); insurance policies; or a car.

Many people qualify for Medicare Extra Help savings and do not know it. The best way to find out if you qualify is to go ahead and

apply.

 

 

     LIS income guidelines (In our experience, as long as the client’s monthly income is around $1400, there is a good chance the

extra help will be granted)

 

How to apply for Medicare Extra Help

 

To apply for the Medicare low-income subsidy, simply fill out an “Application for Extra Help with Medicare Prescription Drug Plan

Costs” (SSA-1020) form with

Social Security. You can apply and submit this form by:

 

• Applying online at:

•  Apply for Extra Help.  (link)

• Calling Social Security at 1-800-771-1213 (TTY 1-800-325-0778) and requesting an application be mailed to you or applying

• over the phone. Social Security

• representatives are available by phone Monday through Friday, from 7 AM to 7 PM.

• Applying in person at your local Social Security office.

Typically, It will take up to a month or more to get the decision back.  The client will need to submit checking account statements

and all the rest of the financial info.

Also, check to see if your state has a Pharmaceutical Assistance program

 

     Pharmaceutical Assistance

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