by Roman B. | Jul 30, 2019 | RESOURCES
Medicare Plans and Supplements Quotes in all States
User : Roman@RGBInsurance.com
Password: Computers2017!
LIS Check
User :
rgbinsurance (lower case)
Password:
rgbinsurance1 (lower case)
Need to Have :
First +Last+ DOB+Medicaid or SSN+ Medicare number (New Number only)
*Will show you LIS and Dual eligibility levels (not current plan)
UHC PHD Verification Line
Medicaid Eligibility Check and Provider One Look ups (WA)
Medicaid Status Verification Automated Phone Line
UHC Providers and Rx look up for Dual SNP and AARP Plans
Dual SNP Plan
Rx Drug List:
AARP Medicare Advantage Plans
Providers and Rx Drug list:
Humana Providers and Rx Search
Aetna Providers and Rx Drugs Search
Apply For LIS and Medicaid (WA)
Part D Late Enrollment Penalty Calculator
Types of Social Security Income (SSI, SSDI, SSA)
Apply For Non-Resident License
Required Error & Omission Policy
by Roman B. | Aug 8, 2019 | RESOURCES
Here are some events that agents have found to be successful:
-Although mailers still yield some results, the following ideas will generate much more business for you
and will keep you busy all year round.
-We will help you with setting up events and will make sure you are comfortable doing them
Educational Events
Great way to capture the turning 65 market.
Educational events don’t have to be filed with the carriers.
Suggested locations: Denny’s, IHOP, Sizzler.
Mailers are a good way to get people to attend those meetings.
Senior Centers
Senior centers are a good way to connect directly to a Medicare-eligible audience. Here are examples of events that allowed agents to write much more business all year round.
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Bingo
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Holiday parties/events
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Health fairs
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Medicare Educational events
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Building relationships with caseworkers/managers inside those centers and letting them know you are there to help
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Weekly activity calendars.
This site provides information that is useful for finding a Senior Center in your area.
A page for your state that includes a list of centers specific to your area can be accessed by using the Select a State tool above or
by clicking on your state name at the bottom of this page.
These state pages link to complete listings of centers that include full descriptions, contact information, and photos.
Places of Worship
Best for weekend events. You can sign up a lot of Dual clients you can help right away and connect with others who will sign up during the AEP or when they turn 65.
Agents who have those events and create relationships with religious facilities have noticed that these interactions tend to yield a steady stream of client enrollments.
Religious facilities we worked before included churches, mosques, temples, etc.
Church Finder® is the leading online platform connecting people with local Christian churches.
Church Finder is used by millions of people and includes over 280,000 Christian churches.
-Working local ethnic community centers and reaching out to the various organizations that support people from other countries
is a fantastic way to quickly build a book of business.
-We will help you work within those communities and be successful when you decide to do that.
Meals on Wheels
Meals on Wheels America is the leadership organization supporting the more than 5,000 community-based programs across the country
that are dedicated to addressing senior isolation and hunger.
This network serves virtually every community in America and, along with more than two million staff and volunteers,
delivers the nutritious meals, friendly visits and safety checks that enable America’s seniors to live nourished lives with independence and dignity.
Typically, agents set up a table outside meal times and provide information about Medicare plans available to those who qualify.
Homeless Shelters
Setting up events at homeless shelters is a good way to target Medicare/Medicaid eligibles.
Agents have found that these events usually generate quite a few enrollments as well.
The Homeless Shelter Directory provides Homeless Shelters and Homeless Service Organizations nation-wide.
It includes all resources necessary to help you connect with that opportunity.
Food Banks
An effective way to find dual-eligible clients is by tabling at food banks during distribution times.
The Feeding America nationwide network of food banks secures and distributes 4.3 billion meals each year through food pantries and meal programs
throughout the United States and leads the nation to engage in the fight against hunger.
Housing
Reaching out to different housing centers by speaking to management, hosting events and posting flyers is another way
that agents have been able to meet more potential clients.
Low-income housing communities are a good way to find more dual-eligible clients to help with the plan.
Retirement communities are a good way to reach Medicare-eligible clientele as well as dual-eligible ones.
Dental Offices
Developing relationships with dental offices is a successful way to expand your book of business.
Original Medicare does not offer any dental benefits, and this is why marketing to dental offices is advantageous.
When a client walks into a dental office and is denied coverage, this creates a perfect opportunity for the clinic to refer the client to you for dental benefits.
Or
Reach out to dental offices that work with United Health Care plans by looking them up in the directory
The same goes for any smaller local pharmacy or eyeglasses center.
by Roman B. | Jul 3, 2019 | RESOURCES
Inexpensive Color Copies
Inexpensive Business cards
by Roman B. | Aug 16, 2019 | RESOURCES
Different Senior/Long Term Care Options
Caregiver Information/How it works/Type of Care Programs
-Adult Family Home Locator
! Pace Program (Normally not recommended to change to Dual)
! Health Home (By changing to Dual, the client will have to change the integrated care model)
-COPES (Usually OK to change to Dual)
by Roman B. | Nov 7, 2019 | RESOURCES
By calling PHD – you can verify clients status,
Medicaid status and Eligibility and also
obtain missing Medicare or Medicaid info
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Obtain consumer’s permission
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First and last name
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Medicare or Social Security number
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Medicaid number
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Date of birth
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Address (make sure its the address that is on file with Medicare/Medicaid)
by Roman B. | Nov 7, 2019 | RESOURCES
1) Dial
2) press (1) for English
! Don’t press anything when the system asks if you know the extension
3) press (1) to continue verifying via automated line
4) press (3 ) to check eligibility for today’s date
5) press (1) to enter ( Provider One number) or press ( 2) to enter (SSN) then
6) enter clients (zip code)
by Roman B. | Nov 7, 2019 | RESOURCES
by Roman B. | Nov 7, 2019 | RESOURCES
,,
LIS (Extra Help)
What is the Medicare Low-Income Subsidy?
Eligible beneficiaries, who have limited income, may qualify for a government program that helps pay for
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:
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:
(varies from state to state).
LIS will lower the cost of prescription drugs:
LIS Gives you:
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
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
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Part D monthly premium
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annual deductible
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coinsurance
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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
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 will pay Part D late enrollment Penalties for delayed enrollment into Part D:
If you are enrolled in Medicaid, Supplemental Security Income (SSI), or a Medicare Savings Program (MSP), you
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 LIS online:
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:
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Applying online at:
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Calling Social Security at 1-800-771-1213 (TTY 1-800-325-0778) and requesting an application be mailed to you or applying
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over the phone. Social Security
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representatives are available by phone Monday through Friday, from 7 AM to 7 PM.
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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
by Roman B. | Nov 7, 2019 | RESOURCES
Medicaid Levels/ Extra Help/ LIS
Medicare Savings Programs (MSPs) are Medicaid-administered programs for people on Medicare who have limited income and resources.
These programs help those qualified to afford Medicare.
There are four different Medicare Savings Programs, each with different income and resource eligibility limits. These are the limits for 2022:
Medicare Savings Plan Levels
QMB and QMB + levels are the only ones with 100% of the:
Medicaid Spend-Down
Some clients with SLMB status will have a Spend-Down where, during every 6 month period, they will have to accumulate a certain amount in uncovered Medical costs before Medicaid would step in and start covering Medicare cost-sharing. That amount can vary between $200 to as much as $9000 or more.
You can still enroll those clients into the Dual SNP plan, where they will get access to all the extra benefits, zero Family doctor and Specialist visits, and Max -out -of pocket of $6700 (if the Spend Down amount is less than $6700, then Max out of Pocket is The Spend-Down amount)
( Original Medicare does not have Max-out-of Pocket)
The rest of the Medical Services (besides Doctor’s office visits ) will still be subject to the Spend Down. Make sure the client knows that!
That means –
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Deductible of Part A
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Deductible of Part B
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20% percent Part B coinsurance
( MAPD plan will pay claims just like Original Medicare would pay them), with exceptions of:
-$0 copay Family Doctor and -$0 copay Specialist
-Max- Out-of-Pocket
You can check on somebody’s
Spend Down amount by
calling PHD or local Medicaid.
Medicaid eligibility for Medicare beneficiaries who need long-term care in the home or community
Medicare DOES NOT cover long-term care
Medicaid DOES COVER it for some beneficiaries
Types of Care for Seniors Covered by Medicaid
!Its normally not recommended to enroll somebody who has
Services, such as :
Medicaid Dental/Dentures / Vision/Transportation/ benefits per State
Medicare / Medicaid Coverage for Mental Health
Most of the Mental Health needs for people on Medicare/Medicaid are covered by Medicaid
by Roman B. | Jul 16, 2019 | RESOURCES
