1 Improving the lives of 10 million older adults by 2020 © 2015 National Council on Aging The Part D Low Income Subsidy (LIS/Extra Help) February 2015 Benefits 101

2 Improving the lives of 10 million older adults by 2020 © 2015 National Council on Aging What We’ll Cover  Why Part D LIS/Extra Help Matters o Benefits of the Program  Overview of the LIS/Extra Help Program o Eligibility Rules  How to Apply o Online vs. Paper Form  How You Can Help Your Clients  Resources

3 Improving the lives of 10 million older adults by 2020 © 2015 National Council on Aging Why LIS/Extra Help Matters  Costs of Medicare Part D drug plans can add up: o Part D plan premium, deductible, and prescription drug copayments/coinsurance  Poverty among the Medicare population o Nearly half (48%, or 24M) have income under 200% of the Federal Poverty Level o Many are likely eligible for LIS  Average value of LIS for eligible person is $4,000 a year

4 Improving the lives of 10 million older adults by 2020 © 2015 National Council on Aging More Benefits of LIS/Extra Help  LIS provides access to prescription drug coverage  Protects people from Part D Coverage Gap (closing by 2020)  Waives any late-enrollment penalty premium for Part D  Allows continuous Special Enrollment Period (SEP): o Can change plans as often as every month (though not recommended) o Don’t have to wait until the next Open Enrollment Period to change plans  Can start the application process for Medicare Savings Programs (i.e., QMB, SLMB, and QI) o Note: If working directly with client, may still want to complete separate MSP application, to expedite MSP process

5 Improving the lives of 10 million older adults by 2020 © 2015 National Council on Aging Overview of LIS/Extra Help

6 Improving the lives of 10 million older adults by 2020 © 2015 National Council on Aging Who are the Key Federal Players?  Social Security Administration (SSA) and Centers for Medicare & Medicaid Services (CMS) work together to administer and educate the public about LIS/Extra Help  SSA handles application and eligibility determination, also: o Provides application o Makes eligibility decision  CMS administers the program, also: o Handles Part D plan assignment for those eligible o Coordinates subsidies to Part D plans for eligible enrollees

7 Improving the lives of 10 million older adults by 2020 © 2015 National Council on Aging LIS/Extra Help Eligibility Rules: General  Person must have Medicare Part A and/or Part B  Live within the U.S. (50 states or D.C.)  Also, most people must meet financial eligibility criteria: o Income test based on the annual Federal Poverty Levels (FPLs) o Resource (also called “asset”) test  Some people are “deemed” eligible (automatically get LIS) because they receive another needs-based benefit: o People who get any kind of Medicaid (community or institutional), Supplemental Security Income (SSI), or are enrolled in a Medicare Savings Program (i.e., QMB, SLMB, QI) o These 3 groups do not need to apply for LIS  Once eligible, all get LIS for at least the remainder of year

8 Improving the lives of 10 million older adults by 2020 © 2015 National Council on Aging Levels of Help  Two levels of help from LIS: o Full Help (full subsidy) - for those with lower incomes/fewer resources o Partial Help (partial subsidy) - for those with slightly higher incomes/resources  Both full and partial help eliminate the Part D coverage gap  No late-enrollment penalty premium for anyone with LIS/Extra Help

9 Improving the lives of 10 million older adults by 2020 © 2015 National Council on Aging Full Extra Help  Eligibility criteria (except for those “deemed”) in 2015:  Those who qualify for Full Help pay (in 2015): o No Part D plan premium -- as long enrolled in a “benchmark” plan (i.e., a plan below the LIS premium amount) o No Part D deductible o Copays up to $2.65 generic/$6.60 brand-name drugs (certain people, based on income, pay $1.20 generic/$3.60 brand-name drugs) o No copays after reaching $4,700 limit * Does not include $20 monthly income disregard **Includes $1,500 burial allowance

10 Improving the lives of 10 million older adults by 2020 © 2015 National Council on Aging Partial Extra Help  Eligibility criteria (in 2015):  Those who qualify for Partial Help pay (in 2015): o No premium or sliding scale premium (based on income) o $66 deductible o 15% coinsurance for plan covered drugs o Copays of $2.65 generic/$6.60 brand-name drugs after reaching $4,700 limit * Does not include $20 monthly income disregard **Includes $1,500 burial allowance

11 Improving the lives of 10 million older adults by 2020 © 2015 National Council on Aging Income Test  Countable income includes: o Social Security benefits (e.g., retirement, SSI), Railroad retirement benefits o Pensions or annuities, including veteran’s pensions o Wages (gross) or earnings from self-employment (net) o Alimony o Rental income (net) o Workers compensation  Excluded income includes: o SNAP (Food Stamps) and LIHEAP (fuel assistance) benefits o $20 monthly in unearned income, such as Social Security o Work-related expenses for people who get Social Security benefits for a disability or blindness

12 Improving the lives of 10 million older adults by 2020 © 2015 National Council on Aging Resource Test  Countable resources include: o Financial institution accounts (e.g., checking, savings, CDs) o Cash at home o Stocks, bonds, savings bonds, mutual funds, individual retirement accounts (IRAs), and 401(k) accounts o Real estate (equity value) other than primary home o Certain trusts that allow a person to revoke or have direct use of funds  Excluded resources include: o Home in which the applicant lives o All vehicles (autos, trucks, motorcycles, boats, snowmobiles, etc.) o Household goods/furnishings, and personal effects (e.g., jewelry) o Cash surrender value of life insurance policies o In-kind support (e.g., non-cash help such as shelter) o Irrevocable burial trusts/burial contracts

13 Improving the lives of 10 million older adults by 2020 © 2015 National Council on Aging How to Apply

14 Improving the lives of 10 million older adults by 2020 © 2015 National Council on Aging Two Ways to Apply for LIS/Extra Help  Online: o Either through Social Security’s website at or through o SSA’s online application available in English and Spanish o SSA accepts electronic signature to complete the application  Paper Form: o Obtain a paper form from SSA (either by mail or get from Social Security office) o Be sure and use the form published on or after December 2009, otherwise will hold up application process  SSA will make a determination (usually within 3 wks of a completed application) and send applicant decision letter

15 Improving the lives of 10 million older adults by 2020 © 2015 National Council on Aging Tips When Applying for LIS/Extra Help  Online is usually easier and faster!  No verifying documents needed -- SSA will use federal records to verify answers  If paper form is incomplete, SSA will follow up via phone with applicant  Online application cannot be submitted until complete  Instruction sheets in 15 languages on SSA’s site  IMPORTANT: People who are deemed eligible for LIS (those with Medicaid, SSI, or enrolled in a MSP) do NOT need to apply for LIS; they automatically get LIS. They get a letter from CMS letting them know this.

16 Improving the lives of 10 million older adults by 2020 © 2015 National Council on Aging Tips When Applying (cont.)  Can start the application process for Medicare Savings Programs (i.e., QMB, SLMB, and QI) o SSA sends “leads” data to the state Medicaid office from the LIS application o Some Medicaid programs require clients to answer additional questions o May want to complete a separate MSP application to speed up the process* o Not all clients who qualify for LIS will qualify for MSP *See our fact sheet on why simultaneous submission is important: msp.pdf msp.pdf

17 Improving the lives of 10 million older adults by 2020 © 2015 National Council on Aging How You Can Help

18 Improving the lives of 10 million older adults by 2020 © 2015 National Council on Aging My Client Qualifies for LIS/ Extra Help– Now What?  Automatic Enrollment o If an LIS/Extra Help awardee does not pick a Part D Plan, then Medicare will facilitate enrollment, also called auto-enrollment Should receive notice about auto-enrollment by end of month in which LIS is awarded Have until the end of the following month to opt out or choose a plan o Auto-enrollment is based on paying $0 premium and is randomly selected. Beneficiary medications aren’t considered in auto-enrollment so the play may not cover all their medications. o Can call SSA and opt out  Allows for a continuous Special Enrollment Period (SEP) o Can change plans as often as every month (though not recommended) as needs change (new medications, etc.) o Don’t have to wait until the Open Enrollment Period to change plans

19 Improving the lives of 10 million older adults by 2020 © 2015 National Council on Aging My Client Qualifies for LIS/ Extra Help– Now What? (cont.)  Protection o Protects people from paying more for medication in the Part D Coverage Gap (a.k.a. the “Donut Hole”) o Waives any late-enrollment penalty for Part D o Limited Income Newly Eligible Transition (LINET) administered by Humana o For those awarded LIS/Extra Help but not yet enrolled in a Part D Plan o Point-of-sale (immediate) enrollment with proof of eligibility but must show the pharmacy Medicaid award letter/SSA award letter/Medicare card and the pharmacy will verify eligibility with LINET o For more detail visit: services/linet-information services/linet-information

20 Improving the lives of 10 million older adults by 2020 © 2015 National Council on Aging Ways You Can Help Your Clients  Share resources: Use online resources to guide/assist your clients applying for LIS: o or (to apply for LIS online) o Medicare Plan Finder on (to review plan selections) o (for more info on LIS)  Review mailings: Help your clients sort through/understand various mailings they get from SSA, Medicare, and their current plan  Review options: Help remind your clients with LIS that they can change plans or select one on their own  Person-centered approach: Connect your clients with LIS — and other benefits (e.g., SNAP, LIHEAP, Medicare Savings Programs)

21 Improving the lives of 10 million older adults by 2020 © 2015 National Council on Aging Additional Resources  Social Security’s LIS resources, including their online application at:  SSA’s electronic fact sheet that explains LIS and how to apply at:  Social Security’s (Program Operations Manual System) for rules on the LIS program at:  CMS webpage for resources related to LIS at:

22 Improving the lives of 10 million older adults by 2020 © 2015 National Council on Aging Additional Resources (cont.)  NCOA’s benefits screening and enrollment service, which includes an online LIS application at:  Center for Benefits’ Guide to Mailings & Key Events at: benefits/AEP-Guide-to-Mailings-and-Key-Events.pdf benefits/AEP-Guide-to-Mailings-and-Key-Events.pdf  Center for Benefits’ resource page on LIS, includes eligibility chart, fact sheets, tips for completing application: security/center-for-benefits/prescriptions/extra-help- lis.htmlhttp:// security/center-for-benefits/prescriptions/extra-help- lis.html

23 Improving the lives of 10 million older adults by 2020 © 2015 National Council on Aging Thank You!  Thank you for participating in the Benefits 101 Series from the Center for Benefits Access at NCOA  We invite you to learn more about us by visiting our website:  If you have any questions or comments, please contact us at