1. QuickInsured Brokerage and Selling Outside AEP

2. LEARNING OBJECTIVES
Gain an understanding that there is a big opportunity outside AEP
At the end of this training, you will be able to:
Define Low Income Subsidy (LIS) qualifications
Explain what LIS is and how it works
Understand the different levels and terms used to describe LIS
Understand the options to apply for LIS
Determine if LIS applies for a prospect
Apply the knowledge to grow your business

3. LIS is also known as “Extra Help”
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 $ $6.50
Eliminates the Part D late enrollment penalty
Provides assistance in the coverage gap- $4,950 in 2017
Did You Know?
LIS is also known as “Extra Help”

4. 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 the agent’s value with the consumer
Many consumers have no idea this is available
It’s the right thing to do

5. AUTOMATIC QUALIFICATION
Some consumers are automatically eligible for the low-income subsidy:
Full benefits dual eligible
Consumers and/or members receiving benefits from both Medicare and Medicaid but do not have to pay Part A premiums, in some cases Part B premiums, deductibles 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), Special 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
Did You Know?
Non-deemed consumers are REQUIRED to reapply to LIS every calendar year. The Social Security Administration sends notices to consumers in October encouraging them to reapply

6. Full Low-Income Subsidy (LIS)/ Extra Help (2016) -48 STATES + DC
Beneficiary Group
Annual Income Eligibility Requirement*
Monthly Income Eligibility Requirement*
Asset Eligibility Requirement*
Need to apply for LIS
Monthly Premium
Annual Deductible
Copay/ Coinsurance Plan’s Formulary Drugs
Full-Benefits Duals: Institutionalized or receiving Home and Community-based Services
Meet State Medicaid financial eligibility
No, receive it automatically No
None
Full-Benefit Duals: income < 100% FPL
Meet State Medicaid/MSP financial eligibility
Copay: $1.20 generic/$3.60 brand
Catastrophic Copay: $0
Full-Benefit Duals: income>100%FPL
Copay: $2.95 generic/$7.40 brand
Non-Duals: income< 135% FPL AND lower asset levels
Single: $16,278
Couple: $21,867
Single: $1,357
Couple: $1,823
Single: $8,780
Couple: $13,930
No, if receiving SSI; otherwise, yes

7. Partial Low-Income Subsidy (LIS)/Extra Help (2016)- 28 STATES + DC
Beneficiary Group
Income eligibility Requirement
Monthly Income Eligibility Requirement
Asset Eligibility Requirement
Need to apply to LIS?
Monthly Premium
Annual Deductible
Copay/Coinsurance Plan’s Formulary Drugs
Non duals with income < 135% FLP AND assets between lower and higher limits
Single: $16,278
Couple: $21,867
Single: $1,357
Couple: $1,823
Single: between $8,781-$13,640
Couple: between $13,931-$27-250
Yes No
$74
Coinsurance: 15%
Catastrophic Copay: $2.95 generic/$7.40 brand
Non duals with income between % FPL
Single: $18,060
Couple: $24,270
Single: $1,505
Couple: $2,023
Single: $12,640
Couple: $27,250
Yes, sliding scale

8. Income limits Income is the earnings you receive
Did You Know?
Beginning January 1, 2010, the help received regularly from someone else to pay household expenses (food, mortgage, rent, heating fuel or gas, electric, water, and property taxes) will not count as income
150% of Poverty Levels in 2016
Income
Individual
Married
Yearly
$18,060
$24,270
Monthly
$1,505
$2,023
Income is the earnings you receive
Examples are: wages, Social Security income, Railroad Retirement, and Veteran’s benefits

9. Resources limits Resources are the value of things you own
Individual
Married
Resources
$13,640
$27,250
Did You Know?
Resources don’t include your home, car, household items, burial plot, up to $1,500 for burial expenses (per person), or life insurance policies
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)

10. Lis- low take up rate
A national survey of seniors indicates that there Is a lack of awareness on how to qualify
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

11. Lis- low take up rate continued
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

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

13. lIS Application assistance
Did You Know?
Completing the LIS application starts the process for a Medicare Savings Program. Information is sent to the state and they will contact the consumer to help apply for a Medicare Savings Program
Apply via telephone at Social Security Administration (SSA):
SSA at (TTY )
Paper forms can be requested at:
Online forms available at:
Additional information is available at:
Go to your local Social Security Administration Office

14. What info is needed to complete a lis of extra help application?
Social Security card
Bank account statements: checking, savings, certificates of deposits
Investment information: Individual Retirement Accounts (IRAs), stocks, bonds, savings bonds, mutual fund, other investment statements
Tax returns
Payroll slips
Most recent Social Security benefits award letters
Railroad retirement benefits
Veterans benefits
Pensions
Annuities

15. Assistance- position a solution
Acknowledge the consumer 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?”
Sales Tip
Prior to assisting a consumer with either LIS or a state pharmaceutical program, review the application to ensure it can be completed easily

16. Assistance- position a solution continued
Sales Tip
When trying to determine if a consumer meets the program qualifications, always ask if they make less than the maximum amount
Position
Outline the Program
“Mrs. Frank, ‘Extra Help’ is a program by the Social Security Administration and it helps beneficiaries lower their prescription costs”

17. Assistance do’s and don’ts
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 to the consumer will automatically be eligible for the program
Inform the consumer that eligibility is determined by Social Security Administration or a state agency
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 Medicare Advantage 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 a specific carriers plan

18. 2017 lis rates Medical Mutual of Ohio (MMO) The Health Plan (THP)
Choice plan reduced from $29 to $0
The Health Plan (THP)
Reduced from $40 to $7.70
Anthem
Mediblue plan reduced from $65 to $32.70

19. 2017 Dual plan Gateway Health The Health Plan United Health Care
Anthem

20. Where to market?
Low Income Housing- meet with Housing Leadership and staff
Faith Based Groups
Establish relationships with local senior centers and nursing homes
Civic Organizations- Rotery, Kiwanis
Go to county fairs and festivals and buy a booth
Flea markets
Set up a relationship with a small local pharmacy
Food pantrys

21. What questions do you have?
Question & answer
What questions do you have?