Revised 02/02/2011 1 Low Income Subsidy & Enrollment Assistance Creating Special Election Periods through the Medicare Part D Low-Income Subsidy (LIS)

Revised 02/02/20111

Low Income Subsidy & Enrollment Assistance

Creating Special Election Periods through the Medicare Part D Low-Income Subsidy (LIS)

Revised 02/02/2011

Learning Objectives

At the end of this training you will be able to : Explain why we should assist with LIS Define Low Income Subsidy (LIS) qualifications Understand the options for apply for LIS Determine if LIS, or other state pharmaceutical

program, is the best option for the consumer (DE, MD, NJ and PA only)

Apply the knowledge to grow your business

2

Revised 02/02/2011

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 both the agent’s and Bravo’s value with the consumer

It’s the right thing to do

3

Revised 02/02/2011

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 $2.50 - $6.50– Eliminates the Part D late enrollment penalty– Provides coverage in 2012 Coverage gap is $3,608.

4

* The LIS service is estimated to be worth an average of $34,000 per year. This is determined by the Social Security Administration. (source: www.socialsecurity.gov)

Did You Know?

LIS is also known as

“Extra Help”

LIS is also known as

“Extra Help”

Revised 02/02/2011

Income Limits

Income is the earnings you receive. Examples are: wages, Social Security income, Railroad

Retirement, and Veteran’s benefits

5

Income Individual Married

Yearly $16,335 $22,065

Monthly $1,361.25 $1,838.75

*Income limits may vary for Alaska & Hawaii. Additionally income limits may be higher with additional dependents.

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.

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 level in 2011*

Revised 02/02/2011

Resources Limits

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).

6

Individual Married

Resources $12,640 $25,260Did 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 don’t include your home,

car, household

items, burial plot, up to $1,500 for

burial expenses (per

person), or life insurance

policies.

Revised 02/02/2011

2012 LIS Overview

7

Revised 02/02/2011

LIS – Low Take Up Rate

A national survey of seniors indicates that lack of awareness particularly among low-income seniors of color.

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.

8

Did You Know?

The Henry J. Kaiser Family Foundation has created

“The Medicare Part D Low-Income

Subsidy Program.”

http://www.kff.org/medicare/upload/8094.pdf

The Henry J. Kaiser Family Foundation has created

“The Medicare Part D Low-Income

Subsidy Program.”

http://www.kff.org/medicare/upload/8094.pdf

Revised 02/02/2011

LIS – Low Take Up Rate con’d

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.

Revised 02/02/2011

Automatic Qualification

Some consumers are automatically eligible for the low-income subsidy: Full benefits dual eligibles

– Consumers and/or members receiving benefits from both Medicare and Medicaid but do not have to pay Part A premiums, in some case Part B premiums 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), Specified 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

10

Did You Know?

Non-deemed consumers

are REQUIRED to reapply for

LIS every calendar year.

The Social Security

Administration sends

notices to consumers in

October encouraging

them to reapply.

Non-deemed consumers

are REQUIRED to reapply for

LIS every calendar year.

The Social Security

Administration sends

notices to consumers in

October encouraging

them to reapply.

Revised 02/02/2011

Why an Agent Should Assist?

Agent AssistanceApplication Submission Application completed immediately

LIS Award Letter Average Award letter is produced within 10 – 14 business days

Program Understanding Can ask questions of the agent to understand the benefits

Value Recognition Consumer relates value of assistance with you and Bravo Health

Consumer Experience Consumer has a relationship with agent and feels more comfortable talking about financial situation and any concerns they have

11

Revised 02/02/2011

LIS Application Assistance

LIS can be applied for with a paper application. GOODGOOD

LIS can be applied for with an online application. BETTERBETTER

LIS can be applied for with a telephone application. BESTBEST

12

Did You Know?

That when applying for

LIS a consumer DOES NOT

have to submit

documents verifying their

income and resources.

That when applying for

LIS a consumer DOES NOT

have to submit

documents verifying their

income and resources.

Revised 02/02/2011

LIS Application Assistance

1. Apply via the telephone at Social Security Administration (SSA):– SSA at 1-800-772-1213 (TTY 1-800-325-0778)

2. Paper forms can be requested at: – SSA at 1-800-772-1213 (TTY 1-800-325-0778)

3. Online forms available at:– http://www.ssa.gov/prescriptionhelp/

4. Additional information is available at:– http://www.socialsecurity.gov/pubs/10525.html

13

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

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

Revised 02/02/2011

What info is needed to complete application?

Social Security card Bank account statements: checking, savings, certificates of

deposit Investment information: Individual Retirement Accounts (IRAs),

stocks, bonds, savings bond, mutual fund, other investment statements

Tax returns Payroll slips Most recent Social Security benefits award letters Railroad retirement benefits Veteran benefits Pensions Annuities

14

Did You Know?

The Social Security

Administration created a guide titled “Application

for Extra Help with Medicare

Prescription Drug Plan

Costs”

http://www.socialsecurity.gov/prescriptionhelp/SSA-1020B-OCR-SM-INST.pdf

The Social Security

Administration created a guide titled “Application

for Extra Help with Medicare

Prescription Drug Plan

Costs”

http://www.socialsecurity.gov/prescriptionhelp/SSA-1020B-OCR-SM-INST.pdf

Revised 02/02/2011

If completing a paper application...follow these tips

Use black ink in because application is scanned at SSA and black ink scans better

Enter name and number exactly as it appear on your SS Card or Railroad Retirement Card

Don’t mark the yes and no boxes in any section If you are single (divorced, widowed, not living with spouse) do not

complete any sections that ask for spousal information Return entire packet and not just the page signed Do not send other documents (e.g. doctor bills, Rx info, IRS info, etc) Do not used a photocopied, faxed or downloaded form – use the

original paper form or apply online DO NOT complete question 15 if you want help from the Medicare

Savings Program

15

Did You Know?

Applying for LIS with a

paper application

adds 10 business days

to the determination

process.

Applying for LIS with a

paper application

adds 10 business days

to the determination

process.

Revised 02/02/2011

What is the Alabama SenioRx Partnership for Medication Access ?

Alabama’s SenioRX Partnership for Medication Access administered by the Department of Senior Services through 13 Area Agencies on Aging.

Eligible individuals who have at least 55 years of age or you are deemed disabled by Social Security and in the 24 month gap for Medicare coverage.

– No prescription drug coverage.– Have a chronic medical condition.– In the Medicare Part D “Gap”.– Legal resident of the state of Alabama.

16

Did You Know?

The SeniorRX Partnership

that provides assistance

with applying for drug

assistance programs

provided by pharmaceutic

al manufacturer

s.

The SeniorRX Partnership

that provides assistance

with applying for drug

assistance programs

provided by pharmaceutic

al manufacturer

s.

Revised 02/02/2011

SenioRX Income Limits

Income is the earnings you receive.– Examples are: wages, Social Security income, Railroad Retirement, and

Veteran’s benefits

There is no Resource test for SenioRX.

17

Income Individual* Married

Yearly $21,660 $29,140

Monthly $1,800 $2,482

Did You Know?

If a consumer exceeds the

income limits they still may

qualify for DPAP if they

have prescription

costs exceeding

40% of their income.




have prescription

costs exceeding


Revised 02/02/2011

SenioRX Application Assistance

Contact 1-800-AGE-LINE (243-5463) to request an application.

Applicants will need to include the following:– Social Security

– Medicare Card

– Medicaid Card (if applicable)

– Supplemental Card (if applicable)

– Medicare Part D Prescription Card (if applicable)

– Veterans Benefit, pension, earnings, interest on savings and/or investments, and cash given to you or any other income must be reported.

– List of all medications from a pharmacist

– List of all monthly bills 18

Revised 02/02/2011

SenioRX vs. LIS

19

SenioRX LIS

Income Limit 200% of FPL 150% of FPL

Resource Limit NO YES

Documentation YES NO

Processing 7 business days 10 – 21 business days

RX Benefit No set benefit. Application assistance with pharmaceutical manufacturers drug programs

$2.50 – $6.50

RX Premium NO Varies based on LIS level

Coverage Gap NO YES

Which program is more beneficial for the consumer?

Revised 02/02/2011

What is the Delaware Prescription Assistance Program?

Delaware’s Prescription Assistance Program (DPAP) is a State program administered by the Delaware Health and Social Services for provides up to $3,000 per individual in each calendar year for eligible clients.

Eligible individuals who have no prescription insurance other than Medicare Part D, and whose income is at or below 200% of the Federal Poverty Level (FPL), or whose prescription costs exceed 40% of their income.

DPAP program pays for prescription drug related costs:

– Assistance to cover RX drugs 5.00 or 25%, whichever is greater

20

Did You Know?

DPAP was funded by the

tobacco settlement.

DPAP was funded by the

tobacco settlement.

Revised 02/02/2011

DPAP Income Limits

Income is the earnings you receive. Examples are: wages, Social Security income, Railroad

Retirement, and Veteran’s benefits

There is no Resource test for DPAP.

*If one spouses' income(social security and or pension etc.) exceeds the annual income then that spouse doesn't qualify

21


Yearly $21,780 n/a

Monthly $1,815 n/a

*Income limits may vary for Alaska & Hawaii. Additionally income limits may be higher with additional dependents.

200% of Poverty level in 2011Did You Know?




have prescription

costs exceeding





have prescription

costs exceeding


Revised 02/02/2011

DPAP Application Assistance

DPAP can only be applied for with a paper application and require the following documentation to be submitted with the application:– Social Security

– Social Security Disability Benefit

– Veterans Benefit, pension, earnings, interest on savings and/or investments, and cash given to you or any other income must be reported.

Individuals needing assistance the DPAP application can call 1-800-996-9969, Option 2, then Option 1 to reach a representative.

22

Did You Know?

The DPAP paper

application is located online

at:

http://www.dhss.delaware.gov/dss/files/dpapapplication.pdf

The DPAP paper


at:

http://www.dhss.delaware.gov/dss/files/dpapapplication.pdf

Revised 02/02/2011

DPAP vs. LIS

23

DPAP LIS





RX Benefit $5.00 or 25% $2.50 – $6.50

RX Premium NO Varies based on LIS level

Coverage Gap YES YES


Revised 02/02/2011

Florida

Florida does not have a state prescription assistance program for Medicare recipients.

Some Florida counties offer Pharmaceutical Prescription Assistance Programs for individuals who cannot afford their prescriptions.

Florida does offer the Florida Discount Drug Card is designed to lower the cost of prescriptions for Florida residents without drug insurance coverage. Enrollees save an estimated 5 to 40 percent on Rx purchases. More information can be found at http://www.floridadiscountdrugcard.com/pdfs/AboutFactSheet.pdf

24

Revised 02/02/2011

Georgia

Georgia does not have a state prescription assistance program for Medicare recipients.

25

Revised 02/02/2011

What is Illinois Care RX?

Illinois Care RX BASIC plan covers prescription drugs for the treatment of Alzheimer’s disease, arthritis, cancer, diabetes, glaucoma, heart and blood pressure problems, HIV/AIDS (if eligible for Medicare), lung disease and smoking related illnesses, multiple sclerosis, osteoporosis and Parkinson’s disease.

Illinois Care RX PLUS plan covers all classes of medically necessary drugs

Enrollees in either plan will pay:– $2.50 for generic drugs, $6.30 for preferred brand name drugs

– $15 for specialty and non-preferred brand name drugs,

– 20% plus the applicable co-pay after $2,700 in drug benefits have been paid on your behalf. After

– $6,440 of total drug costs, enrollees pay 5% co-insurance and Medicare pays 95% of the drug costs.

26

Revised 02/02/2011

Care RX Income Limits



There is no Resource test for Care RX.

27


Yearly $21,780 36,635

Monthly $1,815 $3,052

Did You Know?

In order to enrollee in Care RX an individual

must apply for Medicare Part D Extra Help even if they do not meet Extra Help

qualifications.

In order to enrollee in Care RX an individual

must apply for Medicare Part D Extra Help even if they do not meet Extra Help

qualifications.

Revised 02/02/2011

Care RX Application Assistance

Care RX can be applied for at: https://cbrx1.aging.illinois.gov/app/cbci/

Paper applications can be obtained by:– http://www.state.il.us/aging/1rx/cbrx/forms/

il1363.pdf

– Calling the Senior Help Line at 1-800-252-8966– Calling the Senior Health Insurance Program at 1-

800-548-9034.

28

Revised 02/02/2011

Care RX vs. LIS

29

SPDAP LIS

Income Limit of FPL 150% of FPL



Processing Online Application: 6 WeeksPaper Application: 4 months

10 – 21 business days

RX Benefit $2.50 - $15.00 $2.50 – $6.50

RX Premium - Varies based on LIS level



Revised 02/02/2011

What is the Maryland Senior Prescription Drug Assistance Program?

Maryland’s Senior Prescription Drug Assistance Program (SPDAP) is a State program administered by the Maryland Health Insurance Plan and provides financial assistance to moderate-income Maryland residents who are eligible for Medicare and are enrolled in a prescription drug plan.

SPDAP pays for prescription drug related costs:

– $35 per month towards the cost of their monthly Medicare Rx or Medicare Advantage Prescription drug premiums

– Will pay 95% of the drug costs for consumers during the coverage gap

30

Did You Know?

In order to be eligible for the

“Coverage Gap Subsidy” the consumer

MUST be enrolled in an

approved plan.

In order to be eligible for the

“Coverage Gap Subsidy” the consumer

MUST be enrolled in an

approved plan.

Revised 02/02/2011

SPDAP Income Limits



There is no Resource test for SPDAP Couples must complete separate applications if both are

applying for the benefit

31


Yearly $ 32,670 $ 44,130

Monthly $2,722.50 $3,677.50

300% of Poverty level in 2011Did You Know?

To enroll into SPDAP a

consumer CANNOT be enrolled in

LIS.

To enroll into SPDAP a

consumer CANNOT be enrolled in

LIS.

Revised 02/02/2011

SPDAP Application Assistance

SPDAP can only be applied for with a paper application and require the following documentation to be submitted with the application:

Proof of at least six months of Maryland residency

Copy of your most recent federal income tax return

32

Did You Know?

The SPDAP paper


at:

http://www.marylandspdap.com/

Portals/1/Docs_Marylan

dSPDAP/SPDAP

%20Application%20Revised%20113010%20approved.p

df

The SPDAP paper


at:

http://www.marylandspdap.com/

Portals/1/Docs_Marylan

dSPDAP/SPDAP

%20Application%20Revised%20113010%20approved.p

df

Revised 02/02/2011

SPDAP vs. LIS

33

SPDAP LIS





RX Benefit 95% during the Coverage Gap

$2.50 – $6.50

RX Premium Up to $35 for partner plans

Varies based on LIS level



Revised 02/02/2011

Mississippi

Mississippi does not have a state prescription assistance program for Medicare recipients.

34

Revised 02/02/2011

What is the New Jersey Pharmaceutical Assistance to the Aged and Disabled Program?

New Jersey’s The Pharmaceutical Assistance to the Aged and Disabled (PAAD) is a State program administered by the Department of Health and Senior Services and provides financial assistance to residents who are eligible for Medicare and are enrolled in a prescription drug plan.

PAAD pays for prescription drug related costs:

– Assistance to cover RX drugs $5.00 (generic) or $7.00 (name brand)

– Contribute up to the regional benchmark amount towards the prescription portion of the total premium.

35

Did You Know?

If a Medicare Part D plan

does not pay for a

medication because the

drug is not on its formulary,

PAAD beneficiaries will have to switch to a drug on the Part D plan's

formulary

If a Medicare Part D plan

does not pay for a

medication because the

drug is not on its formulary,

PAAD beneficiaries will have to switch to a drug on the Part D plan's

formulary

Revised 02/02/2011

PAAD Income Limits

Income is the earnings you receive.– Examples are: wages, Social Security income,

Railroad Retirement, and Veteran’s benefits There is no Resource test for PAAD

36


Percentage of FPL 225% 205%

Yearly $24,432 $29,956

Monthly $2,036 2,496

Percentage varies between individual& married

Did You Know?

The application for

PAAD also includes

information to apply for the Lifeline Utility

Credit/ Tenants Lifeline

Assistance Program.

The application for

PAAD also includes

information to apply for the Lifeline Utility

Credit/ Tenants Lifeline

Assistance Program.

Revised 02/02/2011

PAAD Application Assistance

PAAD can only be applied for with a paper application and require the following documentation to be submitted with the application:

Verification of date of birth (birth certificate, Social Security record, baptismal certificate, Railroad Retirement record)

37

Did You Know?

The PAAD paper


at:

http://www.state.nj.

us/health/forms/ap-

2.pdf

The PAAD paper


at:

http://www.state.nj.

us/health/forms/ap-

2.pdf

Revised 02/02/2011

PAAD vs. LIS

38

PAAD LIS

Income Limit > 200% of FPL 150% of FPL



Processing 10 - 14 business days 10 – 21 business days

RX Benefit $5.00 & $7.00 $2.50 – $6.50

RX Premium Up to the regional benchmark for the RX portion of the premium

Varies based on LIS level



Revised 02/02/2011

What is the Pennsylvania’s Prescription Assistance?

Pennsylvania’s Prescription Assistance (PACE) is a State program administered by the Department of Health and Senior Services and provides financial assistance to residents with prescription costs.

39

Did You Know?

That PACEPLUS Medicare

includes PACE & PACENET

That PACEPLUS Medicare

includes PACE & PACENETPACE PACENET

RX Benefit $6.00 & $9.00, potentially lower based on income level

$8.00 & $15.00

Premium Benefit Covers the premium if RX plan is a partner plan

No premium benefit

Revised 02/02/2011

PACE Income Limits


Railroad Retirement, and Veteran’s benefits There is no Resource test for PACE

40


Percentage of FPL 133% 120%

Yearly $14,500 $17,700

Monthly $1,208 $1,470

Percentage varies between individual& marriedDid You Know?

That a consumer is not enrolled into a Part D Plan at the

time of enrollment in

PACE or PACENET the Department

of Health and Senior

Services may provide

recommendations.

That a consumer is not enrolled into a Part D Plan at the

time of enrollment in

PACE or PACENET the Department

of Health and Senior

Services may provide

recommendations.

Revised 02/02/2011

PACENET Income Limits


Railroad Retirement, and Veteran’s benefits There is no Resource test for PACENET

41


Yearly $23,500 $31,500

Monthly $1,958 $2,625

216% of the FPL in 2010Did You Know?

That a consumer

does not have to enroll in Part D to enjoy the

benefits of PACE or

PACENET; however they

will be responsible

for a PACE or PACENET monthly

deductible of $32.09

That a consumer

does not have to enroll in Part D to enjoy the

benefits of PACE or

PACENET; however they

will be responsible

for a PACE or PACENET monthly

deductible of $32.09

Revised 02/02/2011

PACE & PACENET Application Assistance

PACE & PACENET can be applied for with a paper or online application and require the following documentation to be submitted with the application:

Verification of date of birth (birth certificate, Social Security record, baptismal certificate, Railroad Retirement record)

42

Did You Know?

The PACE paper


at:

http://pa.gov/portal/

server.pt/community/

pace___pacenet_application

s/17945

The PACE paper


at:

http://pa.gov/portal/

server.pt/community/

pace___pacenet_application

s/17945

Revised 02/02/2011

PACE/PACENET Application Assistance

PACE/PACENET applications DO NOT require supporting documentation. Applications can be submitted in the following:

1.PACE/PACENET paper application is available at: http://pa.gov/portal/server.pt/community/pace___pacenet_applications/17945

2.PACE/PACENET online application is located at: http://pa.gov/portal/server.pt/community/pace___pacenet_applications/17945

43

Revised 02/02/2011

PACE & PACENET vs. LIS

44

PACE PACENET LIS

Income Limit 133% & 120% of FPL

216% of FPL 150% of FPL

Resource Limit NO NO YES

Documentation NO NO NO

Processing 10 business days 10 business days 10 – 21 business days

RX Benefit $6.00 & $9.00 $8.00 & $15.00 $1.00 – $6.30

RX Premium Covers the premium if RX plan is a partner plan

NO Varies based on LIS level

Coverage Gap YES YES YES


Revised 02/02/2011

Tennessee

Tennessee does not have a state prescription assistance program for Medicare recipients.

45

Revised 02/02/2011

Texas

Texas does not have a state prescription assistance program for Medicare recipients.

46

Revised 02/02/2011

Washington D.C.

Washington D.C. does not have a state prescription assistance program for Medicare recipients.

Residents of the Washington Metropolitan Area now have access to a FREE discount prescription drug card program. DC Rx Card will provide savings of up to 75% on prescription drugs at over 50,000 pharmacies across the country. More information can be found at http://dcrxcard.com

47

Revised 02/02/2011

West Virginia

West Virginia does not have a state prescription assistance program for Medicare recipients.

48

Revised 02/02/2011

Assistance – Is there a Need?

Needs Analysis Ask questions about their prescription needs

• “How many medications do you take each month?”

• “How much do you spend on your medications each month?”

• “Do you not get all your prescriptions filled each month because of the cost?”

• “Have you ever applied for state or federal programs that could help lower your prescription costs?”

• “Would you like some assistance in applying for these programs to help lower your prescription costs?”

Listen for keywords that indicate need.

49

Sales Tip

When discussing a consumer’s

current coverage,

inquire about what they pay

for prescriptions,

if the costs are lower

than the plan benefits they

may be on LIS.

When discussing a consumer’s

current coverage,

inquire about what they pay

for prescriptions,

if the costs are lower

than the plan benefits they

may be on LIS.

Revised 02/02/2011

Assistance – Position a Solution

Position Acknowledge the consumers 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?

50

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.

Prior to assisting a consumer

with either LIS or a state

pharmaceutical program review the

application to ensure it can be completed

easily.

Revised 02/02/2011

Assistance – Position a Solution con’d

Position Outline the program

• “Mrs. Frank, ‘Extra Help’ is a program by the Social Security Administration and it helps beneficiaries lower their prescription costs.”

• “Mr. Frank, The Department of Heath and Senior Services has a program called Pharmaceutical Assistance to the Aged and Disabled….”

Determine if they qualify• “Mrs. Adams, would you mind if I ask you a few questions about your finances to

see if you qualify?”

• “Mr. Adams, is your annual income less than a certain amount?”

51

Sales Tip

When trying to determine if a consumer

meets the program

qualifications always ask if they make

less than the maximum amount.

When trying to determine if a consumer

meets the program

qualifications always ask if they make

less than the maximum amount.

Revised 02/02/2011

Assistance – Position a Solution con’d

Position Complete the application

• “Mrs. Washington, in order to complete the application I’d like to ask you a few detailed financial questions. Are you comfortable with that?

• “Mr. Washington, once you’ve answered a few questions we can submit the application to lower your prescription costs.

Follow-up• “Mrs. Jones, you will be receiving a letter in about 14 business days that will

indicate if you’ve been enrolled in the program. When you get that letter will you please call me?”

• “Mr. Jones, if you don’t mind I’d like to give you a call back in two weeks to see if you’ve been accepted into the program.”

52

Sales Tip

Request brochures from the

Social Security Administratio

n and state departments that outline

the programs. The

brochures will validate your discussion.

Request brochures from the

Social Security Administratio

n and state departments that outline

the programs. The

brochures will validate your discussion.

Revised 02/02/2011

Assistance Do’s Don’ts

DO DON’TEncourage 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 the consumer will automatically be eligible for the program.

Inform the consumer that eligibility is determined by Social Security Administration or a state agency, and not the health plan.

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 a Bravo Health 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 DrugPlan.

Imply that the prescription benefit is unique to Bravo Health plans.

53

Revised 02/02/2011

Question & Answers

What questions do you have?

54

Documents

Revised 02/02/2011 1 Low Income Subsidy & Enrollment Assistance Creating Special Election Periods through the Medicare Part D Low-Income Subsidy (LIS)