Transcription
Low Income Subsidy / Extra Helpand Enrollment Assistance2016
ObjectivesAfter actively participating in this session, agents should beable to: Identify the value of assisting LISeligible consumers. Identify features and benefits of theLow Income Subsidy (LIS) program. Recognize general criteria that mayqualify consumers for LIS. Assist consumers in seekingcandidacy for LIS. Use bConnected to track consumers’LIS enrollment (if applicable).Confidential property of UnitedHealth Group. For Agent use only. Not intended for use as marketing materials for the general public. Donot distribute, reproduce, edit or delete any portion without express permission of UnitedHealth Group.4.6.162
LOW INCOME SUBSIDY / EXTRA HELPIntroduction3
l property of UnitedHealth Group. For Agent use only. Not intended for use as marketing materials for the general public. Donot distribute, reproduce, edit or delete any portion without express permission of UnitedHealth Group.4.6.164
What is LIS / Extra Help?A federal subsidy programthat helps low-incomeMedicare-eligibleconsumers save moneyon their prescriptioncosts and other relatedPart D costs.Confidential property of UnitedHealth Group. For Agent use only. Not intended for use as marketing materials for the general public. Donot distribute, reproduce, edit or delete any portion without express permission of UnitedHealth Group.4.6.165
Plan Enrollment Opportunities“SEP – LIS”?LIS-qualified consumershave a continuouselection periodand can change theirplan at any time!Confidential property of UnitedHealth Group. For Agent use only. Not intended for use as marketing materials for the general public. Donot distribute, reproduce, edit or delete any portion without express permission of UnitedHealth Group.4.6.166
ROLESProgram Administration and Consumer Assistance7
Who administers the program?Social SecurityAdministration(SSA)LISProgramConfidential property of UnitedHealth Group. For Agent use only. Not intended for use as marketing materials for the general public. Donot distribute, reproduce, edit or delete any portion without express permission of UnitedHealth Group.4.6.168
Consumer ConsiderationsSSALISProgram The SSA decides who qualifies The SSA determines the benefit level The SSA processes LIS applicationsConfidential property of UnitedHealth Group. For Agent use only. Not intended for use as marketing materials for the general public. Donot distribute, reproduce, edit or delete any portion without express permission of UnitedHealth Group.4.6.169
Who administers the program?SSALISProgram Who qualifies Benefit level LIS applicationsConfidential property of UnitedHealth Group. For Agent use only. Not intended for use as marketing materials for the general public. Donot distribute, reproduce, edit or delete any portion without express permission of UnitedHealth Group.4.6.1610
Your Sales Role Help consumers understand how theLIS program may work for them. Assist consumers in completingtheir LIS application. Consider that consumers mayhave unique plan needs based ontheir limited income and resources. Explain that a change in theconsumer’s status maychange their eligibility for LIS.Confidential property of UnitedHealth Group. For Agent use only. Not intended for use as marketing materials for the general public. Donot distribute, reproduce, edit or delete any portion without express permission of UnitedHealth Group.4.6.1611
LIS PROGRAMFeatures and Benefits12
Program Benefits Medicare Part D plan premium Annual deductible Prescription coinsurance andcopayments Assistance to cover prescriptioncosts Coverage in the gap Assistance with Medicare Part DLate Enrollment Penalty costsBenefit levels vary by consumer,as determined by the SSA.Confidential property of UnitedHealth Group. For Agent use only. Not intended for use as marketing materials for the general public. Donot distribute, reproduce, edit or delete any portion without express permission of UnitedHealth Group.4.6.1613
Program Benefits Medicare Part D plan premium Annual deductible How does the subsidy helpcover a consumer’s planpremium and/or deductible?Confidential property of UnitedHealth Group. For Agent use only. Not intended for use as marketing materials for the general public. Donot distribute, reproduce, edit or delete any portion without express permission of UnitedHealth Group.4.6.1614
Program Benefits Prescription coinsurance andcopayments Assistance to cover prescriptioncosts Coverage in the gapWhat prescription cost savings may applyfor an eligible consumer?Confidential property of UnitedHealth Group. For Agent use only. Not intended for use as marketing materials for the general public. Donot distribute, reproduce, edit or delete any portion without express permission of UnitedHealth Group.4.6.1615
Program BenefitsHow does LISeligibility impact theLate EnrollmentPenalty? Assistance with Medicare Part DLate Enrollment Penalty costsConfidential property of UnitedHealth Group. For Agent use only. Not intended for use as marketing materials for the general public. Donot distribute, reproduce, edit or delete any portion without express permission of UnitedHealth Group.4.6.1616
LISQualifications17
Qualifications Medicare consumers who are orwill be enrolled in a MedicarePart D plan Based on the consumer’s incomeand resources U.S. citizen or legal resident(includes 50 states and District of Columbia)Confidential property of UnitedHealth Group. For Agent use only. Not intended for use as marketing materials for the general public. Donot distribute, reproduce, edit or delete any portion without express permission of UnitedHealth Group.4.6.1618
Automatic Qualification Full Benefit Dual Eligibles(i.e. Medicare and full Medicaid coverage) Supplemental Security Income (SSI)Recipients with Medicare Medicare Savings ProgramsParticipants Qualified Medicare Beneficiaries (QMB)Specified Low Income Medicare Beneficiaries (SLMB)Qualifying Individuals (QI)Qualified Disabled Working Individual (QDWI)Confidential property of UnitedHealth Group. For Agent use only. Not intended for use as marketing materials for the general public. Donot distribute, reproduce, edit or delete any portion without express permission of UnitedHealth Group.4.6.1619
RequalificationWhat actions do automatically-qualifiedconsumers need to take? No action required forconsumers who receive the‘purple letter’ LIS reapplication requiredfor consumers who losetheir Medicaid status My Advocate will contact identifiedmembers Medicare Savings Program(MSP)-eligible individualsmust reapply for their stateMSP annuallyConfidential property of UnitedHealth Group. For Agent use only. Not intended for use as marketing materials for the general public. Donot distribute, reproduce, edit or delete any portion without express permission of UnitedHealth Group.4.6.1620
QualificationIncome Wages&Resources Real estate Social Security Income Bank accounts Annuities (as income) Cash Support from other familymembers Stocks and bonds Mutual funds Annuities (as investments) Individual RetirementAccounts (IRAs)Confidential property of UnitedHealth Group. For Agent use only. Not intended for use as marketing materials for the general public. Donot distribute, reproduce, edit or delete any portion without express permission of UnitedHealth Group.4.6.1621
Qualification LevelsIncome Levels150% of Federal Poverty Level (2016)*IndividualMarriedYearly Gross Income 17,820 24,030Monthly Gross Income 1,485 2,003*Income limits may vary for Alaska & Hawaii. Additionally income limits may behigher with additional dependents.Resource Levels150% of Federal Poverty Level (2016)ResourcesIndividualMarried 13,640 27,250Confidential property of UnitedHealth Group. For Agent use only. Not intended for use as marketing materials for the general public. Donot distribute, reproduce, edit or delete any portion without express permission of UnitedHealth Group.4.6.1622
Qualification LevelsIncome Levels150% of Federal Poverty Level (2016)*IndividualMarriedYearly Gross Income 17,820 24,030Monthly Gross Income 1,485 2,003*Income limits may vary for Alaska & Hawaii. Additionally income limits may behigher with additional dependents.ConsumersMary and BobResource Levels Annual incomeof 21,400150% of Federal Poverty Level (2016) Total resourcesof 28,000ResourcesIndividualMarried 13,640 27,250Marginally exceedlimits; submitapplication in caseother circumstances.Confidential property of UnitedHealth Group. For Agent use only. Not intended for use as marketing materials for the general public. Donot distribute, reproduce, edit or delete any portion without express permission of UnitedHealth Group.4.6.1623
Qualification LevelsIncome Levels150% of Federal Poverty Level (2016)*IndividualMarriedYearly Gross Income 17,820 24,030Monthly Gross Income 1,485 2,003ConsumerEllen(Within 20)Resource Levels150% of Federal Poverty Level (2016)ResourcesIndividualMarried 13,640 27,250 Monthly grossincome of 1,505 Total resourcesof 12,000Yes – Submit theapplication.Confidential property of UnitedHealth Group. For Agent use only. Not intended for use as marketing materials for the general public. Donot distribute, reproduce, edit or delete any portion without express permission of UnitedHealth Group.4.6.1624
ScenarioAssist Carlos inunderstandinghis potentialeligibility forExtra Help Confidential property of UnitedHealth Group. For Agent use only. Not intended for use as marketing materials for the general public. Donot distribute, reproduce, edit or delete any portion without express permission of UnitedHealth Group.4.6.1625
ScenarioIncome Wages Social SecurityIncome 1,100 monthly Annuities (as income) Support from otherfamily members 200 monthly Support forhouseholdexpenses 200 monthlyTotal Income: 1,300Individual Limit –Monthly Gross Income 1,485Confidential property of UnitedHealth Group. For Agent use only. Not intended for use as marketing materials for the general public. Donot distribute, reproduce, edit or delete any portion without express permission of UnitedHealth Group.4.6.1626
ScenarioIncomeResources Wages Real estate Social SecurityIncome 1,100 monthly Support from otherfamily members 200 monthly Support forhouseholdexpenses 400 Cash 100 200 monthly 1,485 2,000 Mutual funds Annuities (as investments) IRAsTotal Income: 1,300Individual Limit –Monthly Gross Income Bank accounts Stocks and bonds Annuities (as income) 5,000 Home value 5,000 120,000 Vehicle Personal property 500 2,000 Life insurance 2,500Total Resources: 12,500Individual Limit – Resources 13,640Confidential property of UnitedHealth Group. For Agent use only. Not intended for use as marketing materials for the general public. Donot distribute, reproduce, edit or delete any portion without express permission of UnitedHealth Group.4.6.1627
ResourcesWhere can you find the currentLIS qualification levels? United Distribution Portal (UDP)(Distribution or Producer website)www.unitedhealthproducers.com orwww.unitedhealthadvisors.com SSA websitewww.socialsecurity.gov/prescriptionhelp/ UHCMedicareSolutions.com idential property of UnitedHealth Group. For Agent use only. Not intended for use as marketing materials for the general public. Donot distribute, reproduce, edit or delete any portion without express permission of UnitedHealth Group.4.6.1628
ResourcesConfidential property of UnitedHealth Group. For Agent use only. Not intended for use as marketing materials for the general public. Donot distribute, reproduce, edit or delete any portion without express permission of UnitedHealth Group.4.6.1629
SALES CONVERSATIONDetermining Needs for LIS Consumers30
Conversation TriggersWhat might a consumer sayto indicate they may be acandidate for LIS?Confidential property of UnitedHealth Group. For Agent use only. Not intended for use as marketing materials for the general public. Donot distribute, reproduce, edit or delete any portion without express permission of UnitedHealth Group.4.6.1631
Recognizing Financial ConcernsSocial Security constituted90% or more of the incomereceived by 35% of all SocialSecurity beneficiariesSeniors average 5,069in out-of-pocket healthcare expenses,an increase of 35%since 2003.Seniors spend anaverage of 12.2% oftheir income onhealth, almosttwice spent by allconsumers (6.7%)Seniors living alone weremuch more likely to be poor (16.7%)than those living with familyThe highest poverty rates wereexperienced by Hispanic women (45.4%)Over 4.2 million seniors (9.5%) were belowthe poverty level in 2013:7.4% are Caucasians 17.6% are African-Americans13.6% are Asians19.6% are HispanicsHigher than average poverty rateswere found in seniors wholived in principal cities (12.9%),and in the South (11%)Older women havea higher poverty ratethan older menAnother 2.5 million seniors areclassified as “near poor” with incomesbetween the Federal Poverty Level (FPL)and 125% of the FPL* “A Profile of Older Americans: 2014” Administration on Aging U.S. Department of Health and Human ServicesConfidential property of UnitedHealth Group. For Agent use only. Not intended for use as marketing materials for the general public. Donot distribute, reproduce, edit or delete any portion without express permission of UnitedHealth Group.4.6.1632
Mentioning Extra HelpHow do you mention Extra Help as a possible option forappropriate consumers?What do you do if the consumer has already qualified forLIS assistance?What should you cover in the Need Dialogue for LIScandidates?What should you consider in determining and positioning aplan for consumers who may be eligible for LIS?Confidential property of UnitedHealth Group. For Agent use only. Not intended for use as marketing materials for the general public. Donot distribute, reproduce, edit or delete any portion without express permission of UnitedHealth Group.4.6.1633
ASSISTING THE CONSUMERThe LIS Application34
Application Assistance MethodsAgent AssistMy AdvocateAssistPreferredoption!SSA AssistConfidential property of UnitedHealth Group. For Agent use only. Not intended for use as marketing materials for the general public. Donot distribute, reproduce, edit or delete any portion without express permission of UnitedHealth Group.4.6.1635
Accessing the LIS ApplicationApply through the Social Security Administration (SSA): Complete and submit the application Application is reviewed by SSA Letter will notify the consumer if qualifiedPaper Form /SSA Assistance:SSA at 1-800-772-1213 (TTY 1-800-325-0778)Online ial property of UnitedHealth Group. For Agent use only. Not intended for use as marketing materials for the general public. Donot distribute, reproduce, edit or delete any portion without express permission of UnitedHealth Group.4.6.1636
Medicare Savings Program ApplicationSubmitting the LIS applicationstarts the applicationprocess for the MedicareSavings Program in theconsumer’s state, when available.Confidential property of UnitedHealth Group. For Agent use only. Not intended for use as marketing materials for the general public. Donot distribute, reproduce, edit or delete any portion without express permission of UnitedHealth Group.4.6.1637
Information for the LIS ApplicationGovernment-based Information: Social Security card Letters from Medicare Most recent Social Security benefits award letters Railroad retirement benefits Veteran benefitsPersonal Financial Information: Tax returns Payroll slips Bank account statements: checking, savings,certificates of deposit Investment information: IRAs, stocks, bonds, savingsbond, mutual fund, other investment statements Pensions AnnuitiesConfidential property of UnitedHealth Group. For Agent use only. Not intended for use as marketing materials for the general public. Donot distribute, reproduce, edit or delete any portion without express permission of UnitedHealth Group.4.6.1638
Application TipsTo help avoid delays in application processing, follow these tips: Use the original paper form orapply online Enter consumer’s name andnumber exactly as it appears onofficial documents The consumer’s Social Security orRailroad Retirement Board numbermust be includedPaper Applications Only: Use black ink Return the entire applicationpackage Do not send other items such asphysician bills, prescription lists,Internal Revenue Service forms, etc. Do not mark off both the Yes andNo boxes in any sectionConfidential property of UnitedHealth Group. For Agent use only. Not intended for use as marketing materials for the general public. Donot distribute, reproduce, edit or delete any portion without express permission of UnitedHealth Group.4.6.1639
Application Details – Paper1. Contact Information2.22.12Confidential property of UnitedHealth Group. For Agent use only. Not intended for use as marketing materials for the general public. Donot distribute, reproduce, edit or delete any portion without express permission of UnitedHealth Group.4.6.1640
Application Details – Paper2. Spouse Information2.22.12Confidential property of UnitedHealth Group. For Agent use only. Not intended for use as marketing materials for the general public. Donot distribute, reproduce, edit or delete any portion without express permission of UnitedHealth Group.4.6.1641
Application Details – Paper3. Income2.22.12Confidential property of UnitedHealth Group. For Agent use only. Not intended for use as marketing materials for the general public. Donot distribute, reproduce, edit or delete any portion without express permission of UnitedHealth Group.4.6.1642
Application Details – Paper4. Resources2.22.12Confidential property of UnitedHealth Group. For Agent use only. Not intended for use as marketing materials for the general public. Donot distribute, reproduce, edit or delete any portion without express permission of UnitedHealth Group.4.6.1643
Application Details – Paper5. – 7. Burial Expenses, Real Estate, Relatives Supported2.22.12Confidential property of UnitedHealth Group. For Agent use only. Not intended for use as marketing materials for the general public. Donot distribute, reproduce, edit or delete any portion without express permission of UnitedHealth Group.4.6.1644
Application Details – Paper8. – 9.Other Income2.22.12Confidential property of UnitedHealth Group. For Agent use only. Not intended for use as marketing materials for the general public. Donot distribute, reproduce, edit or delete any portion without express permission of UnitedHealth Group.4.6.1645
Application Details – Paper10. – 14.Wages2.22.12Confidential property of UnitedHealth Group. For Agent use only. Not intended for use as marketing materials for the general public. Donot distribute, reproduce, edit or delete any portion without express permission of UnitedHealth Group.4.6.1646
Application Details – Paper15. Medicare Savings Program2.22.12Confidential property of UnitedHealth Group. For Agent use only. Not intended for use as marketing materials for the general public. Donot distribute, reproduce, edit or delete any portion without express permission of UnitedHealth Group.4.6.1647
Application DetailsSignaturesNote:The electronic Extra Helpapplication does not requirea consumer’s signature.2.22.12Confidential property of UnitedHealth Group. For Agent use only. Not intended for use as marketing materials for the general public. Donot distribute, reproduce, edit or delete any portion without express permission of UnitedHealth Group.4.6.1648
LIS Award LetterThe SSA will send a notice ofapproval / denial to the consumerin 15-30 business days.2.22.12Confidential
(Distribution or Producer website) www.unitedhea
