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We are within the first 9 months of the year (the MDE enrollment code may not be used from Oct-Dec).
Verify they have not already used their quarterly SEP this quarter (only one MDE enrollment may be used per quarter).
Quarter 1: January 1 - March 31
Quarter 2: April 1- June 30
Quarter 3: July 1 - September 30
The enrollment quarters are based on the submission date, not the effective date. Example: If a customer submitted an application on March 15th for an April 1st effective date, this is considered a quarter 1 enrollment. The customer would still be able to change plans in quarter 2.
If a customer has Medicaid, this means they also qualify for LIS/Extra Help. When quoting Medications, quote the non-LIS pricing as well as the LIS pricing.
Example: “I am now going to quote you the prescription pricing that would apply if you did not qualify for Extra Help followed by the pricing you should expect to pay as long as you remain qualified for Extra Help.”
2021 LIS Table
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Level
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Deductible
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Generic/Preferred Drugs
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Other Drugs
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Above Catastrophic Limit
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Level 1
...
$0
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$3.70**
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$9.20**
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$0.00
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Level 2
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$0
...
$1.30**
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$4.00**
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$0.00
...
Level 3
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$0
...
$0.00
...
$0.00
...
$0.00
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Level 4
(25% Subsidy)
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$92
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15% Coinsurance
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15%
Coinsurance
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$3.70 or 5% whichever is greater
$9.20 or 5% whichever is greater
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Level 4
(50% Subsidy)
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$92
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15% Coinsurance
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15%
Coinsurance
...
$3.70 or 5% whichever is greater
$9.20 or 5% whichever is greater
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Level 4
(75% Subsidy)
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$92
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15% Coinsurance
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15%
Coinsurance
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$3.70 or 5% whichever is greater
$9.20 or 5% whichever is greater
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Level 4
(100% Subsidy)
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$92
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15% Coinsurance
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15%
Coinsurance
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$3.70 or 5% whichever is greater
$9.20 or 5% whichever is greater
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Right-Click Here and open in a new tab to view the 2021 LIS Table.
When quoting plans, check the Summary of Benefits (SOB) to verify what levels of Medicaid the plan accepts. Every D-SNP accepts FBDE. Use Ctrl+F to easily locate the levels of Medicaid the plan accepts within the SOB. The example below confirms this Anthem plan accepts FBDE, QMB, and QMB+.
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