A great place in the call to verify LIS is on the “Medicare Determine Eligibility” plate.
...
Right-click and open this link in a new tab to open the step-by-step Marx guide.
Follow the instructions in the guide to determine:
Customer’s name as it appears on their Medicare card
Date of Birth
Address
Part A/B eff dates
Current plan along with plan’s effective date
LIS (Low Income Subsidy) level
Note: If customer does not have LIS, they do not have Medicaid.
On the “Medicare Verify Coverage 2” On the “Verify Coverage” plate:
Indicate if the shopper has Medicaid. If “Yes” or “Unsure,” move to step 2.
Proceed to “Look up Medicaid info.”
...
Use either Vantage, Jarvis, or Vantage mProducer portals to verify Medicaid eligibility.
Richt-Right click and open in a new tab for the Jarvis (UHC) step-by-step guide.
Right click and open in a new tab for the Vantage (Humana) step-by-step guide.
Right click and open in a new tab for the mProducer (Anthem) step-by-step guide.
Note - It is better to use Jarvis if possible Vantage because you may enter can use either the Medicaid ID or Medicare Social Security number to verify eligibility. Vantage Jarvis requires the Medicaid or Social Security number along with the Medicare numberID number to verify eligibility.
Now that Medicaid information is verified:
...
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
...
Level
...
Deductible
...
Generic/Preferred Drugs
...
Other Drugs
...
Above Catastrophic Limit
...
Level 1
...
$0
...
$3.70**
...
$9.20**
...
$0.00
...
Level 2
...
$0
...
$1.30**
...
$4.00**
...
$0.00
...
Level 3
...
$0
...
$0.00
...
$0.00
...
$0.00
...
Level 4
(25% Subsidy)
...
$92
...
15% Coinsurance
...
15%
Coinsurance
...
$3.70 or 5% whichever is greater
$9.20 or 5% whichever is greater
...
Level 4
(50% Subsidy)
...
$92
...
15% Coinsurance
...
15%
Coinsurance
...
$3.70 or 5% whichever is greater
$9.20 or 5% whichever is greater
...
Level 4
(75% Subsidy)
...
$92
...
15% Coinsurance
...
15%
Coinsurance
...
$3.70 or 5% whichever is greater
$9.20 or 5% whichever is greater
...
Level 4
(100% Subsidy)
...
$92
...
15% Coinsurance
...
15%
Coinsurance
...
$3.70 or 5% whichever is greater
$9.20 or 5% whichever is greater
** Co-payments for 30-day supply is the same for a 90-day supply
...
Right-Click Here and open in a new tab to view the 2022 LIS Table.
When quoting plans, the “Plan Decider Plate” should only show plans that the beneficiary qualifies for, based on the information you previously entered. You can also 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+.
Tip: Be aware that the The Routine Costs within the Plan Features section of D-SNP plans will likely indicate a 20% Dr. coinsurancecoinsurance for doctor’s visits and hospital stays.
...
This is not accurate. To see the correct $0 copaycopays, you may verify by using this link to open Sunfire Blaze in a new tab or navigate to the “Medical Benefits Description” plate.
...
open the Summary of Benefits for the plan. It is advisable to open the Summary of Benefits on EVERY D-SNP plan to verify that you are providing accurate information.
A screenshot of the Medical Benefits Description Plate is below. Notice the copay/coinsurance says either $0 or 20% depending on Medicaid level but participants with a D-SNP FBDE, QMB, or QMB+ Medicaid Levels will have a $0 copay. All other levels of Medicaid can expect to pay 20% coinsurance on this plan, and may benefit more from a different D-SNP plan or regular MAPD plan.
...
Tip: Be aware that the The application allows agents to indicate the participant does not have Medicaid. The agent must indicate Medicaid eligibility and enter the Medicaid number on the app for a D-SNP enrollment.
Sales Tips:
Utilize verbiage such as “a DSNP plan is a plan that will help coordinate your Medicare and Medicaid benefits.”
Focus on the extra benefits that a DSNP’s plans offer
Over the counter benefits
Dental
Vision
Hearing
Healthy food cards
Flex cards
Enrollment Reasons
Plan | Medicare Code/Reason | Dialer Code/Reason | Uses |
|---|---|---|---|
MA/MAPD/PDP |
MDE |
MDE | May |
be used |
MA-Only
ICEP
ICEP
May not be used again after the plan goes into effect
Medigap
GI
GI
once per quarter if shopper currently has Medicaid. | |||
MA/MAPD/PDP | MCD | MCD | May be used if they had a Change to their Medicaid status this month, or within the past 2 months. |
Medigap | NA | NA | It is usually illegal to sell a Medigap to a Medicaid participant |