Medicaid/LIS

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” plate:

1. Indicate if the shopper has Medicaid. If “Yes” or “Unsure,” move to step 2.

2. Proceed to “Look up Medicaid info.”

Use either Jarvis or Vantage portals to verify Medicaid eligibility.

• Richt-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.
  
  Note - It is better to use Jarvis if possible because you may enter either the Medicaid or Medicare number to verify eligibility. Vantage requires the Medicaid or Social Security number along with the Medicare number.

Now that Medicaid information is verified:

1. Select the level of Medicaid.

2. Enter the Medicaid number.

3. Click “Save & Next.”

The next plate will indicate the customer qualifies:

Before you read this scripting to the customer, first identify:

• 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

 ** Co-payments for 30-day supply is the same for a 90-day supply

• 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+.

  

Tip: Be aware that the Routine Costs within the Plan Features section of D-SNP plans will likely indicate a 20% Dr. coinsurance.

This is not accurate. To see the correct $0 copay, you may verify by using this link to open Sunfire Blaze in a new tab or navigate to the “Medical Benefits Description” plate.

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 will have a $0 copay.

Tip: Be aware that 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.

Enrollment Reasons