Medicare Compliance & Reimbursement

Make your mantra 'When in doubt, fill it out'

If some of your customers are among the millions who could benefit from Part D paired with a Low Income Subsidy (LIS), take note: Finding--and qualifying for--the assistance may not be as difficult as you think.

Ka-ching: The LIS can be very valuable for Part D enrollees: The average annual value of the benefit to a person with Medicare who qualifies for the LIS is $3,700, according to the Centers for Medicare & Medicaid Services and the Social Security Administration.

That means beneficiaries have fewer woes paying out-of-pocket costs; they're also more likely to adhere to their needed drug regimens and achieve better outcomes.

A beneficiary who qualifies for LIS can enroll in a Medicare prescription drug plan (PDP) through Dec. 31 and pay no late enrollment penalty.

Ask And You May Receive

LIS assistance is available for those who meet certain income and asset criteria, but more beneficiaries may meet the cut-offs than expect to. Resources not included toward the limit are your client's home, vehicles, burial plots or personal possessions.

If your client's income or resources are slightly higher than the limits listed below, you should still complete the application, urges Howard Bedlin, vice president of public policy and advocacy for the National Council On Aging in Washington, DC.

Why? The Social Security Administration allows other deductions that may make the person LIS eligible.

Step 1: Get the ball rolling. To begin to see if a beneficiary is eligible, refer him to www.BenefitsCheckUp.org, a service of the National Council On Aging.

The beneficiary or his legal representative can also visit the Web site www.socialsecurity.gov or call Social Security at 800-772-1213 (or 800-325-0778 for TTY).

Step 2: Know your options. Medicare beneficiaries can apply for LIS using the forms and process established by the Social Security Administration or through a process set up by their state's Medical Assistance (Medicaid) office.

Tip: Applying through the Social Security Administration is most common, but there are some instances in which it may be advantageous to submit the LIS application through the state Medicaid office. This may be true in cases where beneficiaries have incomes and resources above the federal limits set in the Social Security application process.

Some states have more generous eligibility limits for their Medicare Savings Programs (e.g., no asset test, higher asset limits allowed), coaches the Washington, DC-based Access To Benefits Coalition.

Beneficiaries who are enrolled in a Medicare Savings Program are automatically "deemed eligible" for LIS even if they would not qualify under Social Security Administration's federal eligibility limits for the subsidy. That means that encouraging your client to apply through a Medicaid office may in some cases provide a "back door" entrance to LIS help.

Step 3: Fill in the [...]