Best Way to Handle those Eligible for Extra Help and MSPs?

[beachbum2012]

I seem to be running into more and more folks during T65 visits that based on their income and asset amounts should qualify for some level of state assistance for Medicare. If I find out that as single/married they make less than $17,235/$23,265 annually, and have less than the thresholds for asset amounts too, I'll start explaining about Extra Help and Medicare Savings Programs. I'll show them what Parts A, B, & D of Medicare cover, what the premiums and cost shares usually are with them, then based on exactly their level of income and assets what they can probably qualify for as far as getting the various premiums, deductibles, etc. paid for. Since by this point, they've almost always told me they "can't afford any insurance", I instruct them to go to the local Social Security office and apply for Extra Help and MSPs, and see what they can get. Then after this, I mention, I can help them cover the remainders of what's left.

The problem is that I rarely hear from these folks again. Even though I'll give them explicit instructions on what to ask to apply for or what they should qualify for, they either don't get back with me or answer/return my follow up calls. I'm trying to help these folks get all the assistance they're entitled to and then enroll them in a D-SNP or Plan N or something (whatever's appropriate in their case), but I rarely end up getting the chance.

How do you guys handle these situations? Are you possibly going to the Social Security office with them? If you call Medicare or the SSA with them in this first appointment, will they be able to give an answer right away about what the beneficiary can qualify for, or is there an application and approval process that takes several weeks? If they could give an answer quickly, would it be available for someone still 6 months out, or maybe they'd have a better idea when their T65 month gets closer? I know Medicare will send letters to beneficiaries letting them what help they qualify for, but this seems to be more of the exception that the norm. Earlier this week, I talked to a 72 y/o guy who has A & B with no other supplement, whose only income is ~$1,100 of Social Security, and they've always taken the Part B premium out of his check. This doesn't seem right.

Anyway, any advice or helpful experiences are appreciated!

 

[kstein]

What stops you from enrolling them in a plan just like they are not eligible? I usually help them enroll via SSA.gov. it takes 20 min and then continue the presentation.

I try to enroll them into a plan that meeting if possible and then follow up and adjust after you see what level they qualify for.

While rare, they have rolling sep to switch if need be.

For part D, I would choose a plan that coordinates to $0 under extra help which can be picked at medicare.gov

 

[yorkriver1]

That's great detail on the process. Thanks. I have a couple of these now. Good reminder that if the first plan we do isn't quite a fit, they can change month to month. Of course, we don't want a bunch of 1st coverage quarter lapses, but good backstop for any issues that might come up.

I have helped one or two with the online LIS application. We can even do that with client over the phone, sign on as their helper for the online app.

Here's the link for the online extra help app. It took me a bit of searching the 1st time I did one of these: https://secure.ssa.gov/i1020/start

One prospect is eligible for Medicare to start in 3 months. On that one, I figured go ahead and do the app, work out what plan to put her on.

In my state if they are all the way Medicaid eligible as a QMB+ we agents are now forbidden to tell them detail about the non-agent involved HMO's that take over their coverage. There is a number to call for them to get information and enroll if they haven't been already. Have to be cautious here. With some very low income, I am doing LIS + request for full review of eligibility for further help first. It's then out of my hands if they are QMB+. I can call Humana to check that status.

 

[yogooglethis]

I seem to be running into more and more folks during T65 visits that based on their income and asset amounts should qualify for some level of state assistance for Medicare. If I find out that as single/married they make less than $17,235/$23,265 annually, and have less than the thresholds for asset amounts too, I'll start explaining about Extra Help and Medicare Savings Programs. I'll show them what Parts A, B, & D of Medicare cover, what the premiums and cost shares usually are with them, then based on exactly their level of income and assets what they can probably qualify for as far as getting the various premiums, deductibles, etc. paid for. Since by this point, they've almost always told me they "can't afford any insurance", I instruct them to go to the local Social Security office and apply for Extra Help and MSPs, and see what they can get. Then after this, I mention, I can help them cover the remainders of what's left.

The problem is that I rarely hear from these folks again. Even though I'll give them explicit instructions on what to ask to apply for or what they should qualify for, they either don't get back with me or answer/return my follow up calls. I'm trying to help these folks get all the assistance they're entitled to and then enroll them in a D-SNP or Plan N or something (whatever's appropriate in their case), but I rarely end up getting the chance.

How do you guys handle these situations? Are you possibly going to the Social Security office with them? If you call Medicare or the SSA with them in this first appointment, will they be able to give an answer right away about what the beneficiary can qualify for, or is there an application and approval process that takes several weeks? If they could give an answer quickly, would it be available for someone still 6 months out, or maybe they'd have a better idea when their T65 month gets closer? I know Medicare will send letters to beneficiaries letting them what help they qualify for, but this seems to be more of the exception that the norm. Earlier this week, I talked to a 72 y/o guy who has A & B with no other supplement, whose only income is ~$1,100 of Social Security, and they've always taken the Part B premium out of his check. This doesn't seem right.

Anyway, any advice or helpful experiences are appreciated!

When you say you have been " running into more and more folks during T65 visits that based on their income and asset amounts should qualify for some level of state assistance for Medicare " I assume because you say you are planning on discussing PDP and MA that these visits are scheduled in home appointments with a signed SOA that were scheduled from inbound calls or BRC responses as a result of advertising.If so it's not too hard to get a good idea of the prospects financial situations just by asking a few questions and listening for some tell tale signs of a person who is no stranger to entitlements.

I find that these people are always looking for help and will usually will gladly tell you on the phone before your appointment all the info you need to know including what their income is so you can have a pretty good idea of what they are going to buy.If they are reluctant to give you info which is rare for the vry low income clientele you can use Google maps to look at where they live to give you a pretty good idea if it's going to be a SNP or a Med supp prospect.

I carry the Medicare Savings Program applications with me and fill them out and fax it to the local DCF office for those who qualify.FYI in Fl anyway if someone is just getting medicare for the first time you want to wait until no less than 30 days out to send the MSP application to DCF because if you send it 2 or 3 months prior it won't get processed.After I do this I monitor the progress of the application by calling the automated phone line of DCF at 1-866-762-2237 and call the client once it approved to give them the good news

 

[yorkriver1]

Yogooglethis, you have inspired me to dig deeper, learn more about MSP/Medicaid.
I want to help in the right way, stay out of trouble with our insurance commissioner's office. We have current stories of agents being called on the carpet for possibly steering folks away from the non-agent involved plan for QMB+ beneficiaries. We are not to discuss the plan with beneficiaries, just refer them.
One of my LIS app beneficiaries isn't eligible for Medicare until July 1. Will get her referred to our QMB+ plan folks, as her SS income is $524 or so.
She just received her full LIS letter. We ticked the box to have her app referred on for MSP/Medicaid consideration, not sure if that will happen, since she is 90 days out from benefit start date.
I am saving docs to my desktop with the MSP/Medicaid info so I can be compliant and get involved appropriately.

 

[Bobster999]

Good info here. Thanks

 

[CALTCAgent]

How do you help people apply for MSP ?

If you do apply for MSP, does it trigger a check to see if qualified for Medi-Cal/Medicaid ?

When you assist someone to apply online for LIS, do you put your contact info under "other" or apply like they are applying themselves?

What is the difference between SLMB & QI, looks like the same benefit, but QI lets you have higher income?

Thanks!

 

[yogooglethis]

How do you help people apply for MSP ?

If you do apply for MSP, does it trigger a check to see if qualified for Medi-Cal/Medicaid ?

When you assist someone to apply online for LIS, do you put your contact info under "other" or apply like they are applying themselves?

What is the difference between SLMB & QI, looks like the same benefit, but QI lets you have higher income?

Thanks!

First carry this eligibility grid with you for your state. I'm in Florida so I use this http://www.dcf.state.fl.us/programs/access/docs/ssi_fin_elig_chart.pdf

I use this paper " short form " for the Medicaid/Medicare Buy In Application and fax it to the DCF office in the county where the applicant resides: www.dcf.state.fl.us/DCFForms/Search/OpenDCFForm.aspx?FormId=464

Sometimes a person doesn't qualify because of income but they may be supporting grandchildren, blind etc. and this is factored in .If so then you may want to do the application online at your states DCF website because they ask many more questions about expenses and these additional expenses may make them qualify whereas the " short form" doesn't allow for this additional information to be provided.

I also carry the LIS income qualifications details on a separate sheet and staple all 3 of these together so that I am loaded for bear when I find duallies in my crosshairs. Usually I tear off the eligibility grid and leave it with the client if I submit an application for them. It is also is a good opportunity to ask the client if they know anybody else who may qualify for a MSP and they seem to try extra hard to come up with names of people they know who would like an extra 104.90 a month. Many times it's cousins and aunts already living in the same household !

 

[CALTCAgent]

I use this paper " short form " for the Medicaid/Medicare Buy In Application and fax it to the DCF office in the county where the applicant resides:

So they apply for both medicaid and MSP at the same time ?

Is there a way to apply for only MSP if the person does not want medicaid ?

Another factor I am considering is that some counties sign the Medi-Cal beneficiary up for a dual eligible plan with no agent involvement.

I don't know anything about those plans. I would think there is not much incentive for the agent.

I also carry the LIS income qualifications details on a separate sheet and staple all 3 of these together so that I am loaded for bear when I find duallies in my crosshairs.

Does applying online for LIS or elsewhere trigger anything regarding Medicaid & MSP application to be sent to the client?

Or is it just for LIS only ?

 

[kstein]

Msp is state specific and the income and asset restrictions will differ. The same is true for SPAPs. Extra help and LIS are federal benefits and offered through SSA.gov.

In Missouri if a client wants MSP only I'd simply apply through dfs.gov or direct them to the state entity. If they qualify for Medicaid its also state specific. In MO they use the same app and you can check which box you want to apply , QMB, SLMB 1/2 or LIS or MSP. Its important to know these income limits and resource limitations. In MO you get MORx which is a SPAP at $22,000 income with no asset test, you get the $104.90 paid if your under $1,200/ MO income with less than 10k assets and if your under $800, you get QMB which starts paying rx co pays and premiums along with the $104.90 The income amounts are estimates but pretty close.