Categories
FBDE-Full Benefit Dual Eligible
Full Benefit Dual-Eligible beneficiaries are eligible for both Medicare and full Medicaid benefits. These beneficiaries must meet the qualifications for Medicare mentioned on Page 2 and the qualifications for their state-specific Medicaid program.
MSP's - Medicare Savings Programs
Based on income/assets, individuals who are partial dual-eligible typically fall into one of the following four Medicare Savings Program (MSP) categories.
It should also be noted that QMB beneficiaries are, in many cases, eligible for Special Needs Plans along with FBDE beneficiaries. In some cases, other MSP beneficiaries are eligible for SNPs as well. Eligibility should always be confirmed with every carrier before applying for enrollment.
LIS-Low Income Subsidy
Medicare beneficiaries with limited income and assets may qualify for the Part D Low Income Subsidy, also known as LIS or Extra Help. This subsidy helps pay for premiums, deductibles, and copays related to Medicare drug coverage. Beneficiaries enrolled in both Medicaid and Medicare, a Medicare Savings Program, or Supplemental Security Income (SSI) will qualify for LIS automatically and do not need to submit an application. LIS is granted in Full/100%, 75%, 50%, and 25% levels depending on the beneficiary’s income.
* Income amounts reflect threshold without/with the $20 monthly income disregard (annually = $240); income is rounded to the nearest whole dollar. ** Asset limits include amount without/with $1,500/person burial allowance. Income Levels Source:
https://aspe.hhs.gov/poverty-guidelines Asset/Resource Levels: https://www.cms.gov/files/document/lis-memo.pdf Part D Cost-Sharing Source: https://www.cms.gov/files/document/2023-announcement.pdf
How to Apply
Medicare beneficiaries may apply for LIS in one of three ways:
- Apply online at http://www.socialsecurity.gov/extrahelp.
- Call Social Security at 1-800-772-1213 (TTY 1-800-325-0778) and request an application by mail or apply over the Social Security representatives are available by phone Monday through Friday, from 7 AM to 7 PM.
- Apply in person at their local Social Security
Application for MSP’s (QMB/SLMB, etc.) may be completed in one of two ways:
- In conjunction with LIS application via http://www.socialsecurity.gov/extrahelp if the beneficiary does not already receive LIS benefits.
- Via the applicant’s resident state e-app or paper Check the beneficiary’s resident state Medicaid website.
Converting Approval into a Sale
Upon approval of any subsidy/extra help, advise the applicant/beneficiary of the effect that the subsidy will have on their plan eligibility, coverage premium, and/or drug coverage costs. You should also offer updated coverage to correlate with increased benefits.
Remember, beneficiaries receiving LIS/MSP/FBDE benefits are eligible for a Special Election Period. Affirming you helped a beneficiary acquire extra help is the perfect time to write updated Medicare coverage and/or ancillary benefits as well.
The typical response time for these applications is 3-4 weeks. The applicant will be notified via mail of approval/benefit level or denial. If denied, the decision may be appealed.
