D-snp and "extra Help"

keith365

Super Genius
118
I'm new to Florida. I met my first prospect who has "extra help" from the state for his drug plan. He doesn't pay anything for anything. Back home in Cleveland, we could enroll this type of prospect into any drug plan, and the state would pay at the same level as the drug plan that they put the prospect into. In other words, It didn't matter what drug plan they were in, their cost sharing was the same. Does anyone know if it's the same way nationwide? Or at least in Florida? I called the Medicaid office, and, as expected, they couldn't tell me anything. I also called the states managed care division. No luck with an answer there either. Thanks!
 
There is a difference between partial and full Medicaid/Medicare beneficiaries, and those beneficiaries who are on "Extra Help" from the Social Security office.

One of the main differences is the gross income and assets allowance provided for the eligibility standards.

Those people who are on "Extra Help" may not qualify for Medicaid.

I would call the agent services division of the company that you are thinking of placing them with and having them verify that they do, indeed, receive "Extra Help." If the person does receive extra help, then that is a special election in order to place them in a new plan if they desire to do so.
 
Are you familiar with My Care Ohio? LIS cost sharing is the same regardless of what state they live in for PDP plans. LIS cost sharing is determined by the Social Security Admn not the state in which they live. The My Care Ohio plans have zero cost sharing for any medication, in most cases, where as there my be cost sharing for someone even if they are full LIS. The My Care Ohio is one of the CMS demonstration projects for Dual Eligible s and I am not sure if they have a plan like My Care Ohio. If they do, that is where zero cost sharing for all medications would come into play. Zero co pays could have been a feature of his plan, but that is different from the LIS cost sharing. Otherwise his Rx cost sharing is the same regardless of whether he is in Florida or any other state. People often get Medicaid guideline which usually only apply to medical coverage, with prescription/ LIS benefits and that eligibility is determined by Social Security. I hope this helps.
 
I'm new to Florida. I met my first prospect who has "extra help" from the state for his drug plan. He doesn't pay anything for anything. Back home in Cleveland, we could enroll this type of prospect into any drug plan, and the state would pay at the same level as the drug plan that they put the prospect into. In other words, It didn't matter what drug plan they were in, their cost sharing was the same. Does anyone know if it's the same way nationwide? Or at least in Florida? I called the Medicaid office, and, as expected, they couldn't tell me anything. I also called the states managed care division. No luck with an answer there either. Thanks!

If he pays $0 for all RX, he probably has full LIS and likely is QMB too so all his Part A and B benefits are likely to be $0 as well.
 
I'm new to Florida. I met my first prospect who has "extra help" from the state for his drug plan. He doesn't pay anything for anything. Back home in Cleveland, we could enroll this type of prospect into any drug plan, and the state would pay at the same level as the drug plan that they put the prospect into. In other words, It didn't matter what drug plan they were in, their cost sharing was the same. Does anyone know if it's the same way nationwide? Or at least in Florida? I called the Medicaid office, and, as expected, they couldn't tell me anything. I also called the states managed care division. No luck with an answer there either. Thanks!

"Extra Help" formally know as Low Income Subsidy (LIS), comes from the the Federal Govt, not the state. It does help with lowering the cost of prescriptions. The are a couple different levels of Extra help...Full and Partial..

Full...People who qualify for the full low-income subsidy for Medicare prescription drug coverage. People who get full Extra Help pay $0 for their monthly Medicare drug plan premium, $0 deductible, and no more than $3.30 (generic) or $8.25 (brand) for their prescriptions.

Partial...People who qualify for the partial low-income subsidy for Medicare prescription drug coverage. People who get partial Extra Help may pay a percentage of their monthly Medicare drug plan premium depending on their income and resources, $82 for their annual deductible, and may pay up to 15% coinsurance for the cost of their prescriptions.

(I copy pasted those definitions from the medicare.gov site)

The Medicaid office isnt helping you because they arent involved on the help with part D, they help with payment for part B.

I understand the benefits to be the same nationwide, however I have only helped people in my own state, Oklahoma, with LIS. If he gets full help, which it sounds like he does, the LIS benefit pays about $30 per month towards his premium. So if you enroll him in a plan that is less than that, he will not pay anything for it. But, if you enroll him into a plan that has a $40 monthly premium, he may have to pay $10.

I get answers to a lot of questions about this through google, which usually takes me to this site....https://www.medicareinteractive.org/
 
I'm new to Florida. I met my first prospect who has "extra help" from the state for his drug plan. He doesn't pay anything for anything. Back home in Cleveland, we could enroll this type of prospect into any drug plan, and the state would pay at the same level as the drug plan that they put the prospect into. In other words, It didn't matter what drug plan they were in, their cost sharing was the same. Does anyone know if it's the same way nationwide? Or at least in Florida? I called the Medicaid office, and, as expected, they couldn't tell me anything. I also called the states managed care division. No luck with an answer there either. Thanks!

You look in the back of the Medicare and You booklet for the state where the beneficiaries are. The premiums printed in blue mean that the person will not pay a premium for that plan if they are 100% LIS.

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"Extra Help" formally know as Low Income Subsidy (LIS), comes from the the Federal Govt, not the state. It does help with lowering the cost of prescriptions. The are a couple different levels of Extra help...Full and Partial..

Full...People who qualify for the full low-income subsidy for Medicare prescription drug coverage. People who get full Extra Help pay $0 for their monthly Medicare drug plan premium, $0 deductible, and no more than $3.30 (generic) or $8.25 (brand) for their prescriptions.

Partial...People who qualify for the partial low-income subsidy for Medicare prescription drug coverage. People who get partial Extra Help may pay a percentage of their monthly Medicare drug plan premium depending on their income and resources, $82 for their annual deductible, and may pay up to 15% coinsurance for the cost of their prescriptions.

(I copy pasted those definitions from the medicare.gov site)

The Medicaid office isnt helping you because they arent involved on the help with part D, they help with payment for part B.

I understand the benefits to be the same nationwide, however I have only helped people in my own state, Oklahoma, with LIS. If he gets full help, which it sounds like he does, the LIS benefit pays about $30 per month towards his premium. So if you enroll him in a plan that is less than that, he will not pay anything for it. But, if you enroll him into a plan that has a $40 monthly premium, he may have to pay $10.

I get answers to a lot of questions about this through google, which usually takes me to this site....https://www.medicareinteractive.org/


You look in the back of the Medicare and You booklet for the state where the beneficiaries are. The premiums printed in blue mean that the person will not pay a premium for that plan if they are 100% LIS.
 

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