What It Is
Extra Help (also known as "Part D Low-Income Subsidy (LIS)" is a federal program to help people with limited income and resources pay Medicare prescription drug program costs. It can help with premiums, deductibles, and copayments. Extra Help can pay for some to most of the out-of-pocket costs of Medicare prescription drug coverage.
Extra help gives your client a Special Enrollment Period (SEP) once per calendar quarter during the first nine months of the year to enroll in a Part D plan or to switch between plans.
Most people on Medicare don’t even know whether they're eligible for LIS. You can help your existing clients and prospects by helping them apply for LIS.
What It Covers
- Part D premiums
- Annual deductibles
- Coinsurance and copayments
- Donut Hole gap
- Part D late enrollment fees
If your clients qualify for the LIS Medicare Extra Help Program, the also may qualify for Medicaid. Low-income clients who qualify for both Medicare and Medicaid are called “dual eligible,” and they can enroll in Medicare Advantage plans called Dual Special Needs Plans (DSNP). Most DSNPs have enticing benefits at no cost. When you sell DSNPs you also have the advantage of being able to sell them year-round without having to wait for AEP.
Why It Matters
(1) Save Your Clients Money
There are 4 subsidy levels (LIS 1-4). The least generous level will reduce brand-name drug copayments to less than $10. Especially if your client is a high-utilizer, you can save them hundreds of dollars of Part D copayments.
(2) Help Clients & Prospects Switch Plans
If a client or prospect isn't happy with their current plan, they can use their Special Election Period 1x per quarter to change it.
(3) Generate Client Goodwill
Clients will remember when you put money back into their pocket! Use the opportunity to ask for referrals, "Who else do you know who I'd be able to help?"
Checking Eligibility in UHC, Anthem and Humana Portals
UHC:
Anthem:
Humana: