Help a client enroll in LIS or MSP

Why is this important for you to know?

How do I help a client enroll in LIS (Low-Income Subsidy) or MSP (Medicare Savings Program)?

• To apply for the Medicare low-income subsidy, direct your client to fill out an “Application for Extra Help with Medicare Prescription Drug Plan Costs” (SSA-1020) form with Social Security. You can apply and submit this form by:
• Applying online at www.socialsecurity.gov/extrahelp.
• Calling Social Security at 1-800-772-1213 (TTY 1-800-325-0778) and requesting an application be mailed to you or applying over the phone. Social Security representatives are available by phone Monday through Friday, from 7AM to 7PM.
• Applying in person at your local Social Security office.
• Your client will be notified about their eligibility by mail within 2 weeks of submitting their application.
• Follow up with your client to confirm they've received their notification, then assist them with changing their plan.

How can I check a client or prospect's eligibility?

• You don't want to tell a client to apply for Extra Help if there's no way that they're eligible! Here's the income & resource cutoffs:
• You have Medicare Part A and/or Part B
• Individual: no more than $1,615 income & $14,610 assets
• Couple: no more than $2,175 income & $29,160
• You can also use these portals:
• United (Jarvis). Walkthrough here
• mProducer. Walkthrough here

Notes: You cannot use the Extra Help SEP during the fourth calendar quarter of the year, also known as AEP (October 15th through December 7th). You should use Fall Open Enrollment during this time to make prescription drug coverage changes.

What your client's should be on the lookout for.

There are 4 groups of people who already have LIS, but may need some help to keep it or to understand that their LIS is changing. We* send them targeted notices on colored paper when there are changes to their LIS. (*We refers to CMS)

1. People who won’t automatically be eligible for the LIS
• Each September, we mail a notice (CMS Publication No. 11198) (PDF) on gray paper to people who’ll no longer automatically get the LIS. This notice is a LIS application, and it includes a postage-paid pre-addressed envelope. These people may still qualify for the LIS, but they will need to send in a new application. The gray notice:
• Tells the person why they no longer automatically qualify for the LIS
• Encourages them to fill out and send in a LIS application
2. People who’ll have a change to their LIS co-payment
• In early October, we mail a notice (CMS Publication No. 11199) (PDF) on orange paper to people who’ll qualify for extra help, but will have a change to their co-payment.
3. People who’ll be reassigned to a new plan
• In early November, we mail a notice on blue paper (CMS Publication No. 11208) (PDF) to people who qualify for the LIS, but will be reassigned to a new prescription drug plan starting on January 1st.

We automatically reassign people who:

1. Qualify for the full (100%) premium subsidy
2. Are in a prescription drug plan that’s raising the premium above the low-income premium amount
3. Were enrolled in their current plan by CMS

We’ll also automatically reassign people who qualify for the LIS, if their prescription drug plan leaves the Medicare Program.

4. People who chose their plan
• In early November, we mail a notice (CMS Publication No. 11267) (PDF) to people:
• Whose premium cost will increase, but we’re not automatically reassigning to a new plan, because they chose and joined their plan.
• Who qualify for the full (100%) premium subsidy, but are in a plan that’s increasing their premium amount so it’s more than the standard low-income premium subsidy amount.

This notice tells people about the increase in their drug plan premium costs, and explains their options to stay in their plan or join another plan (including plans they won’t pay a monthly premium for).

Resources

• Getting financial assistance with Medicaid
• Medicare Savings Programs
• Extra Help Programs
• Limited Income and Resources