SEP

SEP & Low Income Subsidy (LIS) – Ep. 2

Episode 2 is focused around the change from OEP to SEP and how to use the Low Income Subsidy Medicare Program to help you generate leads. With that in mind, in Episode 2, we begin by discussing the importance of SEP. As you probably already know by now, most of your business is done during AEP. But just because AEP is over and OEP is nearing close, doesn’t mean you can’t still help beneficiaries get the coverage they deserve!

Since most Medicare-eligible individuals don’t qualify for a Special Enrollment Period, it’s important for you to get creative with your lead generation techniques! One group of individuals who are eligible to enroll in plans outside of Annual Enrollment are the Dual Eligible population. Dual-eligible individuals also qualify for Low-Income Subsidies!

This brings us to our next topic… The Low Income Subsidy Medicare Program, also known as Medicare Extra Help. LIS helps beneficiaries save on their prescription drug costs. In this episode, we break down what LIS is, how to qualify beneficiaries for LIS and how to plan an event to generate LIS leads.

Finally, we end this week’s episode with feel-good stories from the hosts, Sarah and Jessica, so you can get to know them a bit better! Want to be featured on the podcast? Look for  “Share Your Story” under the Contact Us tab and send us your motivational stories!

Podcast #2: SEP & Low Income Subsidy (LIS) Transcript

Sarah: Welcome to Episode 2 of Selling SMART with Sarah Smith….

Jessica: And Jessica Vara!

Sarah: In today’s episode, we are going to talk about the Special Enrollment Period AKA SEP! With SEP approaching quickly, the amount of beneficiaries you will be able to help will decrease, meaning you’ll need to get more strategic with your lead generation! 

Jessica: Which brings us to our next topic… The Low Income Subsidy Program! We will be talking about what LIS is, why you should care, and how you can host an event focused around LIS! And of course we will end on a positive note! So lets go ahead and jump right in!!

Disruptive Waves:

Sarah: As you probably know by now, OEP is about to end and we are quickly moving into SEP. As a Medicare insurance agent, most of your business is done during AEP. But just because AEP is over and OEP is nearing close, doesn’t mean you can’t still help beneficiaries get the coverage they deserve! There are plenty of folks out there who are eligible for a Special Enrollment Period! Your job is to find those individuals!

Jessica: The Special Enrollment Period (also known as SEP) allows individuals who qualify to make changes to their Medicare plan outside of the Annual Enrollment Period. People who qualify for a Special Enrollment Period have special circumstances such as having low-income, moving to a new service area or losing current coverage.

Sarah: Since most Medicare-eligible individuals don’t qualify for a Special Enrollment Period, it’s important for you to get creative with your lead generation techniques! One group of individuals who are eligible to enroll in plans outside of Annual Enrollment are the Dual Eligible population, meaning they qualify for both Medicare AND Medicaid. While not every individual who qualifies for LIS is Dual-Eligible, but individual who is Dual-Eligible also qualifies for LIS! This brings us to our next topic… Low-Income Subsidies!

All Aboard the Knowledge Train:

Sarah: First off, what IS LIS?

Jessica: LIS stands for low income subsidy. The Low Income Subsidy program, also known as Medicare Extra Help, allows low-income Medicare-eligible consumers to save on their prescription costs.

Sarah: Some of the benefits included in the Low Income Subsidy Program include:

Jessica: Most people who are eligible for LIS don’t even know it. These people tend to be people who are struggling to afford basic expenses and really need help paying for their healthcare costs. This is where you, the agent, can help them apply for that extra help.  

Sarah: So, when is a beneficiary eligible for LIS? A beneficiary is eligible for LIS at 150% of the Federal Poverty Level. We don’t have updated resource and asset limits from CMS just yet, they should come out very soon, so you will still need to use the 2018 guidelines until the U.S. government determines the levels for 2019

According to Social Security, in 2018, beneficiaries  are eligible for Extra Help if they have Medicare Part A and meet the following requirements:

Individual Extra Help beneficiaries must have an income of no more than $18,210 per year, and resources valued at no more than $14,100 per year. Married Extra Help beneficiaries must have an income of no more than $24,690 per year and resources valued at no more than $28,150 per year. 

Income includes wages, social security income, annuities, and family support. Resources include real estate, stocks and bonds, mutual funds, and IRAs, or Individual Retirement Accounts. 

Jessica: So you know people who are eligible for LIS need your help, but how do you find them? A good way to find LIS leads is to host an event.

NOTE: You must register your event as an “informal sales event” with CMS. You won’t be able to collect lead information and permission to contact without classifying the event that way.

Sarah: Plan events at locations where low-income seniors either live or frequent often such as:

  • Low-income housing
  • Churches
  • Bingo tournaments, 
  • Flea markets, 
  • Food banks and veteran’s groups
  • And Clinics, doctor’s offices, dentists, and pharmacies

Jessica: Remember to bring a laptop for digital applications, branded materials, business cards, permission to contact forms, LIS information flyers, and a notebook to help you keep track of your new contacts.

You can sit with seniors and help them apply for LIS on the spot! You can apply online at www.socialsecurity.gov/extrahelp. Once you submit their application for LIS, Social Security will review it and send them a notification in the mail letting them know if they are eligible or not. 

Always collect a permission to contact form from the beneficiary and let them know you will be in touch to discuss next steps. prior to enrolling your Scope of Appointment form when you reach back out and they qualify.

Sarah: Make sure to follow up with your new clients to see if they qualified for the Low Income Subsidy Program. If your new client is accepted, see if they’d like to set an appointment to discuss their next steps. Don’t forget to get a Scope of Appointment to have on file prior to your appointment date. They will be eligible to enroll in a Medicare Part D plan at that time and you can help them find the right plan option for them.

If your new client is denied, let them know that you can help find a Medicare plan during the next AEP. Follow up with the facility as well! Thank them for their assistance and see if they can refer you to another facility for your next event.

Jessica: With LIS, you’re helping benes save money in a way that they may have not known about before. 

Sarah: What are you waiting for? Contact your local senior facilities and event coordinators now, so you can help seniors in need AND grow your business.