MEDICARE ENROLLMENT PERIODS

Question 1

Initial Enrollment Period (IEP)

Answer 1

: This period begins three months before the month you turn 65 and lasts until the end of the third month after. If you sign up before your birthday month, your coverage takes effect the first of the month you turn 65. If you don’t sign up for Part B during your IEP, you may have to wait until the general enrollment period.

Question 2

Special Enrollment Period (SEP):

Answer 2

This period is for those who are covered by an employer group health plan. You can sign up any time while working and still covered by the group health plan, within 8 months of the day you or your spouse stop working, or within 8 months of the group health plan ending while you or your spouse continue to work.

Question 3

General Enrollment Period (GEP):

Answer 3

This period is from January 1 to March 31 each year. If you have not enrolled during the other periods, you can still sign up during this time. However, you may face a late enrollment penalty

Question 4

In the context of Medicare, what is “LIS”?

Answer 4

“LIS” stands for “Low-Income Subsidy.” This subsidy is also known as “Extra Help” and is a program designed to assist individuals with limited income and resources in paying for their prescription drug costs. The LIS program helps eligible Medicare beneficiaries afford their prescription medications by reducing or eliminating the costs associated with Medicare Part D prescription drug coverage.

Question 5

What is the Low-Income Subsidy eligibility base on?

Answer 5

Qualification for the Low-Income Subsidy is based on income and resources, and those who qualify typically receive assistance with premiums, deductibles, and co-payments related to their Medicare Part D prescription drug coverage.

Question 6

Who administers the Low-Income Subsidy (Extra Help) Program?

Answer 6

The program is administered by the Social Security Administration (SSA) and is intended to make prescription drugs more affordable for individuals with limited financial means.

Question 7

Who determines if a beneficiary is eligible for Low-Income Subsidy (Extra Help) and how does one apply for it?

Answer 7

Eligibility for LIS is determined by the SSA, and individuals can apply for the program through the SSA or their state’s Medicaid office. The specific income and resource limits for qualification can vary by year,

Question 8

How does someone being eligible for Low-Income Subsidy create a Special Enrollment Period?

Answer 8

Eligibility for the Low-Income Subsidy (LIS), also known as Extra Help, can create a special enrollment period for individuals in the Medicare program. When someone becomes eligible for LIS, they may also become eligible for a Special Enrollment Period (SEP) for Medicare Part D, which allows them to enroll in, switch, or drop a Medicare Part D prescription drug plan outside of the regular enrollment periods.

Question 9

Here’s how eligibility for LIS can create a Special Enrollment Period:

Answer 9

1. Initial Enrollment Period (IEP): If an individual becomes eligible for LIS during their Initial Enrollment Period for Medicare (the seven-month period that begins three months before the month of their 65th birthday, and ends three months after that month), they can use this Initial Enrollment Period to enroll in a Medicare Part D plan.
2. Annual Election Period (AEP): If an individual becomes eligible for LIS during the Annual Election Period (October 15 to December 7 each year), they can use this special enrollment period to enroll in, switch, or drop a Medicare Part D plan.
3. Special Enrollment Period (SEP) for Extra Help: Individuals who qualify for LIS may be eligible for a Special Enrollment Period to enroll in or make changes to their Medicare Part D coverage at any time during the year. This SEP allows eligible individuals to join, switch, or drop a Medicare Part D plan once per calendar quarter during the first three quarters of the year.

Question 10

What enrollment period is triggered when a beneficiary is eligible for LIS?

Answer 10

Eligibility for LIS triggers a special enrollment period specifically for Medicare Part D prescription drug coverage.

Question 11

If a Beneficiary is enrolled in Medicaid would it be necessary to check eligibility for LIS?

Answer 11

No, it would not be necessary to check eligibility for LIS if a beneficiary is enrolled in Medicaid. This is because people who are enrolled in Medicaid are automatically eligible for LIS and do not need to apply for it. They will receive the full benefits of LIS, such as paying no premiums, deductibles, or copays for their Part D prescription drug coverage. However, they may still need to choose a Part D plan that works best for them, or they will be randomly assigned to one by Medicare.

Question 12

how does a medicare agent determine if a beneficiary is LIS eligible?

Answer 12

A Medicare agent can determine if a beneficiary is LIS eligible by checking their income, assets, and enrollment in other programs that qualify them for the Low-Income Subsidy (LIS), also known as Extra Help. According to the information I found, there are three ways a beneficiary can be eligible for LIS:

They have Medicare Part A and/or Part B, live in the U.S., and meet the income and asset limits for LIS.
They receive Medicaid or Supplemental Security Income (SSI), or are enrolled in a Medicare Savings Program (such as QMB, SLMB, and QI).
They apply for LIS through the Social Security Administration (SSA) and are approved.
A Medicare agent can check the beneficiary’s eligibility for LIS by using the online tool on the SSA website4, or by contacting the SSA or the State Medicaid office directly

Question 13

What is QMB?

Answer 13

QMB stands for Qualified Medicare Beneficiary, a program that helps low-income Medicare beneficiaries pay for their Medicare premiums and cost sharing. QMB is one of the four Medicare Savings Programs that are available for people who are eligible for both Medicare and Medicaid, also known as dual eligibles. QMB can help you save money on your health care expenses and access the services you need.

Question 14

What is SLMB?

Answer 14

SLMB stands for Specified Low-Income Medicare Beneficiary, a program that helps low-income Medicare beneficiaries pay for their Part B premiums. To qualify for SLMB, you must have both Part A and Part B, live in the U.S., and meet the income and resource limits for the program. If you qualify for SLMB, you will also get Extra Help paying for your prescription drugs. You can apply for SLMB through your state Medicaid program.

Question 15

What is QI?

Answer 15

QI stands for Qualified Individual, a program that helps low-income Medicare beneficiaries pay for their Part B premiums. To qualify for QI, you must have Part A or be eligible for it, live in the U.S., and meet the income and resource limits for the program. You must also not be eligible for Medicaid1. If you qualify for QI, you will also get Extra Help paying for your prescription drugs. You can apply for QI through your state Medicaid program.

Question 16

In the context of medicare, during the LIS-SEP, may the beneficiary be enrolled into a MA-PD plan; or Medicare Advantage plan with a stand-alone part D drug plan?

Answer 16

yes, but only under certain conditions. LIS-SEP stands for Low-Income Subsidy Special Enrollment Period, which allows beneficiaries who are eligible for Extra Help to enroll in or switch Part D plans at any time1. However, this SEP does not apply to Medicare Advantage plans, unless the beneficiary is also enrolled in Medicaid, a Medicare Savings Program, or Supplemental Security Income. In that case, they can enroll in or switch both Part D and Medicare Advantage plans at any time.

Therefore, if a beneficiary is eligible for LIS-SEP and wants to enroll in a Medicare Advantage plan, they have two options:

They can enroll in a MA-PD plan, which is a Medicare Advantage plan that includes prescription drug coverage. This way, they can use their LIS-SEP to join or switch MA-PD plans at any time.
They can enroll in a Medicare Advantage plan without drug coverage, and also enroll in a stand-alone Part D plan. This way, they can use their LIS-SEP to join or switch Part D plans at any time, but they can only join or switch Medicare Advantage plans during certain periods, such as the Initial Enrollment Period, the General Enrollment Period, or the Fall Open Enrollment Period.