How To Understand & Approach Extra Help, LIS, and QMB/Medicaid (Learn This & Sell Year Round)

The Extra Help & Medicaid programs can be very overwhelming & confusing. Ethan gives a general breakdown of how they work and how to handle them in a sales environment.
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[@DIANAGONZALEZ-cj6yl]

Thank you!!!! I'm a year 2 agent and keep getting such conflicting information on this!!

[@MedicareMillennials]

Glad it was helpful!

[@zelenia99]

Hi Ethan, great information! Here in MA LIS Medicare Savings Buy In program pays for their Part B as well. It's a huge selling point because once I save them $1700 I sell them Hospital plan for their MAPD.

[@MedicareMillennials]

That’s an awesome perk for your clients!

[@joelnewcomb5445]

Ethan.. this video was very helpful for me this week... did close a customer on doing a formulary search for a non-covered drug she had. So just wanted to say thank you..

[@MedicareMillennials]

That’s great man! Thanks for watching

[@jacksycz]

Medical Coder here. You may be able to do a formulary exceptiion on a non-covered drug.

[@chocolatebutterfly9295]

Thank you for this info. My question is so we need to know their Medicaid level in order to see what plan we will put them in?

[@MedicareMillennials]

Yes you do! There’s different levels to Medicaid. If you call the carrier of your choice, they can let you know if the client qualifies for their dual plan :)

[@melcopelandseifu5853]

Thank you. It’s so confusing but you broke it down and this helps

[@MedicareMillennials]

Hey Mel, glad we could help :) reach out if you have any questions

[@jennifermoore3685]

Great content! Thank you!

[@MedicareMillennials]

Glad you liked it!

[@jacksycz]

I would be neglectful if I didn't add this. QMB patients cannot be billed for no shows, balance billing between medicare and medicaid unless its a medicaid copay or a non-covered service. If the provider accepts medicare but not medicaid, the provider's office must either eat the cost or go in network. SE 1128 is the Medicare Learning Matters paperwork on this (in part). QMB status transfers between states. So if you're on vacation in Florida, QMB status still applies and the patient cannot be balance billed.

[@MedicareMillennials]

Love this! Thank you for adding this :)

[@1shakasean]

Ethan, thanks again!

[@merinphilip7316]

Would you be able to clarify? Can LIS/Extrahelp be used even with medicare advantage ( Part C) plans as long as the drug is covered ( example, Tier 5)? Is it true then in these situations that members wont be in a '"donut hole" while getting extra help?

[@MedicareMillennials]

Sure let’s see if I can clarify a bit more! LIS/extra help is a program through social security that caps prescription drug costs, eliminates the donut hole, and helps with any Part D cost (including those incurred from a MAPD plan). This program will cap all drugs as long as the medication is covered by and on formulary with the insurance company you have coverage through.

[@merinphilip7316]

@@MedicareMillennials thank you! Your video was really helpful!

[@DavidAlanDeaton]

Do you help people apply for Extra Help? How long does it take to hear back from social security?

[@MedicareMillennials]

Typically yes. It normally takes around 3 weeks for them to get a letter back from social security

[@howdy2496]

Do we put our name on the section that asks if someone is helping them fill the form out?

[@CLItoughtrigal]

Yes I help

[@joannagreen8277]

I am in Connecticut. I have Medicare QMB. If I enroll in an Advantage plan, then want to go back to Medicare QMB, will I have to undergo all of the QMB applications for QMB qualifications?

[@MedicareMillennials]

I do not know the state specific rules for Connecticut. That being said, in Texas you do not lose your QMB when you enroll or disenroll from a Medicare advantage plan.

[@ambrosia-qt9ts]

That's right. I have QMB and a Medicare Advantage plan. I have a very expensive RA medicine. Last year it was $6500 everytime l received a treatment.

[@dominicalarissa7269]

Thank you for this 🙏

[@MedicareMillennials]

You are welcome!

[@broderickyarbrough5354]

Thanks

[@hopemiller6079]

But they can get a formulary exception from their doctor and the new insurance company will provide a one month supply of the medication until the exception is either approved or denied, right? Just because it's not on the formula, it doesn't mean it can't be covered.

[@howdy2496]

Good question. That's what I was going to ask.

[@MedicareMillennials]

Yes, they can also go through the process of requesting a formulary exception! However, there is no guarantee that it will be granted, and its a super big pain in the butt for the client :/ When possible, I try to find a plan that covers all of their drugs :)

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