LIS Levels Chart

• LIS always follows the beneficiary no matter what plan they are on.

LIS Level	Cost for Generic	Cost for Name Brand
1	$0 – $4.50	$0 – $11.20
2	$0 – $1.55	$0 – $4.60
3	$0	$0

• 2024 Low Income Subsidy (LIS) Monthly Income Limit:
  • $1,903 (Single)
  • $2,257 (Couples)
  • Assets are also considered.
• Beneficiaries with LIS will, on average, have $34.70 premium coverage for their plan, as long as it includes Part D Prescription Drug Coverage (MAPD or PDP plans ONLY).

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How to Do a MARx Check (Step-by-Step):

1. Login: https://portal.cms.gov/portal/
2. Select "MARx UI" (you may need to click "Application").
3. Under "MCO Representative", click "Logon with Selected Role."
4. At the top middle of the screen, select "Beneficiaries" > "Eligibility."
5. Enter the customer’s FULL Medicare ID# OR fill out the fields below:
   • First Name, Last Name, Date of Birth, and the last 3 digits of their Medicare Number (MBI).
   • Tip: Asking for the last 4 characters of their Medicare ID (2 numbers + 2 letters) works well.
6. If they don’t have their Medicare Card, use their FULL SSN instead of the MBI.
7. Ask for customer permission before looking them up in the system.
8. Once permission is granted, click “Find.”

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Medicaid Look-Up Hack:

You can check a beneficiary's Medicaid status using:

• UHC Jarvis (Login):
  • Need Medicare # only for most states.
  • If Medicaid level isn’t specific, copy the Medicaid # to Humana or Anthem (MProducer) for details.
• Humana Vantage (Login):
  • Need Medicaid # OR SSN.
  • Use "Quote and Enroll" > "Eligibility Verification" (8th option).
• MProducer (Anthem) (Login):
  • Need Medicaid OR SSN AND Medicare #.
  • Select "Eligibility Check Medicare and Medicaid" > "DSNP Eligibility Check."
• Cigna (Login):
  • Must have Medicaid #.
  • Use "Tools" > "Medicare/Medicaid Eligibility."

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Original Medicare (Part A & B)

Part A:

• Provides inpatient and hospital coverage.
• $1,632 yearly deductible (2024).
• Beneficiary pays 20% coinsurance after the deductible is met.

Part B:

• Provides outpatient care, home health care, durable medical equipment, and preventive care.
• $174.70/month (2024), covered by Medicaid if applicable.
• $240 yearly deductible.
• Beneficiary pays 20% coinsurance after deductible.

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Medicare Part C – Medicare Advantage

• Covers ALL medical needs (Part A & B services).
• Often includes additional benefits like dental, vision, hearing, grocery, and utility money.
• Includes:
  • HMO Plans (stay in-network, often richer benefits).
  • PPO Plans (in and out-of-network care options).

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D-SNP (Dual-Eligible Special Needs Plan)

• For those with both Medicaid and Medicare.
• Always an MAPD plan (covers medical and prescription needs).

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Chronic Special Needs Plan (C-SNP)

• For those with chronic conditions (e.g., diabetes, COPD).
• May include additional benefits like money for food, utilities, or personal care items.

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TRICARE and VA Benefits Coordination

TRICARE:

• Works with Medicare Advantage (MA/MAPD).
• Covers copays for services if the provider accepts TRICARE.
• For prescriptions, inform the pharmacy of both MAPD and TRICARE coverage.

VA Benefits:

• Primarily used at VA hospitals.
• MA/MAPD plans are not utilized when receiving care at a VA hospital.