Social Security and Medicare are separate programs serving older and disabled Americans, but they have one important thing in common.
The Social Security Administration (SSA) manages registrations for Medicare Part A (hospital insurance) and Part B (medical insurance). In addition, the SSA has a specific role in the Medicare Prescription Drug program (Part D). The SSA determines eligibility for the Supplemental Assistance program while Medicare enrolls beneficiaries in Medicare Part D plan sponsors.
While anyone eligible for Medicare Part A and / or Part B can purchase Part D prescription drug coverage, some people with limited income and resources may also be eligible for additional help with their monthly premiums, annual deductibles. and their co-payments. Unfortunately, despite the many benefits of Extra Help, very few people know about, let alone apply for the program. At the end of this column you will find information on how to request additional help.
More than ten years ago, Medicare created the Bridging Program for Newly Eligible Limited Income, now known as LI-NET. Simply put, LI-NET provides temporary Part D coverage for low-income people who are in the process of switching to Medicare Part D coverage, but have not signed up for a Part D plan. How LI-NET works is a little hard to explain, but if you keep in mind that LI-NET has the following various purposes, you can see how it makes it easier for a recipient to transition to additional aid status. and registration in Part D.
• LI-NET smooths out any bumps in the registration process. If there is a delay or confusion in the registration process for Additional Help, or if you have not received timely notification of your registration, you can still have your prescriptions filled as pharmacists can. deal directly with the LI-NET program to make this happen.
• LI-NET facilitates the transition to Part D and additional help. Medicare’s LI-NET program provides immediate and temporary access to medication for newly-assisted Medicare beneficiaries who do not have a prescription drug plan. These beneficiaries are initially and temporarily placed in a drug plan that will cover, almost without exception, all the prescription drugs they take. This gives recipients some time, as they transition to a regular Part D drug plan, to have their prescriptions adjusted or use the exception process to ensure that their prescriptions will continue to be valid. be covered to the extent possible.
• LI-NET facilitates retroactive reimbursement. Recipients who are entitled to additional help because of Medicaid or Supplemental Security Income (SSI) may sometimes be retroactively entitled to additional help, and therefore eligible for reimbursement for prescriptions they have already paid for. This program is designed to facilitate their compensation for drugs they have paid for out of pocket during the period of their retroactive registration.
• LI-NET notifies beneficiaries of ineligibility. Some beneficiaries who believe they are entitled to Part D or additional assistance may be told by their pharmacy that this is not the case. This program will notify beneficiaries in writing of this outcome and indicate what they can do to resolve any issues.
Medicare beneficiaries are eligible for LI-NET if they:
• Have been found eligible for Medicare Part D Supplemental Aid. This includes: Full Duels – those who are considered eligible for Supplemental Aid because they are receiving Medicaid or Supplemental Security Income (SSI) benefits and partial duels – those who receive a Medicare Savings Program (MSP). This also includes people who have requested additional help through Social Security and received an award notification letter from the Social Security Administration AND who are not enrolled in a plan. Part D or who have prescription drug coverage through a Medicare Advantage plan.
Question: How to register for LI-NET?
A: If you are an eligible duplicate, Medicare will automatically enroll you in LI-NET. If you are partially eligible or have requested the Extra Help program directly, you must register for the LI-NET program at your pharmacy. This latter group of beneficiaries must provide the “best available evidence” (BAE) to pharmacy staff for immediate dispensing of prescriptions and registration with LI-NET. This BAE may include one of the following documents:
• A letter from Social Security or Medicare indicating the award of additional assistance (eg, official award letter, notice of change, notice of planned action)
• A copy of a person’s current condition Medicaid award letter with effective dates.
• State eligibility verification system queries (interactive voice response, online).
Beneficiaries must bring documentation of their dual eligibility or additional aid status to a pharmacy, ask the pharmacist to enter certain information into their systems, and obtain immediate approval to dispense the drug. If the LI-NET complaint system does not recognize beneficiary information, a pharmacist can request a waiver for each drug. The pharmacist should fax the BAE to Humana at (877) 210-5592 and call the Humana Helpdesk at (800) 783-1307. These are sometimes referred to as “point of service” or “POS” recipients.
If a person is later found to be ineligible, the Medicare program holds that person, and not the pharmacy, responsible for the cost of the prescriptions. Additionally, if the beneficiary’s co-payment level subsequently turns up or down, any refunds or bills for additional charges will go directly to the beneficiary, not the pharmacy.
Question: What drugs are on the LI-NET form and are there any restrictions?
A: LI-NET has an open form and contains all Part D drugs except those excluded from the Part D program. With LI-NET you can go to any pharmacy you want. Certain drug limits may be imposed for safety reasons, such as quantity limits or prior authorization. For example, recipients are only allowed a maximum limit of 30 days of opioids, regardless of diagnosis or location. Patients who have just started taking opioids will be limited to an initial 7-day supply for the treatment of acute pain. All other medications are limited to a 60 day supply on LI-NET.
Question: Can a beneficiary be reimbursed for reimbursable expenses while registering with LI-NET?
A: A beneficiary who paid out of pocket for prescription drugs while enrolled in LI-NET may be eligible for reimbursement. All LI-NET eligible beneficiaries will receive a “Welcome Letter” for the beneficiary’s LI-NET coverage dates. Beneficiaries should follow the instructions on the attached Prescription Drug Claim Form to request reimbursement for claims. A beneficiary has 36 months from the date of filing the order to request a refund.
Question: How long can a beneficiary keep LI-NET?
A: Medicare typically enrolls beneficiaries with additional assistance in Part D plans within a month or two. Full duels with Medicaid or Full SSI are automatically and randomly entered on the first day of the following month after receiving a Medicare award letter. All other Extra Help beneficiaries are granted random and facilitated enrollment in a Medicare Part D drug plan two months after the Extra Help grant date and receive notification via a Medicare letter.
Question: You have more questions ?
A: The LI-NET and Extra Help connection can be complex. PA MEDI (formerly known as APPRISE) is available to provide free, confidential Medicare advice and assistance. You can contact a counselor by calling the PA MEDI Hotline at (800) 783-7067, Monday through Friday, 8 a.m. to 5 p.m.
To request additional help, contact the Social Security Administration at (800) 772-1213 (TTY (800) 325-0778) or go to their website at: https://www.ssa.gov / benefits / medicare / prescriptionhelp. html
Find the additional help brochure at https://www.ssa.gov/pubs/EN-05-10508.pdf
(Joel Mekler is a Certified Senior Advisor. Send your questions to [email protected])