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Grupo Misitio

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Christian Cooper
Christian Cooper

Medicare Lis Application


You may visit or call your local Office of Family and Children to apply for Medicare Buy-In. You will need to complete an application form and participate in an interview. The interview can take place in person or over the telephone. Within 45 days, you will receive a notice in the mail that tells you whether your application was approved.




medicare lis application



The application process is different for each company. Usually a doctor must sign your completed application form and have his/her office submit it for you. Rx for Indiana can provide assistance with matching your prescriptions with these assistance programs. Contact Rx for Indiana at 1-877-483-9275.


**DSS Field Offices and our staffed telephone Benefits Center (1-855-6-CONNECT or 1-855-626-6632) are closed on Wednesdays to allow our staff time to process applications, renewals and related work.


Income-eligible EPIC seniors are required to apply for Extra Help. This may be done at the time of completing the EPIC application to enable EPIC to apply for this federal benefit on their behalf. This can also be done after becoming an EPIC member by using the application but checking off the box "Extra Help only". The application for Extra Help will also be submitted to the New York State Medicaid program for eligibility in a Medicare Savings Program that provides additional benefits as well as LIS for approved members.


The Medicare Savings Program (MSP) program consists of three programs, Qualified Medicare Beneficiaries (QMB), Specified Low-Income Medicare Beneficiaries (SLIB or SLMB) and Qualified Individuals-1 (QI-1). A person may apply for MSP when an application for the Low Income Subsidy (LIS) program is completed through the Social Security Administration (SSA). Current procedures for processing MSP applications are unchanged.


Beginning 01/01/2010, a person may apply for MSP when an application for LIS is completed through the SSA. These new applications that come to DHS because of the LIS application have to be treated differently by federal law. The date of application for MSP is the same date the applicant applied for LIS.


If the application is received after the due date it is no longer considered a LIS application and should be treated as a regular MSP application. See due date posted on the bottom of Form 2378M.


If the FCRC receives the CMS Application for Medicare Premium Assistance, do not require the applicant to complete Form 2378M. Process this application the same as Form 2378M is processed. This is not an LIS application.


SSA sends an electronic file to DHS for persons who applied for LIS and want to apply for MSP. This file will be treated as an application for MSP. The application date is the date the LIS application was filed with SSA.


HBWD will write or stamp the date of the LIS application in the "Agency Use Only" box on the 2378M. The date that the application is due to the FCRC will be indicated on a sticker on the bottom of the first page of Form 2378M. HBWD will mark 'LIS' in red at the top of the first page. New Form 267MSP will be mailed along with Form 2378M to the applicant. The 267MSP will have instructions to complete the 2378M and return it to the FCRC within 10 days.


FCRC registers Form 2378M upon receipt. Use the date in the "Agency Use Only" box (not the date the application is received by FCRC). Register these applications under caseload "LIS". Do not use "LIS" as the caseload number for applications received after the due date. Register the untimely application using the regular caseload assignment.


If Form 2378M is returned untimely, do not use the date in the "Agency Use Only" box as the date of application. The application date is the first workday the correct office receives the application. Process the application in the normal way according to PM 02-04-06/WAG 02-04-06.


QMB eligibility starts the first day of the month after the month the application is approved. If Form 2378M is returned untimely, do not use the date in the "Agency Use Only" box as the date of application. The application date is the first workday the correct office receives the application.


Example: Mr. Johnson applies for LIS in January. DHS receives the application from SSA in March. Mr. Johnson returns Form 2378M by the due date. Mr. Johnson's monthly income is $1,000 and reported assets are $5,000. Mr. Johnson is SLIB eligible because his income is more than the 100% but less than 120% of the Federal Poverty Level (FPL). Approval is based on the month the applicant applied for LIS. Mr. Johnson is eligible for coverage beginning January.


Example: Ms. Johnson applies for LIS in February. DHS receives the application from SSA in March. Form due to the FCRC in April. Ms. Johnson returns Form 2378M in May. The FCRC registers the application on the date of receipt. Ms. Johnson's income is $1,050 monthly and reported assets are $2,000. Ms. Johnson meets all the eligibility requirements for Qualified Medicare Beneficiary (QMB) except countable income is more than 100% but less than 120% of the Federal Poverty Level (FPL).Ms. Johnson returned the application after the due date. Approval is based on the month the applicant returned Form 2378M to the FCRC (not the date of the LIS application).


Example: Ms. Miller applies for LIS in January. DHS receives the application in February. Ms. Miller returns Form 2378M to the FCRC. Ms. Miller's income is $700 monthly and reported assets are $6,000. Ms. Miller meets all the eligibility requirements for QMB. Approval is based on the date the FCRC determines she is eligible for QMB (February). Ms. Miller is eligible for QMB beginning March. Applicant is not eligible for retroactive coverage because QMB eligibility starts the first day of the month after the month the application is approved.


Example: Mr. Smith applies for LIS in January. DHS receives the application from SSA in March. Mr. Smith returns the 2378M by the due date. His monthly income of $1,000 and reported assets are $3,000. Mr. Smith is SLIB eligible because his income is more than 100% but less than 120% of the FPL. Approval is based on the month the applicant applied for LIS. Mr. Smith is eligible for retroactive coverage beginning October. Mr. Smith is eligible for retroactive coverage because his assets do not exceed the asset limit in 2009.


Example: Mr. Jones applies for LIS in April. DHS receives the the application from SSA in May. The FCRC receives the 2378M by the due date. Mr. Jones' income is more than 120% but less than 135% of the FPL and his assets are below $6,600. He is eligible for QI-1. The date of his MSP application is the same as the month of application for LIS (April). His application for MSP is approved regular role effective June. Mr. Jones is eligible for retroactive coverage beginning January.


Example: Ms. Moore applies for LIS in February. DHS receives the application from SSA in March. Form 2378M was due in March. The FCRC receives Form 2378M in April. Ms. Moore's income is more than 120% but less than 135% of the FPL and her assets are below $6,600. She is eligible for QI-1. The date of her MSP application is the date the FCRC received the application (April). Her application for MSP is approved regular role effective May. Ms. Moore is eligible for retroactive coverage beginning January.


When you apply, you will fill out an application form and be asked for proof of some of the information you give. You also will talk with a person who works for the county agency. There are people at the county who can help you fill out the application. You can print a copy of the application from the Web at Minnesota Department of Human Services and mail it in.


It takes 30-45 days to process the application. Enrollees pay a monthly premium based on family size, income and the number of people in their family who are covered. Children under age 21 who meet a lower income guideline pay a fixed premium of $4 a month. Coverage starts the first of the month after payment is received. Continued coverage depends on timely payment of premiums. MinnesotaCare enrollees must complete a renewal application every year.


To apply for financial assistance, contact a certified Georgia SHIP counselor for application assistance anytime Monday through Friday, between 8 a.m. and 5 p.m. Call 1-866-552-4464 and select Option 4.


Main Outcomes and Measures Using survey assessments of overall cognition and numeracy from 2006 to 2010, we examined how cognitive abilities were associated with self-reported Part D enrollment, awareness of the LIS, and application for the LIS. We also compared out-of-pocket drug spending and premium costs between LIS-eligible beneficiaries who did and did not report receipt of the LIS. Analyses were adjusted for sociodemographic characteristics, household income and assets, health status, and presence of chronic conditions.


Results Compared with LIS-eligible beneficiaries in the top quartile of overall cognition, those in the bottom quartile were significantly less likely to report Part D enrollment (adjusted rate, 63.5% vs 52.0%; P = .002), LIS awareness (58.3% vs 33.3%; P = .001), and LIS application (25.5% vs 12.7%; P


Conclusions and Relevance Among Medicare beneficiaries likely eligible for the Part D LIS, poorer cognition and numeracy were associated with lower reported take-up. Current educational and outreach efforts encouraging LIS applications may not be sufficient for beneficiaries with limited abilities to process and respond to information. Additional policies may be needed to extend the financial protection conferred by the LIS to all eligible seniors. 041b061a72


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