Member Eligibility & Assistance Checklist

Identifying Medicaid, SSI, Medicare Savings Programs & Extra Help

When assisting a Medicare beneficiary, it is important to determine whether the individual currently receives financial assistance through Medicaid, Supplemental Security Income (SSI), a Medicare Savings Program (MSP), or Medicare Extra Help (LIS).

These programs can affect a beneficiary's Medicare costs, prescription drug costs, eligibility for certain Medicare Advantage plans, and available enrollment opportunities.

Do not assume a member's eligibility based solely on income or what they remember.

Whenever possible, ask the member to provide current documentation from Medicare, Medicaid, Social Security, or their state Medicaid agency.

A Resource for Your Medicare Population

ProgramFederal or State?Administered ByWhat It DoesMedicareFederalCenters for Medicare & Medicaid Services (CMS)Health insurance primarily for people 65+, certain people with disabilities, and people with ESRDMedicaidFederal + StateState Medicaid agencies under federal requirementsHealth coverage/assistance for eligible individuals based on state eligibility rulesSSIFederalSocial Security Administration (SSA)Monthly cash assistance for eligible aged, blind, or disabled people with limited income/resourcesMedicare Savings Program (MSP)State-administeredState Medicaid agencyHelps eligible Medicare beneficiaries pay certain Medicare costsExtra Help (LIS)Federal Medicare programMedicare/CMS; SSA processes applicationsReduces Medicare Part D prescription drug costs

How We Support Your Practice

Planvesa serves as a Medicare resource for your patients and staff.

We can assist with:

Medicare Education — Helping patients understand Original Medicare, Medicare Advantage, prescription drug coverage, and available plan options.
Turning 65 Support — Guiding patients approaching Medicare eligibility through the Medicare enrollment process.
Plan & Benefit Reviews — Helping patients understand their current coverage and available options.
Provider & Network Verification — Verifying whether preferred physicians, specialists, hospitals, and other providers participate with a plan.
Prescription Drug Reviews — Reviewing medications and available prescription drug coverage.
Enrollment Support — Providing personalized assistance when an eligible patient chooses to enroll in a Medicare plan.
Year-Round Assistance — Remaining available after enrollment to help patients understand and navigate their coverage.

A Medicare Resource for Your Staff — Medicare questions can be time-consuming for practice staff. Planvesa serves as an additional resource for patients who need assistance understanding Medicare eligibility, enrollment periods, plan options, provider networks, or prescription coverage.
Better-Informed Patients — Our educational approach helps patients understand important considerations such as provider networks, referrals, prescription formularies, copayments, and other plan benefits.
Personalized Patient Support — We provide one-on-one assistance based on the individual's coverage needs, medications, preferred providers, and coverage preferences.
Year-Round Partnership — Our relationship doesn't end after enrollment. Planvesa remains available throughout the year to assist Medicare beneficiaries with coverage questions and help them understand their benefits.

Member Eligibility & Assistance Checklist

Identifying Medicaid, SSI, Medicare Savings Programs & Extra Help

A Resource for Your Medicare Population

How We Support Your Practice

Interested in Working With Planvesa?

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