Overview
Connecticut provides assistance with health care costs for
low-income individuals covered by Medicare under the Medicare Savings Program. This
program pays all or a portion of the costs of Medicare premiums. In some cases, the
program pays part of the cost of medical care covered, but not fully paid for, by
Medicare. This program is available to those covered by Medicare who are at least 65
years old as well as those who are disabled. In some cases, benefits can amount to
several thousands dollars per year and eliminate the need to buy costly Medicare
supplemental insurance coverage.
The Connecticut Department of Social Services administers this
program. The Medicare Savings Program was previously known as the Medicare
Cost-Sharing Program or the Medicare Buy-In Program. You may find that some
Department staff still refer to the program by one of the older names.
The three components of the Medicare Savings Program:
- The Qualified Medicare Beneficiary (QMB) program.
- The Specified Low-Income Medicare Beneficiary (SLMB)
program.
- The Additional Low-Income Medicare Beneficiary (ALMB)
program.
Which
program am I eligible for?
Assets
The Qualified Medicare Beneficiary Program, Specified
Low-Income Medicare Beneficiary Program, and the
Additional Low-Income Medicare Beneficiary Program have no asset limit.
Eligibility for Medicare
You must also be a citizen or legal resident of the United States
and the State of Connecticut and be enrolled in Medicare or be eligible for
Medicare Part A. You can participate in these programs even if you are not now
covered by Medicare Part A or Part B, as long as you are eligible to enroll. To be
eligible to enroll you must be a citizen of the U.S., or a permanent legal resident for at
least 5 years and be at least 65 years old or disabled.
Income
Income limits are increased twice each year on the first days of
January and April. Social Security cost of living increases effective in January
will not affect eligibility until April. For purposes of
determining eligibility during the first three months of a year, the
amount of Social Security income for December of the previous year
should be used.
Effective
October 1, 2009 - Still in Effect
Qualified Medicare
Beneficiary Program (QMB)
| Monthly income limit for one
person Monthly income limit for a couple |
$1,778.91
$2,393.55 |
| Asset limit for one person Asset limit for a couple |
no limit
no limit |
Specified Low-Income Medicare Beneficiary Program (SLMB)
| Monthly income for one person Monthly income for a couple |
$1,959.51
$2,636.55 |
| Asset limit for one person Asset limit for a couple |
no limit
no limit
|
Additional Low-Income Medicare Beneficiaries Program (ALMB)
| Monthly income for one person Monthly income for a couple |
$2,091.67
$2,816.67 |
| Asset limit for one person Asset limit for a couple |
no limit
no limit |
In determining eligibility, one's gross income is used.
Thus, the Medicare Part B premiums that are normally deducted from one's Social Security
check are counted as income.
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What benefits do each of these
programs offer?
The Qualified Medicare Beneficiary Program
(QMB) has the highest benefit level. QMB pays the
Part A and Part B premiums and all deductible and coinsurance amounts,
including coinsurance and deductible
amounts in Medicare managed care. This includes the Medicare Part
B premium, $96.40 per month in 2010, if you had already been enrolled
in Medicare. For newenrolees in Medicare, in 2010, the Medicare Part
B preimum is typically $110.50 per month, if you earn less than $85,00
per year. Plus:
The Medicare Part A premium. Elderly
or disabled individuals who do not qualify for Social Security or
Railroad Retirement benefits can
obtain Medicare Part A coverage by paying a premium for Part A. The
Part A premium for 2010 will be $461.00 per month.
The Medicare Part A hospital deductible and
coinsurance amounts. Any Medicare beneficiary who is hospitalized
must pay a deductible for each spell of illness and coinsurance
after the 60th day of hospitalization. For
2010 the amount is $1,100.00. In 2010, the coinsurance for
days 61 through 90 is $275.00 per day and the coinsurance for the additional
60 lifetime reserve days is $550.00 per day.
The Medicare skilled nursing facility coinsurance.
Medicare only covers the full cost of skilled nursing facility care for
the first 20 days of a nursing facility stay. The patient
must pay coinsurance for days 21 to 100. For 2009, the amount
is $137.50 per day.
The Medicare Part B deductible and coinsurance
amounts.
The annual Part B deductible is $155.00. Medicare Part B pays only
a portion of the cost of doctors' services, outpatient care, ambulance
transportation, and some medical
supplies and equipment. Medicare beneficiaries are required to
pay coinsurance of 20% of the cost of these services.
The Specified Low-Income Medicare Beneficiary (SLMB)
program pays only the Part B premium, $110.50 per month in 2010, for
new enrollees if you earn less than $85,000. If you were enrolled
before 2010, the Mediare Part B premium is $96.40 per month.
The Additional Low-Income Medicare Beneficiary
(ALMB) program pays the full Medicare Part B premium as well.
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If my application is
approved, when do benefits start?
SLMB and ALMB benefits may be awarded retroactively, up to 3
months before the date of application. QMB benefits are awarded retroactively to the date
of application.
How
do I apply for these programs?
If you think you might be eligible, you can apply at the
nearest office of the Connecticut Department of Social Services. For additional
information or an application form, call CHOICES at 1-800-994-9422.
You can obtain a copy of
the application form, in English or in Spanish, and instructions on how to apply here.
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If I'm
eligible for the QMB program, do I need Medigap insurance?
The QMB program duplicates most of the
benefits provided by Medicare Supplemental Health Insurance (Medigap) policies if an
individual's medical providers accept both Medicare AND Medicaid. Those
enrolled in the QMB program can consider canceling Medigap insurance, but need to consider
the possibility that several physicians have stopped participating in the Medicaid program
in Connecticut. If you cancel your Medigap insurance and your eligibility for QMB
ever ends, you will be able to reinstate your former Medigap policy.
The SLMB and ALMB programs do
not duplicate the benefits of Medigap insurance so you should not cancel your policy
if you are only eligible for these programs.
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Will the State place a lien on my home?
The State cannot place a lien on your
home if you receive QMB, SLMB or ALMB benefits. As with most forms of aid from the
State, the State may seek to recover the sums it paid out on your behalf from your
estate after your death.
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What
should I do if my application is denied or if these benefits are cut off?
Your local legal services office may be able
to provide free legal assistance to appeal the denial or termination of benefits.
Click on "How to Get Help" on the left to find the nearest office that can
assist you.
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Would being enrolled in a Medicare
Savings Program help me with costs in the Medicare Prescription Drug Benefit program?
YES. The Medicare Prescription Drug Benefit program
(Medicare Part D) has premiums, deductibles, co-payments. If you are enrolled in one of
the Medicare Savings programs, you will be automatically enrolled for a low-income
subsidy. The low income subsidy cuts Medicare Part D costs dramatically.
Additionally, all Part D beneficiaries eligible for the low-income subsidy are able to
switch Part D Plans every month throughout the year. It is more important than ever to
apply for these programs if you meet the eligibility criteria.
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