Medicare Savings Programs

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 and Specified Low-Income Medicare Beneficiary Programs have an asset limit.  The asset limit is $4,000 for a single person and $6,000 for a married person.  If you have more assets than these limits, you may want to consider spending down enough to qualify for these programs.  Some assets are not counted, such as your home, a car, an irrevocable funeral services account for up to $5,400 each for you and your spouse, a burial plot, and life insurance with a cash value of $1,500 or less.  The Additional Low-Income Medicare Beneficiary Program has 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.  Please note that the income limits below include the unearned income disregard of $241 per person for 2008.

Effective January 1, 2008 - March 31, 2008

Qualified Medicare Beneficiary Program (QMB)

Specified Low-Income Medicare Beneficiary Program (SLMB)

Additional Low-Income Medicare Beneficiaries Program (ALMB)

You may still be eligible for these programs if you have a higher income and you share housing with at least one person who is not related to you as parent, spouse or child.  Different income disregareds apply.

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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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 2008, 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 2008 will be $423.00 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 2008 the amount is $1024.00.  In 2008, the coinsurance for days 61 through 90 is $256.00 per day and the coinsurance for the additional 60 lifetime reserve days is $512.00 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 2008, the amount is $128.00 per day.

The Medicare Part B deductible and coinsurance amounts.  The annual Part B deductible is $135.00.  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, $96.40 per month in 2008.

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.

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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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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