Medicare Savings Program

State Department on Aging

Revised: April 11, 2014

Best Kept Secret

• Medicare Savings Program No asset restrictions

Helps with Medicare Part D prescription costs

May even help with Physician and Hospital Visits

The State of CT will not place a lien on your home or recover any funds from your estate at death

Do You Qualify?

• Individuals with incomes up to $2393.58/month

• Couples with incomes up to $3225.06/month

How Do You Apply?

• Simple Three Page Application with a “fastlink” cover sheet

• No Supporting Documents Are Needed

• Application is mailed for scanning:

DSS ConneCT Scanning Center PO Box 1320 Manchester, CT 06045-1320

Qualified Medicare Beneficiary (QMB) Specified Low Income Subsidy (SLMB) Additional Low Income Medicare Beneficiary (ALMB)

Medicare Savings Program (MSP) (revised 3/14)

Program

Status

Income Limit

Status

Income Limit

NO ASSET LIMITS

FOR MSP

No Estate Recovery

after 1/1/10

Anyone on Medicare

Savings Program is

automatically eligible

for the Low Income

Subsidy which helps

with Medicare Part D

QMB

Single

$2,053.03/mo

Couple

$2,766.21/ mo

SLMB

Single

$2,247.63/mo

Couple

$3,028.41/ mo

ALMB

Single

$2,393.58 /mo

Couple

$3,225.06 / mo

If you qualify for MSP, you will automatically qualify for Extra Help and the lower

co-pays for Part D

Qualified Medicare Beneficiary

Eligibility: Individuals: $2053.03/month

Couple: $2766.21/month

Benefits:

Acts like a Medigap Supplement

Hospital deductibles and co-pays

Physician deductibles and co-pays

You pay NOTHING when you go to the hospital or when you see your doctor !

Mr. James Hospital Pays $0

Mr. James Sees his Doctor Pays $0

• You do not need a separate Medigap or Medicare Supplemental Plan

• Providers cannot charge you anything after Medicare pays its portion

All Three Levels Pay the Following

• Pays your Medicare Part B premium

▫ ($104.90 for most people)

• Eliminates Medicare Part B penalty premium – (A higher premium for people who didn’t enroll in Part B when they were first eligible)

• Enrolls you into Extra Help for your Prescriptions with no additional paperwork

Low Income Subsidy

• Pays your benchmark Medicare Part D premium (or a portion of a non-benchmark plan)

• Lowers what you pay at the pharmacy: $6.35 for brand drugs $2.55 for generic medications

(drugs must be on the plan’s formulary)

• Eliminates the “donut-hole” – continuous coverage for prescriptions

Entitles You to an Open Enrollment

• You are not limited to making changes during the Annual Election Period (October 15 – Dec 7)

• You can select a different Medicare Part D or Medicare Advantage plan or change from or into a Medicare Advantage Plan as often as once per month

How Do I Know When I Have Coverage?

• The Department of Social Services will send you a letter telling you that you are eligible

Don’t Worry:

The letter includes a statement that you not eligible for the month that you sent in your application –you are covered for the following months!

The pharmacy will know that you have Extra Help and you will see lower co-pays

When Do I See An Increase in My Social

Security? State of CT says you are eligible in June

Sends notice to Social Security

2 months later

Medicare Part B isn’t take out of your check &

You receive a check for June & July Part B premiums

Only Individuals on QMB receive a

“grey connect card”

Medicaid

Income

Eligibility

Single $848.38 Couple $1,346.41

QMB

Income

Eligibility

Single $2053.03 Couple $2766.21

Individuals on a Medicaid “Spenddown” should consider the Medicare Savings Program

Most of your medical expenses are covered by the QMB (except dental, eye glasses, hearing, medical transportation

and ongoing homecare services in the home)

What is Medicaid? Now referred to as: Husky C – For people who are blind, have a disability and individuals over the age of 65 Husky D – Medicaid Expanded Benefits For individuals without Medicare ages 18-54

Medicare Medicaid

What is it? A federal health insurance for people who worked 10+years: 65 years or older Under 65 with certain disabilities of any age who have End Stage Renal Disease or ALS

Joint federal & state program: Pays for health care for certain people & families with limited income & resources There are many different types of Medicaid

Who Governs it?

Federal Government State Government

What Does it Cover?

Medicare Part A – Hospital & Nursing Home Rehabilitation Medicare Part B – Doctor visits, outpatient services & preventative care Part D – prescription coverage Or Part C – Medicare Advantage – a private company manages Part A, B and D coverage in one plan

All the benefits of Medicare Plus: Medical Transportation Dental, Hearing, Vision, additional durable medical supplies (for example, bath seats), ongoing home care services, long term nursing home care

Medicare Medicaid

What Does it cost? There are premiums, deductibles & co-pays for services

$0 for hospital & doctor visits Up to $15/month co-pay for individuals with Medicare and Medicaid

How Do I get it? 3 months before 65th birthday (up until 3 months after your 65th birthday) enroll with Social Security for Medicare Part A & B. Individuals on Social Security Disability receive benefits automatically after 24 months. People select Parts D and C through private companies

Apply through the Department of Social Services with supporting documentation or online with www.connect.ct.gov Apply for Medicaid Expanded benefits through accesshealthct.org

Eligibility Individuals who have worked 40 quarters and are now 65 24 months after an individual starts receiving Social Security Disability benefits or at age 65 with a disability

Income Eligibility for Husky C: Single $848.38 Couple: $1346.41 Assets: Single:$1,600 Couple: $2000 Life Insurance $1500 Face Value Pre-paid funeral $5400 Medicaid Expanded: Based on Modified Adjusted Gross Income (MAGI) on federal income tax Single: $1342.00/mo Couple: $1809.18/mo No asset restriction

Medicare Medicaid

Some People are Eligible for Both

My income is too high for Medicaid

• You can still receive help through a “Spend Down process” if your income is too high

• Your spend down is similar to a deductible

• Once you pay or owe your “spend down” amount on medical bills you can receive full Medicaid benefits

How do they determine my Spend

Down?

• Your income $ 1008.00

• Medicaid Income Limit - $ 848.38

$ 159.62 X 6 months $ 957.72

This is you Spend Down Amount

Where do I send proof I met my

spenddown?

HUSKY Spend-down Processing Center P.O. Box 280747, East Hartford, CT 06268 1-877-858-7012; Fax: 1-888-495-2897

You should have received an envelope for this purpose

Include your name and client identification

number on your grey connect card

You will hear within 5 business days

The HUSKY Spend-down Processing Center will tell you within five business days if you qualify for Medicaid or if you need to send in more medical

expenses or additional information

What Type of Expenses Can I Use?

• Premiums, deductibles, and co-insurance charges

• Services such as homemakers, personal response systems, adult day care and meals-on-wheels received by clients ▫ Documentation from a medical provider

• Over-the-counter medications (e.g., aspirin, cough syrup) and/or medical supplies (e.g., bandages, gauze). Vitamins/supplements require a letter from the provider verifying medical necessity

Other Expenses

• Co-pay for Services if you are on the State Funded Home Care Program for Elders or receiving help from Respite Programs

• Glasses

• Hearing Aids

• Dental Care and Dentures

• Eye Exam

Where Can I Receive Help?

• CHOICES Program 1-800-994-9422 (toll free)

• Go to any Department of Social Services office

• Call 1-855-6-CONNECT (1-855-626-6632)

• TTD/TTY 1-800-842-4524 for persons with speech or hearing difficulties

▫ The automated client information center is available 24/7; workers are available 7 a.m. – 4 p.m.