Government Health Care and Benefit Programs Index

Government Health Care and Benefit Programs Index

 

Financial Eligibility Criteria, Benefits, and Related Information

Medicare - Coverage
and Premiums
ConnMAP - Medicare
Assignment
Medicare - Savings
Programs
 
Medicaid - Long Term CareState Supplement
Medicaid - TraditionalSupplemental Security
Income (SSI)
Connecticut Home Care
Program for Elders (CHCPE)
Social Security

Medicare

Effective January 1, 2014

Part A Hospital deductible$1,216.00 per spell of illness

Part A Hospital co-payment

Days 1 - 60

Days 61 - 90

Days 91 - 150

 



0

$304.00 per day

$608.00 per day

Part A SNF co-payment

Days 1 - 20

Days 21 - 100

 

 

0

$152.00 per day

Part A Premium$426.00 per month (for those with less than 30 quarters of Medicare covered employment)

$234.00 per month (for those with 30-39 quarters of Medicare covered employment)
Part B Deductible$147.00 per year
Part B PremiumStandard Premium = $104.90. However, if income greater than $85,000 for single or $170,000 for married couple, then Part B premium is greater.

 Click here for more info.

For more information on Medicare, visit the Center for Medicare Advocacy web site.

Medicare Savings Programs

Effective March 1, 2014

Qualified Medicare Beneficiary Program (QMB)

Monthly income limit for one person

Monthly income limit for a couple
$2,053.03

$2,766.21
Asset limit for one person

Asset limit for a couple
no limit

no limit
Specified Low-Income Medicare Beneficiary Program (SLMB)
Monthly income limit for one person

Monthly income limit for a couple
$2,247.63

$3,028.41
Asset limit for one person

Asset limit for a couple
no limit

no limit
Additional Low-Income Medicare Beneficiaries Program (ALMB)
Monthly income limit for one person

Monthly income limit for a couple
$2,393.58

$3,225.06
Asset limit for one person

Asset limit for a couple
no limit

no limit

Enrollment in a Medicare Savings Plan automatically qualifies an individual for a low-income subsidy (LIS) - also called "extra help" - of the Medicare Part D prescription drug benefit! In addition, eligibility for LIS allows one to change Medicare prescription drug plans anytime throughout the year.

For more information on these programs, including application forms, see Medicare Savings Programs.

Medicaid

Effective January 1, 2014

Community Spouse Allowance Calculation Chart
Insert
monthly shelter costs: rent, mortgage, taxes, insurance, maintenance fees, etc.
 
Add
standard utility allowance
$694.00
Subtract
standard shelter allowance
$589.88
7-1-14 to 6-30-15
Insert
expenses related to exceptional circumstances resulting in significant financial duress
 
Add
Minimum Monthly Needs Allowance (MMNA)
$1,966.25
7-1-14 to 6-30-15
Result equals
the Community Spouse’s Monthly Needs
 
Subtract
community spouse’s income
 
Resulting figure equals
Community Spouse Allowance (CSA)
 
Spousal Impoverishment, Transfer Penalty and Personal Needs Allowances Amounts
Minimum Community Spouse Resource Amount (also known as the Community Spouse Protected Amount)$23,448.00effective 1/1/2014
Community Spouse Resource Amount (CSRA) - assets without a hearing or court order1/2 up to a maximum of $117,240.00effective 1/1/14
Minimum Monthly Needs Allowance (MMNA)$1,938.75effective 7-1-13
Maximum Monthly Needs Allowance (MMNA) without a hearing or court order$2,931.00effective 1/1/14 through 12/31/14
Standard Utility Allowance$694.00effective 10/1/13
Average monthly long-term care cost for purposes of determining transfer of asset penalty periods$11,851.00effective 7-1-14 through 6-30-15
Skilled nursing facility monthly personal needs allowance (Medicaid)$60.00 

The basic Community Spouse Resource Amount (CSRA) noted above may be increased in order to ensure that the Community Spouse has adequate assets to generate income sufficient to increase the Community Spouse’s income to the reach the Community Spouse Allowance (CSA) amount. A fair hearing or court order may be required to establish the CSA amount and to increase the CSRA.

HUSKY C

HUSKY C covers very low-income people who are aged (65+), blind or disabled, including people on both Medicare and Medicaid. Used to be known as Traditional or Community Medicaid.

Effective January 1, 2014

Income limits Region A

Single

Couple

 

 

$912.00

$1,381.00

Income limits Regions B & C

Single

Couple

 

 

$808.00

$1,276.00

Asset limits

Single

Couple

Life insurance (total face value)

Irrevocable funeral contract

 

$1,600.00

$2,400.00

$1,500.00 per person

$5,400.00 per person

Note that the above income limits include unearned income disregard. For an explanation, see the Medicare Savings Program section above.

Medicaid recipients qualify for the full low-income subsidy (LIS) of the Medicare Part D prescription drug benefit, whereby the State of Connecticut pays for all prescription drug co-payments.

Region A is the current listing of towns: Bethel, Bridgewater, Brookfield, Danbury, Darien, Greenwich, New Canaan, New Fairfield, New Milford, Newtown, Norwalk, Redding, Ridgefield, Roxbury, Sherman, Stamford, Washington, Weston, Westport and Wilton.

Regions B & C comprise the rest of the towns of the state.

State Supplement

Effective January 1, 2014

Standard Unearned Income Disregard$325.00
Boarding Home Unearned Income Disregard - residential care homes and adult family living homes$232.70
Special Unearned Income Disregard$392.90

The standard unearned income disregard is used in determining eligibility for the community Medicaid program and Medicare Savings Programs (MSP) as well.

CHCPE - Connecticut Home Care Program for Elders

Effective January 1, 2014

CHCPECategory 1
(65 years or older)
Category 2
(65 years or older)
Category 3
(65 years or older)
Category 4
(CT Home Care Program for Adults with Disabilities) (Under 65 with a degenerative neurological condition)
Category 5
(65 years or older)
Monthly
Income
No limitNo limitind. - $2,163No limitUnd. - $1,437

Assets:
single
couple

 

$35,172.00
$46,896.00

 

 

$35,172.00
$46,896.00

 

$1,600.00 - ind.
$3,200.00 - both as clients
$25,048 - one as client; up to $117,240.00 (or more subject to spousal impoverishment rules)

$35,172.00
$46,896.00

 $1,600.00 - ind

 

For more information on CHCPE, see Medicaid and State-funded Home Care, the state CHCPE web site, or call 1-800-445-5394.

Anyone who would be eligible for Medicaid coverage in a nursing home is eligible for home care services, subject to the asset limits noted above. Individuals receiving Category 3 services receive full Medicaid benefits.

ConnMAP - Connecticut Medicare Assignment Program

Effective January 1, 2014

Maximum income - individual$43,560.00 per year

$3,630.00 per mo.
Maximum income - married couple$58,740.00 per year

$4,895.00 per mo.

The Connecticut Medicare Assignment Program (ConnMAP) is a program run by the Connecticut Department of Social Services. Doctors and other Part B providers of supplies and services are prevented from charging those who are enrolled in ConnMAP more than the rates set by Medicare. Without ConnMAP, doctors and Part B suppliers may charge up to 115% of the Medicare approved rates. For more information or an application call 1-800-443-9946.

Supplemental Security Income (SSI)

Effective January 1, 2014

Monthly Payment Standards
Individual (living alone, SSI only)$721.00
Couple (living together, SSI only)$1,082.00
Asset Limits
Individual$2,000.00
Couple$3,000.00
Student Exclusion Limits
Monthly$1,750.00
Annual$7,060.00

Visit the Social Security Administration SSI home page for more information.

Social Security Benefits (Title II)

Effective January 1, 2014

Cost of living adjustment for 20131.5%
Tax Rate - Employee7.65%
Tax Rate - Self-employed15.30%
Maximum Earnings Subject to Social Security Tax$117,000 per year
Earnings necessary to be credited with one quarter of coverage$1,200 per mo.

Substantial gainful activity (SGA)

non-blind

blind

 

 

$1,070 per mo.

$1,800 per mo.

Trial Work Period (TWP)$770 per mo.
Under full retirement age: One dollar ($1) in benefits will be withheld for every two dollars ($2) in earnings above the limit.

 

$15,480 per year

$1,290 per mo.

Tax exempt earnings in the months of the year prior to the month turning 65. One dollar ($1) in benefits will be withheld for every three dollars ($3) in earnings above the limit.$41,400 per year

$3,450 per mo.
Maximum Social Security benefit for those workers retiring at full retirement age.$2,642 per mo.
Average Monthly Soc. Sec. benefit for all retired workers$1,294 per mo.

Visit the Social Security Administration SSI home page for more information.

For more information, contact:

Statewide Legal Services: 860-344-0380 (Central CT & Middletown) or 1-800-453-3320 (all other regions).

For people over 60, click here to get help from legal aid.

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