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 Care | State Supplement |
| Medicaid - Traditional | Supplemental Security Income (SSI) |
| Connecticut Home Care Program for Elders (CHCPE) | Social Security |
MedicareEffective January 1, 2013 | |
| Part A Hospital deductible | $1,184.00 per spell of illness |
| Part A Hospital co-payment Days 1 - 60 Days 61 - 90 Days 91 - 150 | 0 $296.00 per day $592.00 per day |
| Part A SNF co-payment Days 1 - 20 Days 21 - 100 | 0 $148.00 per day |
| Part A Premium | $441.00 per month (for those with less than 30 quarters of Medicare covered employment) $243.00 per month (for those with 30-39 quarters of Medicare covered employment) |
| Part B Deductible | $147.00 per year |
| Part B Premium | Standard 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.
| Specified Low-Income Medicare Beneficiary Program (SLMB) | |
| Monthly income limit for one person Monthly income limit for a couple | $2,212.98 $2,986.83 |
| 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 | $2,356.68 $3,180.78 |
| 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.
| Spousal Impoverishment, Transfer Penalty and Personal Needs Allowances Amounts | ||
| Community Spouse Resource Amount (CSRA) - assets without a hearing or court order | 1/2 up to a maximum of $115,920.00 | effective 1/1/13 |
| Maximum Monthly Needs Allowance (MMNA) without a hearing or court order | $2,898.00 | effective 1/1/13 through 12/31/13 |
| Standard Utility Allowance | $668.00 | effective 10/1/12 |
| Average monthly long-term care cost for purposes of determining transfer of asset penalty periods | $11,183.00 | effective 7-1-12 through 6-30-13 |
| Skilled nursing facility monthly personal needs allowance (Medicaid) | $60.00 | effective 7-1-12 through 6-30-13 |
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.
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.
The standard unearned income disregard is used in determining eligibility for the community Medicaid program and Medicare Savings Programs (MSP) as well.
For more information on CHCPE, see Medicaid and State-funded Home Care or 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.
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, 2013 | |
| Monthly Payment Standards | |
| Individual (living alone, SSI only) | $710.00 |
| Couple (living together, SSI only) | $1,066.10 |
| Asset Limits | |
| Individual | $2,000.00 |
| Couple | $3,000.00 |
| Student Exclusion Limits | |
| Monthly | $1,730.00 |
| Annual | $6,960.00 |
Visit the Social Security Administration SSI home page for more information.
Social Security Benefits (Title II)Effective January 1, 2013 | |
| Cost of living adjustment for 2013 | 1.7% |
| Tax Rate - Employee | 7.65% |
| Tax Rate - Self-employed | 15.30% |
| Maximum Earnings Subject to Social Security Tax | $113,700 per year |
| Earnings necessary to be credited with one quarter of coverage | $1,160 per mo. |
Substantial gainful activity (SGA) non-blind | $1,040 per mo. $1,740 per mo. |
| Trial Work Period (TWP) | $750 per mo. |
| Under full retirement age: One dollar ($1) in benefits will be withheld for every two dollars ($2) in earnings above the limit. | $15,120 per year $1,260 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. | $40,080 per year $3,340 per mo. |
| Maximum Social Security benefit for those workers retiring at full retirement age. | $2,533 per mo. |
| Average Monthly Soc. Sec. benefit for all retired workers | $1,261 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).
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