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 and have been eligible for Social Security benefits for at least 24 months.  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 (No Asset Limit)

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 each year. 

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.

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 2011, if you had already been enrolled in Medicare. For new enrolees in Medicare, in 2011, the Medicare Part B preimum is typically $110.50 per month, if you earn less than $85,000 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 2011 will be $450.00 per month, if your Social Security quarters is 29 or fewer, or $248 per month, if your Social Security quarters is 30 to 39 quarters.

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 2011 the amount is $1,132.00.  In 2011, the coinsurance for days 61 through 90 is $283.00 per day and the coinsurance for the additional 60 lifetime reserve days is $566.00 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 2011, the amount is $144.50 per day.

The Medicare Part B deductible and coinsurance amounts.  The annual Part B deductible is $162.00.  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 2011, for new enrollees if you earn less than $85,000. If you were enrolled before 2011, 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.

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.

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.

Will the State recover from my estate for benefits received under any one of the three Medicare Savings Programs?

No, if the Medicare Savings Program payments were made after January 1, 2010. Congress changed the recovery rules, so that Medicare Savings Program payments are exempted.

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.

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.