Medicare Savings Programs Can Help Pay Some of Your Medicare Costs

This article was produced by CLS, GHLA, NHLAA, and SLS.

Medicare Savings Programs Can Help Pay Some of Your Medicare Costs

What is Medicare?

Medicare is a national health insurance program. You can enroll in Medicare if you are

  • 65 or older and eligible for Social Security retirement benefits,
  • disabled and eligible for Social Security disability benefits for at least 24 months,
  • eligible for Railroad Retirement or disability benefits, or
  • suffering from end stage renal disease.

For more information about Medicare, call 1-800-Medicare or go to www.medicare.gov.

Medicare has several parts:

Part A covers inpatient hospital care, skilled nursing facility care, hospice care, and some home health services.

Part B covers many of the most frequently used health services, such as doctor visits and diagnostic testing.

Part D helps to pay for prescriptions.

Medicare Out-of-Pocket Expenses

Medicare Part A

1. Premium

Elderly or disabled people who do not qualify for Social Security or Railroad Retirement benefits can get Medicare Part A coverage by paying a monthly premium.

2017 Part A Premium

Quarters of Social Security Coverage

Part A Premium 

 29 or fewer quarters

 $413 per month

 30 to 39 quarters

$227 per month

These amounts change every year.

2. Hospital Deductible and Coinsurance Amounts

People who get Medicare must pay a deductible for every hospital stay. There are additional costs (coinsurance) for hospital stays longer than 60 days.

2017 Part A Hospital Deductible and Coinsurance

Deductible

$1,316

Coinsurance     

        Days 61 - 90

 

$329 per day

        Days 91 - 150

$658 per day

These amounts change every year.

3. Skilled Nursing Facility Coinsurance

After a hospital stay, Medicare covers the full cost of nursing facility care for the first 20 days. You must pay for some of the cost of your care (coinsurance) for days 21 to 100.

2017 Part A Nursing Facility Coinsurance

Days 21 - 100

$164.50 per day

This amount changes every year.

Medicare Part B

1. Premium

Usually, the monthly Part B premium is taken out of your Social Security check.

2017 Part B Premium **

$134.00 per month

*Note: If your income is more than $85,000 (single) or $170,000 (married), your Part B premium may be higher.
**If a beneficiary is covered by the hold harmless provision, they will pay $109.00 on average.

This amount changes every year.

2. Deductible

The Part B deductible is the amount you must pay before Medicare will begin to cover your health care expenses.

2017 Part B Deductible

$183 per year

This amount changes every year.

3. Coinsurance

Medicare Part B pays for only some of the cost of doctors' services, outpatient care, ambulance transportation, and some medical supplies and equipment. You must pay a coinsurance (a portion of the cost of your care) of 20% of the cost of these services.

2017 Part B Coinsurance

20% of the cost of services.

Medicare Part D

Prescription costs:

Medicare Part D helps pay for prescription drugs. Fees may include monthly premiums, deductibles, and copays.

Programs that Help Pay for Out-of-Pocket Costs

Three programs can provide payment help to low-income Medicare recipients who are elderly or disabled:

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

The Qualified Medicare Beneficiary (QMB) Program

The Qualified Medicare Beneficiary (QMB) program fills the gaps in Medicare coverage for low income people by eliminating out-of-pocket expenses for services covered by Medicare. If you use providers who accept Medicaid, the following expenses are covered:

  • the Medicare Part A monthly premium (unless the person qualifies for free Part A);
  • hospital deductible and coinsurance amounts;
  • Medicare Part A Skilled Nursing Facility coinsurance;
  • Medicare Part B premium;
  • Medicare Part B deductible; and
  • Medicare Part B coinsurance.

The Specified Low Income Medicare Beneficiary (SLMB) Program and Additional Low Income Medicare Beneficiary (ALMB) Program

The SLMB and ALMB programs pay the monthly Medicare Part B premium. Usually, the monthly Part B premium is taken out of your Social Security check. If you are enrolled in the SLMB or ALMB program, this deduction will stop and your Social Security check will be larger.

Important Note about ALMB: You should apply each year for the ALMB program –as soon after January 1st as possible. ALMB benefits are granted each year on a first-come, first-served basis. Funding for the ALMB program is limited. Once the funding runs out, applications to the program are not accepted.

Who is eligible for these programs?

If you get Medicare, you are eligible for these programs if all of the following criteria are met:

1.  You are a citizen or legal resident of the United States and of Connecticut.

2. You are enrolled (or eligible to enroll) in Medicare Part A.
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 you must be at least 65 years old or disabled.

3.  You must have limited income.

Here are the income limits for each program:

Monthly Income Limits for 2017

Program

Single

Couple

QMB

$2,120.55

$2,854.83

SLMB

$2,321.55

$3,125.43

ALMB

$2,472.30

$3,328.38

Note: The Part B premium taken from from your Social Security check counts as income.

How to Apply for Medicare

All three programs are administered by the Connecticut Department of Social Services (DSS). To apply, complete a short application form. Call CHOICES at 1-800-994-9422, visit your local DSS office, or go to www.ct.gov/dss/cwp/view.asp?a=2345&q=451382 for an application.

QMB, SLMB, and ALMB benefits usually start the month after you apply. In certain cases, SLMB and ALMB benefits are granted up to 3 months before you apply. This means you could get back up to 3 months' worth of all or some of the premiums that you paid out before you applied.

If I'm eligible for the QMB program, do I need Medigap insurance?

If you get Medicare and you are enrolled in an Original Medicare Program (fee for service), you can purchase a Medicare Supplemental Insurance (Medigap) policy to help pay some of the health care costs that Medicare does not cover.

The QMB program offers most of the benefits of Medigap policies if you visit medical providers who accept both Medicare and Medicaid. Before you cancel your Medigap insurance, make sure your medical providers accept both Medicare and Medicaid. If your QMB coverage ends, you may be able to reinstate your former Medigap policy.

Important Note: SLMB and ALMB programs do not offer the benefits of Medigap insurance. If you are enrolled in the Original Medicare Program, you should not cancel your Medigap policy when you enroll in the SLMB or ALMB programs.

If my income changes, can the state get reimbursed for benefits I received in the past?

No, as long as the payments were made after January 1, 2010.

What should I do if my application is denied or my benefits are cut off?

If you are 60 or over, call your local legal aid office (see inside back cover). If you are under 60, call Statewide Legal Services at 1-800-453-3320 or 860-344-0380.

Is there help for prescription drug costs?

YES. If you are enrolled in one of the Medicare Savings programs, you are automatically enrolled in the Part D Low Income Subsidy, also known as “Extra Help.” This program cuts Medicare Part D costs dramatically. In 2017, it

  • pays Part D premiums up to $34.83/month,
  • provides coverage during the Deductible and Donut Hole periods, and
  • limits your Part D copays to a maximum of $3.30 for generic drugs and $8.25 for brand name drugs.

Enrolling

For more information or assistance:

Elder Law Services in Connecticut    www.ctelderlaw.org

Eastern Connecticut

Connecticut Legal Services, Inc.

872 Main Street

Willimantic, CT 06226

(860) 456-1761 or

1-800-413-7796

Southwestern Connecticut

Connecticut Legal Services, Inc.

211 State Street

Bridgeport, CT 06604

(203) 336-3851 or

1-800-809-4434

 

Connecticut Legal Services, Inc.

20 Summer Street

Stamford, CT 06901

(203) 348-9216 or

1-800-541-8909

Western Connecticut

Connecticut Legal Services, Inc.

85 Central Avenue

Waterbury, CT 06702

(203) 756-8074 or

1-800-413-7797

North Central Connecticut

Greater Hartford Legal Aid, Inc.

999 Asylum Avenue, 3rd Floor

Hartford, CT 06105

(860) 541-5000

South Central Connecticut

New Haven Legal Assistance Association

426 State Street

New Haven, CT 06510

(203) 946-4811

Was this helpful?

CAPTCHA
This question is for testing whether you are a human visitor and to prevent automated spam submissions.