Medicare Savings Program. State Department on Aging Revised: April 11, 2014
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1 Medicare Savings Program State Department on Aging Revised: April 11, 2014
2 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
3 Do You Qualify? Individuals with incomes up to $ /month Couples with incomes up to $ /month
4 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
5 Qualified Medicare Beneficiary (QMB) Specified Low Income Subsidy (SLMB) Additional Low Income Medicare Beneficiary (ALMB)
6 Medicare Savings Program (MSP) (revised 3/14) Program Status Income Limit Status Income Limit NO ASSET LIMITS FOR MSP 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, /mo Couple $3, / mo 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 If you qualify for MSP, you will automatically qualify for Extra Help and the lower co-pays for Part D
7 Qualified Medicare Beneficiary Eligibility: Individuals: $ /month Couple: $ /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!
8 You do not need a separate Medigap or Medicare Supplemental Plan Providers cannot charge you anything after Medicare pays its portion Mr. James Hospital Pays $0 Mr. James Sees his Doctor Pays $0
9 All Three Levels Pay the Following Pays your Medicare Part B premium ($ 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
10 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
11 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
12 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
13 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
14 Only Individuals on QMB receive a grey connect card
15 Individuals on a Medicaid Spenddown should consider the Medicare Savings Program Medicaid Income Eligibility QMB Income Eligibility Single $ Couple $1, Single $ Couple $ Most of your medical expenses are covered by the QMB (except dental, eye glasses, hearing, medical transportation and ongoing homecare services in the home)
16 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
17 What is it? Who Governs it? What Does it Cover? Medicare 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 Federal Government 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 Medicaid Joint federal & state program: Pays for health care for certain people & families with limited income & resources There are many different types of Medicaid State Government 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
18 What Does it cost? Medicare There are premiums, deductibles & co-pays for services Medicaid $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 65 th birthday (up until 3 months after your 65 th 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 Apply for Medicaid Expanded benefits through accesshealthct.org
19 Eligibility Medicare Individuals who have worked 40 quarters and are now months after an individual starts receiving Social Security Disability benefits or at age 65 with a disability Medicaid Income Eligibility for Husky C: Single $ Couple: $ 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: $ /mo Couple: $ /mo No asset restriction
20 Some People are Eligible for Both
21 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
22 How do they determine my Spend Down? Your income $ Medicaid Income Limit - $ This is you Spend Down Amount $ X 6 months $
23 Where do I send proof I met my spenddown? HUSKY Spend-down Processing Center P.O. Box , East Hartford, CT ; Fax: You should have received an envelope for this purpose Include your name and client identification number on your grey connect card
24 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
25 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
26 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
27 Where Can I Receive Help? CHOICES Program (toll free) Go to any Department of Social Services office Call CONNECT ( ) TTD/TTY 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.
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