Q. What are the Medicare Savings Programs (MSP)?
A. The MSP helps to pay some of the out of pocket costs of Medicare. There are three levels of the program that are based on income. All three levels pay for the Medicare Part B premium ($104.90 in 2015 for most individuals) and all three enroll you into a program that helps with Medicare’s prescription benefits, called the Low Income Subsidy (or the ”Extra Help”) .
Q. Who is eligible for the MSP program?
A. Eligibility varies from state to state. Individuals must be a resident of Connecticut, be eligible for Medicare Part A or 65 years of age and legally in the United State for five years or a United States citizen. Eligibility is based solely on your gross income or combined income with your spouse, even if your spouse is not yet eligible to receive Medicare benefits. Connecticut does not review your assets when determining eligibility for the program. As a result, the Department of Social Services will not ask whether you own a home or have money in the bank.
Q. What are QMB (Qualified Medicare Beneficiaries), SLMB (Special Low Income Medicare Beneficiaries) and ALMB (Additional Low Income Medicare Beneficiaries)?
A. QMB, SLMB and ALMB are categories within MSP. Your gross income or combined gross income with your spouse determines which category you qualify for. The new income limit, effective March 1, 2015, are:
QMB - $2,069.91 for a single person and $2,802.08 for a couple
SLMB - $2,266.11 for a single person and $3067.68 for a couple
ALMB - $2,413.26 for a single person and $3,266.88 for a couple
All three categories levels will pay the Medicare Part B premium that is normally deducted from your Social Security beneficiary.
All three levels automatically enroll you into the Low Income Subsidy (LIS), also called “Extra Help”. With the LIS, you will not have to pay more than $6.60 for your covered prescriptions. The LIS also pays the full cost of a Medicare Part D (prescription coverage) benchmark plan or a portion of a non-benchmark plan, yearly deductibles and co-insurance or co-pays. This coverage remains the same even if you reach the coverage gap or donut hole. The LIS also provides you with a special enrollment so that throughout the year you can change your Medicare Part D or Medicare Advantage plans outside of the open enrollment period. For more information about the LIS go to www.socialsecurity.gov
, call 1-800-Medicare or for TTY call 1-800-325-0778.
The QMB is the only category that acts like a Medicare Supplemental or Medigap plan. It will cover the costs of the deductibles or co-pays of Medicare Part A and Medicare Part B up to the Medicaid approved rate. You are protected by federal law from being “balanced billed”, or billed for services after Medicare Part A and B pays its portion of the bill, if a provider agrees to treat you, whether or not the provider is a Medicaid provider.
Q. How do I apply for MSP?
A. You need to complete a short application form for the program that is only three pages long. You do not need to send any supporting documentation unless the DSS worker reviewing the application requests information from you. You then need to return the application form #W-1QMB “Medicare Savings Programs” to:
DSS ConneCT Scanning Center
PO Box 1320
Manchester, CT 06045-1320
Q. What is considered to be income for the MSP Program?
A. The Department of Social Services will consider all funds that you or your spouse receives before any deductions are taken out. Social Security benefits, pension, interest from money in the bank or money you earn from working would all be considered income. Money received from the Veterans’ Program, Aid and Attendance, is not counted towards eligibility. Unlike the Husky D Medicaid program, the program does not look at your modified adjusted gross income based on your tax household and it does not deduct expenses when determining eligibility.
Q. What happens if I work? Can I still be eligible for MSP?
A. The money you earn while collecting Social Security or Social Security Disability is called earned income. If you are receiving Medicare but you continue to work, the first $65 of your earned income is not counted, or disregarded. Only half of the remaining earned income is counted towards eligibility for MSP. However, if your spouse works and is not yet on Medicare, the total amount of your spouse’s earned amount, after certain employment expenses, is considered for eligibility.
Q. How does my provider know I have MSP?
A. If you are eligible for QMB you should receive a grey Connect card from us. You should the CONNECT card along with your Medicare card (or your Medicare Advantage card) to the hospital, doctor and pharmacist. Medicare pays your provider first and QMB acts like a secondary insurance. Until you receive your card, you can use the letter you received from DSS (or granting notice) as proof you have this benefit. We will not send a CONNECT card to you if you already have an EBT card from us. You can use your EBT card right away to help pay for Medicare co-pays and deductibles.
Q. Can I see any provider of my choosing?
A. If you have traditional Medicare, you can receive care from any provider that accepts Medicare. Individuals in a Medicare Advantage Plan are limited to a network of providers. The QMB program works with both Medicare and a Medicare Advantage plans. It will pay the deductibles and co-pays of Medicare Part A and B up to the Medicaid approved rate. Providers are not required to treat you as a patient if they do not accept this reimbursement rate, but if they treat you, they cannot charge you anything after Medicare pays its portion.
Q. Does QMB work with Medicare Advantage plans or Medicare Part C?
A. QMB does work with Medicare Advantage plans and will cover all deductibles and co-pays for Medicare Part A and B costs. Some Medicare Advantage plans charge a premium for benefits. QMB only covers the portion of the premium that covers the prescription standard benefit. QMB recipients may still have a premium for their Medicare Advantage plan if they have enrolled in a plan with a premium for their Medicare Part A and B benefits. QMB beneficiaries should consider either returning to traditional Medicare since QMB covers out of pockets costs for Medicare Part A and B and D or enrolling in a Medicare Advantage plan that offers a zero premium with the LIS subsidy.
Q. Will the QMB pay for me to see a provider that is not in my Medicare Advantage plan network?
A. QMB only covers the costs that Medicare covers. If you are in a Medicare Advantage plan and your plan does not cover a provider, then QMB does not cover the charge. However, individuals on QMB have a special enrollment period and can change Medicare plans throughout the year. One option for you is to return to traditional Medicare or to another Medicare Advantage plan where you are not limited to a network.