Medicare Savings Program

FAQs

  • Can I have MSP and Medicaid?
    Answer:

    MSP and Medicaid are two separate programs. You can have both at the same time. The medical coverage is different for both programs. QMB only covers medical benefits that Medicare covers.

     

    Types of Services

    QMB

    Medicaid

    Hospitalization

    Yes (Maximum of 150 days per benefit period)

    Yes

    Medical appointments

    Yes

    Yes

    Dental Services

    No

    Yes

    Eye Glasses

    No (only after cataract surgery)

    Yes

    Eye Exams

    Sometimes (only if you are treated for a medical condition of the eye)

    Yes

    Medical Transportation

    Limited (only ambulance services for emergency medical care)

    Yes

    Visiting Nurse Services

    Limited (with a doctor’s order, when you are homebound and have a skilled need)

    Yes

    Nursing Home

    Limited (after a 3 night overnight qualifying stay in the hospital, requiring a skilled need with a maximum benefit of 100 days)

    Yes

    Pays Medicare Part B premium

    Yes

    No

    Helps with prescriptions

    Yes (enrolls you into LIS which helps with costs)

    No (will not pay for medications that are available from a Medicare Part D plan). Maximum out of pocket expenses of $17 for drugs on a Part D formulary.

    Full Medicaid benefits under Husky A, Husky C (when spenddown met for Husky C spenddown) or Medicaid for the Employed Disabled pays for medical services even if they are not covered by Medicare.

  • Can I see any provider of my choosing?
    Answer: 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.
  • Do I have to apply for MSP?
    Answer: You must file an application in order to receive MSP. However, enrollment is purely voluntary.  You can also stop MSP at any time.
  • Do I have to pay back any of the benefits that I receive from MSP?
    Answer: We will not recover money for this program for any benefits that you receive after January 1, 2010. However, if you received any benefits under MSP before January 1, 2010, the State can recover money equal to the amount of benefits you received.
  • Does QMB work with Medicare Advantage plans or Medicare Part C?
    Answer: 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.
  • How do I apply for MSP?
    Answer:

    You need to complete a short application form for the program. 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 or W-1QMBS (Spanish version) “Application for Medicare Savings Program” to:

    DSS ConneCT Scanning Center
    PO Box 1320
    Manchester, CT 06045-1320

    You can also enroll online through https://www.connect.ct.gov.

  • How Does My Provider Know I have MSP?
    Answer: If you are eligible for QMB you should receive a grey CONNECT card from us. You should show 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.
  • How long will it take for my application to be approved?
    Answer: It may take forty-five days for the department to process your application. As long as you are eligible, you will receive benefits back to the date that we received your application. However, an individual eligible for QMB (Qualified Medicare Beneficiary) qualifies in the month after the individual is determined to be eligible.
  • How often does DSS review my eligibility?
    Answer: MSP is normally granted for a one year period. One month before your expiration date, you will receive a notice in the mail that you are due for a review of coverage and a renewal form.  Send this completed form to the DSS scanning center.
  • How soon will I see an increase in my Social Security Check?
    Answer: It takes approximately three months from the time that you are granted MSP for you to receive the increase in your Social Security check. The Social Security Administration will send you any back months that are due to you. So, for example, if you are granted MSP in June, you should see an increase in your Social Security check no later than September. Social Security will then send you a check to reimburse you for the months of June, July and August.
  • I am on Husky D; can I stay on Husky D when I receive Medicare?
    Answer: Husky D Medicaid is for individual’s age 19-64 who do not have minor children. You are no longer eligible for this particular Medicaid program when you are Medicare eligible. You should apply for MSP as soon as you are notified that you are eligible for Medicare. You should also consider applying for Husky C Medicaid if your assets are below $1600 (as a single individual).
  • I didn’t enroll in Medicare Part B during my initial enrollment period and Social Security says my Medicare Part B won’t start until July 1, can MSP help me?
    Answer: Yes, it can. Most individuals, who didn’t enroll into Medicare Part B when they were first eligible, are normally limited to enrollment during the General Enrollment Period of January 1 through March 31 with a start date of July 1. All three levels of the MSP can help beneficiaries obtain this benefit faster. The State can “buy-in” your Medicare Part B benefit when your MSP application is approved. As a result, Social Security will place you onto Medicare Part B benefits on the date CT DSS states they will pay your Medicare Part B premium.  This will eliminate any Medicare Part B penalty you might have had to pay.
  • I do not have a Medicare Part D plan, how will LIS help me?
    Answer:

    The federal government has a temporary Medicare Part D plan called LINET, for individuals who are entitled to LIS but who do not yet have a Medicare Part D plan. LINET is premium free and has no drug restrictions. You will be automatically enrolled into a Medicare Part D plan within two months if you have not yet selected a plan. Contact CHOICES at 1-800- 994-9422 for assisting in selecting a Medicare Part D plan.

  • I have a Medicare Part D plan, how does my plan know I now receive LIS?
    Answer:

    It may take some time before your Medicare Part D plan is aware that you have LIS. If you need medications before this point, you should contact your Medicare Part D plan and fax or send your DSS approval letter to your plan as best available evidence that you are entitled to LIS co-pays at the pharmacy.

  • I know when I will be on Medicare, how soon can I apply?
    Answer: You should apply one month before your Medicare start date.
  • I received a transplant and I am on medications under my Medicare Part B benefit, does MSP help with these costs?
    Answer: Only the QMB portion of MSP will help cover Medicare Part B costs, including the cost of specific medications under Medicare Part B. QMB pays the co-pays and deductibles of any Medicare Part A and B benefit.
  • I work even though I collect Social Security, would I be eligible for benefits?
    Answer: 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 is considered for eligibility.
  • If I am removed from MSP benefits, will that affect my LIS benefits?
    Answer: LIS is administered by the federal government. The redetermination date for LIS does not correspond to your MSP dates.          If you were eligible for MSP from January through June, and your MSP ends before July, you remain eligible for LIS until December 31 of the current calendar year. If you were eligible for MSP or Medicaid through July and then your eligibility for the program(s) ends, your LIS benefit will remain in effect for the remainder of the  calendar year and through the next.
  • My provider says I am on a medical spenddown. Do I have medical coverage with QMB?
    Answer: Since QMB is a separate program from Medicaid you have full medical benefits for any medical service covered by Medicare even if you are on a Husky C Medicaid spenddown. and your spenddown is met, you have full Medicaid benefits for the remainder of the spenddown period.
  • What are QMB (Qualified Medicare Beneficiaries), SLMB (Special Low Income Medicare Beneficiaries) and ALMB (Additional Low Income Medicare Beneficiaries)?
    Answer:

    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 monthly income limit, effective March 1, 2017, are:

    QMB - $2,120.55 for a single person and $2,854.83 for a couple

    SLMB - $2,321.55 for a single person and $3,125.43 for a couple

    ALMB - $2,472.30 for a single person and $3,328.38 for a couple

     

    All three levels will pay the Medicare Part B premium that is normally deducted from your social security check.

    All three levels automatically enroll you into the Low Income Subsidy (LIS), also called “Extra Help”. 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 level 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.

     

  • What are the Medicare Savings Programs (MSP)?
    Answer: 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 and all three enroll you into a program that helps with Medicare’s prescription benefits, called the Low Income Subsidy (or “Extra Help”).
  • What happens if I have Medicare Part A?
    Answer: A person who is eligible for Medicare Part A and has income below the program limits may be eligible for the Medicare Savings Program. If you apply for and are found eligible for QMB, the State of Connecticut may pay the Part A premium for you.
  • What is considered to be income for the MSP Program?
    Answer: 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.
  • When will my eligibility begin if my application for MSP is approved?
    Answer:

    The eligibility start date for MSP depends on the program for which an individual is eligible.

    An individual eligible for QMB qualifies in the month after the individual is determined to be eligible. This is usually the month after we receive the application.

    An individual eligible for SLMB or ALMB may qualify for payment during the three months immediately before the date we receive the application.

  • Where can I get more information about MSP?
    Answer: You can get more information about MSP by calling CHOICES at 1-800-994-9422.
  • Who is eligible to receive the MSP program?
    Answer: Eligibility varies from state to state. Individuals must be a resident of Connecticut, be eligible for Medicare Part A or 65 years of age. 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.
  • Will my Medicare benefits change if I enroll in MSP?
    Answer: No, having MSP does not change your Medicare benefits, but it provides more flexibility for enrolling and disenrolling from Medicare plans throughout the year.
  • Will the QMB pay for me to see a provider that is not in my Medicare Advantage plan network?
    Answer:

    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.