Medicare Savings Program

FAQs

  • Can I have a Medigap policy while I am on QMB?
    Answer: Since QMB acts as if it is a Medicare supplement plan, also called Medigap, you may no longer need coverage from a Medigap plan that you purchased. However, you may maintain an existing Medigap policy that you may already have as long as you continue to pay the premium. Some people with QMB consider this option if their preferred doctors do not accept both Medicare and Medicaid. You cannot be sold a duplicative policy of your existing coverage. As a result, you cannot be sold a new Medigap plan or change your existing Medigap company or plan once you receive QMB benefits.
  • 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. If you have Medicare and Medicaid, it is beneficial to also enroll in MSP as it will cover your Medicare Part B premium.

     

    Types of Services

    QMB

    Medicaid

    Hospitalization

    Yes (Maximum of 150 days per benefit period)

    Yes

    Medical appointments

    Yes

    Yes

    Dental Services

    No

    Yes

    Eyeglasses

    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 (generally only ambulance services for emergency medical care)

    Yes

    Home Health Services

    Yes (if you have a doctor’s order, when you are homebound or need nursing and/or therapy)

    Yes

    Nursing Home Care

    Limited (usually after a 3-night hospital stay when you need daily skilled care, with a maximum benefit of 100 days per benefit period)

    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 plan. 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:

    Yes - QMB does work with Medicare Advantage plans. The QMB covers deductibles and co-pays for all Medicare Part A and B covered services received from an in-network provider.

    If you receive treatment from an out-of-network provider for a Medicare A & B covered service, the QMB may cover cost-sharing, depending on the type of Medicare Advantage plan you are enrolled in:

    • If you are in a Medicare Advantage Plan called PPO, you cannot be billed for cost-sharing for Medicare-covered out-of-network services.
    • If you are in a Medicare Advantage Plan called an HMO-POS, the QMB will only cover cost-sharing for services that the plan providers out-of-network coverage for. You can review your plan’s coverage documents or call the pan for more information about which out-of-network services are covered.
    • If you are in a Medicare Advantage Plan called an HMO, that means it does not offer any out-of-network benefits, so if you see an out-of-network provider, your services will usually not be covered, unless it is an emergency, or no in-network provider is available and you get permission from the plan to go out-of-network. If you see an out-of-network provider and your services are not covered by the plan, the QMB will not cover the cost-sharing, and you may not be protected from being billed for the full cost of services.

    The QMB does not cover cost-sharing for extra benefits provided by a Medicare Advantage Plan that are not covered under traditional Medicare, such as routine dental care.

    Some Medicare Advantage plans charge a premium for benefits. The QMB may only cover a portion of that premium, so QMB recipients may still owe a premium for their Medicare Advantage Plan.
  • How do I apply for MSP?
    Answer:

    You need to complete a short application form, W-1QMB or W-1QMBS (Spanish version) "Application for Medicare Savings Program". You then need to mail the application form to:

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

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

    You do not need to send any supporting documentation unless DSS requests information from you.

  • How Does My Provider Know I have MSP?
    Answer: If you are eligible for QMB you should receive a grey CONNECT card from us if you don't have one already. 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.
  • 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 the expiration date, we will review your information to see if you still qualify.

    Your renewal will be completed in one of two ways:

    Automatic renewal: If we have enough information to determine eligibility, your MSP will automatically be renewed. We will send a letter that will confirm your continued coverage.

    Renewal form needed: If we need more information, we will send a renewal form at least 30 days before your renewal is due. In order to keep your coverage, you or your representative must fill out and return the form.

  • How soon will I see an increase in my Social Security Check?
    Answer:

    It takes up to three months from the time that you are granted MSP for the increase to show in your Social Security check. During this processing time, you will still see Medicare premiums taken out, however, the Social Security Administration will refund you.

    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 premiums you paid out-of-pocket 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 designed for individuals age 19-64 who do not have minor children and are not enrolled in Medicare. You are no longer eligible for this particular Medicaid program when you are Medicare eligible. The Department will contact you if additional information is needed to determine eligibility for HUSKY C Medicaid.

    You should apply for MSP as soon as you are notified that you are eligible for Medicare.

  • 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. 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, effective the first of the following month. 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 temporarily covers all drugs that are part of the Part D program. You will be automatically enrolled into a Medicare Part D plan within two months if you have not yet selected a plan, which may not be the best for you. 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 may apply the 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 working is called earned income. If you are receiving Medicare but you continue to work, the first $65 of your earned income is not counted. Only half of the remaining earned income is counted towards eligibility for MSP.  
  • 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. If your spenddown is met, you have full Medicaid benefits for the remainder of the six-month spenddown period.
  • 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 (LIS 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 do not have Part B yet, the MSP program may be able to enroll you in Part B outside of other enrollment periods without a penalty. If you have to pay a premium for Part A and are eligible for QMB, the State of Connecticut pays 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 receive 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, such as VA non-service-connected pensions, Aid and Attendance, and Housebound Allowance are not counted towards 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.

    *As of January 1, 2027 the retroactive coverage period is limited to a maximum of two months.

  • Where can I get more information about MSP?
    Answer: You can get more information about MSP by calling CHOICES at 1-800-994-9422. CHOICES can also help you complete your MSP application.
  • Who is eligible to receive the MSP program?
    Answer: Eligibility varies from state to state. Individuals must be a resident of Connecticut and be eligible for Medicare Part A. 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 it either. 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.