Medicare Savings Programs

• The Qualified Medicare Beneficiary Program,
• The Specified Low Income Medicare Beneficiary Program, and
• The Additional Low Income Medicare Beneficiary Program

Programs that can help pay some of your Medicare costs.

July 2007

The Original Medicare Program and the Medicare Advantage Program
The Qualified Medicare Beneficiary (QMB) Program
The Specified Low Income Medicare Beneficiary (SLMB) Program
The Additional Low Income Medicare Beneficiary (ALMB) Program
Who is eligible for these programs?
How do I apply for these programs?
Would being enrolled in a Medicare Savings program help me with costs in the Medicare Prescription Drug Benefit program?
For more information

Three state-administered programs can provide assistance to elderly or disabled Medicare beneficiaries who have modest incomes and assets. These three programs are:

• The Qualified Medicare Beneficiary (QMB) program,
• The Specified Low Income Medicare Beneficiary (SLMB) program, and
• The Additional Low Income Medicare Beneficiary (ALMB) program.

Any Medicare beneficiary, whether enrolled in the Original Medicare Program or the Medicare Advantage Program (formerly Medicare+Choice), who meets the qualifications can apply for enrollment in these programs.

The Original Medicare Program and the Medicare Advantage Program

Anyone eligible for Medicare can now choose to receive Medicare benefits under the Original Medicare Program or through a Medicare Advantage health plan. A person enrolled in Medicare is called a Medicare beneficiary.

The Original Medicare Program has two parts:

• Part A covers inpatient hospital care, skilled nursing facility care, hospice care, and some home health services.
• Part B covers a wide range of most frequently used health services, such as doctor visits and diagnostic testing.

The Medicare Advantage Program offers Medicare beneficiaries different types of health plans through which they can receive their Medicare benefits. These health plans include:

• Managed Care plans (Health Maintenance Organizations, Provider Sponsored Organizations, Preferred Provider Organizations);
• Private Fee For Service plans; and
• Medical Savings Accounts.

Currently, the Health Maintenance Organization (HMO) is the most common Medicare Advantage plan available. Medicare Advantage plans must provide at least the same benefits that the Original Medicare Program provides. Beneficiaries enrolling in a Medicare Advantage plan must also have Medicare Part B coverage.

Unless otherwise indicated, the information in this pamphlet applies to everyone entitled to Medicare benefits, whether Medicare benefits are received under the Original Medicare Program or through a Medicare Advantage health plan.

For more information on the Original Medicare Program and the Medicare health plans available under the Medicare Advantage Program, see your Medicare Handbook, "Medicare and You" published by the Centers for Medicare and Medicaid Services (the federal Medicare agency). For a free copy, call 1-800-MEDICARE. Information is also available on the Internet at www.medicare.gov.

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The Qualified Medicare Beneficiary Program (QMB)

The Qualified Medicare Beneficiary (QMB) program was designed to fill the gaps in Medicare coverage by eliminating out-of-pocket expenses for Medicare covered services. Unfortunately, for individuals who do not visit medical providers who accept both Medicare and Medicaid as payment, QMB does not fill those gaps, which means out-of-pocket costs would be incurred. Therefore, it is very important to make sure your medical providers accept both Medicare and Medicaid before visiting them. There are also some differences on what is covered depending on whether you are enrolled in the Original Medicare or the Medicare Advantage Program (as explained below).

The Original Medicare Program:

If you are enrolled in the Original Medicare Program, out-of-pocket expenses can include: 

• The Medicare Part A Premium
  Elderly or disabled individuals who do not qualify for Social Security or Railroad Retirement benefits can obtain Medicare Part A coverage by paying a monthly premium for Part A.
  
  If you are enrolled in the QMB program, you will not be responsible for this cost.
  
  The Part A premium for 2007 is $410 per month.
  This amount increases every year.

• The Medicare Part A Hospital Deductible and Coinsurance Amounts
  Any Medicare beneficiary who is hospitalized must pay a deductible for each spell of illness and a coinsurance (a portion of the cost of your care) after the 60^th day of hospitalization.
  
  For 2007, the following amounts apply:
  Deductible: $992
  Coinsurance:
          61^st through 90^th day: $248 per day
          91^st through 150^th (lifetime reserve days): $496 per day
  These amounts increase every year.
  
  If you are enrolled in the QMB program, you will not be responsible for these costs.

• The Medicare Part A Skilled Nursing Facility Coinsurance
  Medicare covers the full cost of skilled nursing facility care after a qualified hospital stay for only the first 20 days of your stay. You must pay a coinsurance (a portion of the cost of your care) for days 21 to 100.
  
  For 2007, the nursing facility coinsurance is $124 per day.
  This amount increases every year.
  
  If you are enrolled in the QMB program, you will not be responsible for theses costs. 

• The Medicare Part B Premium
  Usually the monthly Part B premium is deducted from your Social Security check. If you are enrolled in the QMB program, this deduction will stop and your Social Security check will be larger.

For 2007, the Part B premium is $93.50 per month.  
This amount increases every year.
Also, higher income Medicare beneficiaries, for the first time in 2007, pay a higher part B premium.  Income related Part B premiums are $105.80, $124.40, $142.90 and $161.40 depending on the amount the beneficiaries' annual income exceeds $80,000 ($160,000 if married).

If you are enrolled in the QMB program, you will not be responsible for theses costs. 

• The Medicare Part B Deductible
  The Part B deductible is the amount you are responsible for paying before Medicare will begin to cover Part B health care expenses.
  
  For 2007, the annual Part B deductible is $131.
  
  If you are enrolled in the QMB program, you will not be responsible for this cost.

• The Medicare Part B Coinsurance
  Medicare Part B pays only a portion 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.
  
  If you are enrolled in the QMB program, you will not be responsible for these costs.

The Medicare Advantage Managed Care Plan:

If you are enrolled in a Medicare Advantage Managed Care plan, out-of-pocket expenses can include:

• the Part A Premium,
• the Part B premium,
• deductibles,
• coinsurance, and
• co-payments related to Medicare covered services.

    If you are enrolled in the QMB program, you will not be responsible for these costs.

Important Note: The QMB program WILL NOT pay the monthly premium the Medicare Advantage plan charges its enrollees.

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The Specified Low Income Medicare Beneficiary (SLMB) Program

For those who qualify, the SLMB program pays the monthly Medicare Part B premium.

Usually the monthly Part B premium is deducted from your Social Security check. If you are enrolled in the SLMB program, this deduction will stop and your Social Security check will be larger.

The Additional Low Income Medicare Beneficiary (ALMB) Program

The ALMB program pays the monthly Medicare Part B premium. Usually the monthly Part B premium is deducted from your Social Security check. If you are enrolled in the ALMB program, this deduction will stop, or will be reduced, and your Social Security check will be larger.

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

Who is eligible for these programs?

All Medicare beneficiaries, whether enrolled in the Original Medicare Program or the Medicare Advantage Program, are eligible for these programs if all of the following criteria is met:

1. You must be a citizen or legal resident of the United States and the State of Connecticut and be enrolled in Medicare Part A or be eligible to enroll in Medicare Part A.
   
   You can participate in these programs even if you are not covered now by Medicare Part A or Part B, as long as you are eligible to enroll. 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 be at least 65 years old or disabled.
   
2. You do not exceed the asset limits.

   For the QMB and SLMB programs:   A single person can have no more than $4,000 in liquid assets ($6,000 for a married couple).   Some assets are not counted, such as your home, a car, an irrevocable burial account up to $5,400 each for you and your spouse, and life insurance with a cash value of $1,500 or less.
   
   For the ALMB program:  There is no asset limit.

3. You must have limited income.
   Income limit requirements for each program are as follows:

Income Limits for April 2007 - December 2007*
Program	Single	Couple
QMB	$1078.00	$1595.00
SLMB	$1248.20	$1823.20
ALMB	$1375.85	$1994.35
*The income limits for these programs change every year on January 1st and April 1st.

• The Part B premium currently deducted from your Social Security check is counted as income and will be considered when determining your eligibility.

• The gross monthly income limits shown above assume that you have at least $227 (the 2007 amount) per month per person in "unearned income" such as Social Security or pension benefits.  If you don't have this much "unearned income," the income limits for these programs will be lower. Your "unearned income" amount will be determined when you apply.

• Different income limits apply to those who live in a licensed boarding home or who share housing with at least one person who is not related to them as parent, spouse or child.

How do I apply for these programs?

All three programs are administered by the Connecticut Department of Social Services (DSS). To apply, you only need to complete a short application form and provide minimal documents to show your current income and assets. You can call CHOICES for an application at 1-800-994-9422 or visit your local DSS office.

When do benefits start?

QMB, SLMB and ALMB benefits generally start the month after the month you apply. However, in certain cases, SLMB and ALMB benefits may be granted up to 3 months before the month of application. This means that you could get back up to 3 months' worth of all or some of the premiums that you paid out before you applied for these programs.

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

Medicare beneficiaries enrolled in the Original Medicare Program generally purchase a Medicare Supplemental Insurance (Medigap) policy to help pay some of the health care costs that Medicare does not cover.

The QMB program duplicates most of the benefits provided by Medigap policies if QMB beneficiaries visit medical providers who accept both Medicare and Medicaid.  If you enroll in the QMB program, you could consider canceling your Medigap insurance only after determining that your medical providers currently accept, and plan to continue to accept, both Medicare and Medicaid as payment. If you cancel your Medigap insurance and your eligibility for QMB ever ends, you may be able to reinstate your former Medigap policy.

Important Note: The SLMB and ALMB programs do not duplicate 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.

Can the State place a lien on my home?

While these programs are a form of state aid, the State can not place a lien on your home if you receive QMB, SLMB or ALMB benefits. However, after your death, the State may seek to recover the money it paid out on your behalf from your estate.

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

Your local legal services office may be able to provide free legal assistance to appeal a denial or termination of benefits. Please see below for the office nearest you.

Would being enrolled in a Medicare Savings program help me with costs in the Medicare Prescription Drug Benefit program?

YES. The Medicare Prescription Drug Benefit program (Medicare Part D) will have premiums, deductibles, and co-payments. If you are enrolled in one of the Medicare Savings programs, you will be automatically enrolled for a low-income subsidy. The low-income subsidy cuts Medicare Part D costs dramatically.   Additionally, all Part D beneficiaries eligible for the low-income subsidy are able to switch Part D plans every month throughout the year.  It is more important than ever to apply for these programs if you meet the eligibility criteria.

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For more information or assistance:

Statewide Legal Services: (860) 344-0380 (Central CT & Middletown)  1-800-453-3320 (All other regions)

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This document was produced by the Legal Assistance Resource Center of Connecticut in cooperation with Connecticut Legal Services, Greater Hartford Legal Aid, New Haven Legal Assistance Association and Statewide Legal Services.

The information in this document is based on the laws in Connecticut as of July 2007. We hope that the information is helpful. It is not intended as legal advice for an individual situation. If you need further help and have not done so already, please call one of the legal services offices listed above or contact an attorney.

Copyright:  July 2007