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Medicare Savings Program CT

If you would like some information on Medicare Savings Program CT, you should read this post.  The Medicare Savings Programs (MSP), has multiple levels called QMB (qualified Medicare beneficiary), SLMB (specified low income medicare beneficiary) as well as ALMB (additional low income Medicare beneficiary). As you can see, there can be many confusing terms used for the same program. We hope this will help you sort it out a little.  All are programs that can help qualified individuals pay for both their Medicare premiums and drug costs.  In fact, QMB will also help you by paying your Medicare coinsurance as well as your deductibles.

Who is eligible for the Medicare Savings Program CT

If you are eligible for Medicare Part A and your income is below the program limit, you could be eligible for one of CT’s Medicare assistance programs.  Eligibility for the programs is determined by the amount of your annual adjusted gross income.  The amount of your assets will not matter when determining your eligibility.  However, any money being drawn out of a qualified retirement plan such as an IRA will count as income in the year it is taken. Individuals with income below $2,265 a month are eligible for MSP at the ALMB level.  Couples under $3,064 are also eligible.

Benefits

MSP does more than pay the monthly part B Medicare premium.  Depending on the level of help, the program can reduce drug copays, pay monthly part D drug premiums (up to the benchmark) create a special election period and pay medical copays.  (QMB level and higher)

Single vs. Couple Medicare Savings Program CT

If a couple is married, the income of both spouses is considered. They are not able to qualify as an individual.  Any Medicare Part B premium deductions you have will also count towards your income.  Even though the part B premium is being pulled out of your Social Security check, it still counts as income.

Re-determination of Medicare Savings Program CT

Those on MSP will need to re-certify for the program on an annual basis.  Failure to fill out the re-determination notice will result in removal from the program.

Click for MSP Application

Click for MSP Brochure and Income levels

Medicare vs work insurance as primary

Some people have insurance coverage through both their employer/group plan and through Medicare.  When this is the case, the question comes up about which is the primary insurance which is what we will answer for you in our Medicare vs work insurance as primary blog.

If you are 65 or over, eligible for Medicare, and have insurance through your or your spouse’s current job, you should still enroll in Medicare Part A.  For most people, Medicare part A is free.

In order to decide whether to take Part B (medical insurance), for which most people pay a monthly premium of $134 a month, you should ask your benefits manager or human resources department how your employer insurance interacts with Medicare  and confirm this information with the Social Security Administration (SSA). Be aware that when you qualify for Medicare, your employer insurance may start to work differently for you.  Your employer insurance may start to pay as the secondary insurance. This is usually the case for groups under 20 employees.  When you are over 65 and working for a employer under 20 employees you usually need to purchase Part B of Medicare in order maintain coverage.

As a first step, assess whether your employer insurance will be primary or secondary to Medicare.

• Secondary insurance:
•  pays all or some of the unpaid portion of covered health care expenses after the primary/main insurer has paid.  If your employer insurance will be secondary to Original Medicare, you should generally take Medicare Parts A and B when you are first eligible to enroll.
• Primary insurers pay first:
• Normally, you do not need Medicare Part B if you have primary employer coverage. You may decide to take Part B if you are unhappy with that coverage. This is usually for an employer group of 20 or more employees.  Before you decide to waive part B Medicare, you may want to evaluate which coverage is a better deal.

You qualify for a special election period when;

You are over 65 and getting coverage while working on your own or through a working spouses coverage.

If you drop the group health coverage or you or your spouse stops actively working.

IMPORTANT:  You have an 8 month period to enroll in Medicare part B.

Part B enrollment special election rules

Before you sign up for your Part B Medicare coverage there are some Part B enrollment special election rules that you need to understand.

You are not required to take Medicare Part B during your Initial Enrollment Period (IEP)  (the first of the month you turn age 65) if you are have insurance through work and either you and/or your spouse is still working.  You should only delay Part B if the employer insurance (called group health insurance) is the primary payer on your health care expenses.  This means that Medicare would pay secondary (after your group/employer plan pays). It is a good idea to talk with the employer or the HR department to see which is the primary payer. Usually the employer must have more than 20 employees in their plan in order for the plan to be considered the primary insurance . If you are eligible for Medicare because you get Social Security Disability Insurance, the employer must have more than 100 employees to be the primary payer.

When there are fewer than 20 employees at the company where you get your insurance, Medicare is likely your primary coverage. If this is the case, you should not delay your part B enrollment. If you do so, that can leave you without any insurance coverage at all.

In either case:

If you have insurance from a current employer, you remain eligible for a Special Enrollment Period (SEP). During this time, you can enroll in Part B without penalty at any time. This is true while you or your spouse is still working.  This is also true for up to eight months after you lose employer coverage, switch to retiree coverage, or stop working. However, if you have a lapse in coverage more than eight months at any time after you become 65 and Medicare-eligible, you will lose your SEP. A lapse means any period of time where you were not covered by either Part B or insurance from a current employer.

Part B enrollment special election rules- Cobra and retiree insurance

Important: Medicare DOES NOT consider COBRA or any retiree insurance the same as current employer insurance. If you are on either of these, you will not have a Special Enrollment Period to enroll in Medicare beyond the eight months you have after you retired/stopped working. If you have COBRA or retiree insurance and delay enrollment in Part B, you will likely have a Medicare Part B late enrollment penalty when you do sign up for part B

It important to note:

If you had already taken Social Security before you turned 65, or if you become eligible for Medicare due to disability, you will be automatically enrolled in both Medicare Part A and Part B. It is not mandatory that you take Part B.  If you decide not to take Part B, you will need to send back the Medicare card you received in the mail with the form you received stating that you do not want Part B. After you do this, you will receive a new Medicare card in the mail. The new card will have part A only on it and not part B.  You will not need to pay your Medicare Part B premium as a result.

If you are thinking about turning down Part B—or enrolling in only Part A it is advised you call the Social Security Administration at 800-772-1213 and ask if you delay enrollment will you be subject to the Medicare Part B late enrollment penalty.   Be sure to explain the type and source of your other insurance and other circumstances in as much detail as possible. When you call Social Security, make sure to write down whom you spoke to, when you spoke to them, and what they said. Remember you generally must be covered under a group health insurance plan which you have access to due to you or your spouse working in order to avoid the part B late enrollment penalty.

Medicare special election periods

Anyone that is currently enrolled in Medicare or that will be soon should be familiar withe Medicare special election periods.  The information in this post will explain about the Medicare special election periods.  Special election periods pertain to Medicare Advantage and Medicare stand alone part D rx plans.

Medicare special election periods for MAPD and Part D Rx plans

• You’re limited in when and how often you can join, change or leave a Medicare Advantage Plan (also known as a Managed Medicare plan or Medicare part C) or drug plan (Part D).
• You can enroll in a Medicare Advantage or Part D plan during the initial period when you first qualify for Medicare. (3 months before, the month of and 3 months after you are eligible for Medicare parts A and B.
• During the first 45 days of each year (the Medicare Advantage Disenrollment Period, called the MADP, January 1 through February 14), you can leave your Medicare Advantage Plan and change to Original Medicare with or without also selecting a separate stand-alone Medicare drug plan.  Please note: You can’t make any changes to your coverage during this period
  if you have Original Medicare. You also can’t switch from one Medicare Advantage Plan to another during this period.
• During Fall Open Enrollment, October 15 through December 7 of each year, you can change how you get your Medicare health coverage and enroll in, change or drop Medicare drug coverage.
• Outside of the above three periods, you can only change how you get your health coverage and enroll in, change or drop Part D drug coverage if you qualify for a Special Enrollment Period (SEP).

The link below will list all the Medicare special election periods. Some notable ones to pay special attention to are the SEP for moving out of the service area, losing group/employer coverage or losing or gaining prescription drug assistance and the MAPD Trial Right.

CLICK HERE FOR MEDICARE SEP CHART