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Extra help Medicare

Medicare provides programs and benefits to many people. This includes the Extra Help Medicare program that provides qualified beneficiaries help paying their Medicare Part D monthly premium, annual deductible, coinsurance and copays for their prescription medications.
To qualify for this program, individuals must meet income requirements.  Individuals who are accepted into this program do not have to pay any Part D late enrollment penalty they may have acquired.

How to apply for extra help

If you do not automatically qualify for Extra Help, you will need to apply.  You must meet the following qualifications to be eligible for Extra Help.

1. Applicants must have Medicare Parts A and B.
2. They must reside in the U.S. or the District of Columbia.
3. They do not have more than $34,360 in assets that include savings, investments & real estate if they are married, or $17,220 if they are single or not living with a spouse. If your assets are more than that, you are not eligible for Extra Help. Important; this amount does not include your home, cars or personal possessions.  It also does not include life insurance, irrevocable burial contracts or back payments from Social Security or SSI.

If you meet the qualifications specified above, you can apply for Extra Help online.

Click here to apply for Extra Help online

For help with the online application, call Social Security at 1-800-772-1213 (TTY 1-800-325-0778).

Please note: Some people do not need to apply for Extra help.  If you have either Medicare and SSI (Supplemental Security Income) or Medicare and Medicaid, you do not need to apply for Extra Help.  You will automatically be enrolled.

Extra Help isn’t available in Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, or American Samoa. But there are other programs available in those areas to help people with limited income and resources. Programs vary in these areas. Call your State Medical Assistance (Medicaid) office to learn more

Who can get Extra Help

If you think you meet the financial requirements and have Medicare A & B as well as are a resident of the U.S. or District of Columbia, just complete the online application.  You will receive a letter notifying you if you are accepted into the program.

Important:  residents of Guam, Puerto Rico, the US Virgin Islands, Northern Mariana Islands or American Samoa are not eligible for the Extra Help program.  To find alternative programs in those areas, check your state’s Medicaid eligibility at Medicaid.gov to find resources.

Additional financial resources

Individual states also have financial resources available through Medicare Savings Programs for those who meet the income qualifications. Use this link to find additional information for financial help in your area.

Beneficiaries can also go to Medicare.gov  or call 1-800-medicare (TTY 1-877-486-2048)to find information on financial assistance programs.

Please be aware:  Extra Help is not a prescription drug plan.  Beneficiaries must enroll in either an MAPD plan or a stand alone PDP plan to have coverage for prescription medications.

Agents, learn how to run a Medicare PDP or MAPD plan quote using Sunfire or Connecture.  Watch our quick YouTube video

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Medicare Savings Programs FAQ

Connecticut is one of the states in the nation that offers access to financial assistance programs for eligible Medicare beneficiaries. Some of the services that the Medicare Savings Program (MSP) can help pay for are Medicare part B premiums, deductibles, and co-insurance. Depending on the beneficiary’s income, if they qualify for one of the three Medicare Savings Programs, the Department of Social Services will offer financial assistance for the Medicare Part B premium each month. Some seniors may also be eligible for financial assistance for Medicare deductibles and coinsurance. Connecticut’s Medicare Savings Program is funded by Medicaid. The following are some frequently asked questions about MSPs.

Can I have both MSP and Medicaid?

Yes, you can. Medicare Savings Programs and Medicaid are two separate programs and the medical coverage is different for both of them.

Can I see the provider of my choosing?

If you have traditional Medicare, then you can see any healthcare provider that is a participating provider in Medicare. Seniors on a Medicare Advantage plan are limited to a network of providers chosen by the insurance carrier. However, the MSP works with both of these plans.

Do I have to apply for MSP?

Yes, you must file an application in order to receive the assistance from a Medicare Savings Program. Enrollment in an MSP is voluntary, meaning you can stop at any time even if you still qualify financially for the assistance.

How do I apply for an MSP?

There is a short application form that must be sent to the Department of Social Services. There is no supporting documentation needed unless the DSS requests it from you. The application form is #W-1QMB or W-1QMBS (Spanish version).

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.

It may take the DSS up to 45 days to review your application. However, if eligible,  benefits are backdated to the day the office received your application.

How often does the DSS review my eligibility?

Yearly. A month or so before the expiration date, beneficiaries receive a notice explaining that they are due for a review of coverage and a renewal form, which must be sent to the DSS scanning center.

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Medicare Savings Program CT 2023

If you are either a Medicare beneficiary, eligible to receive Medicare or a Medicare agent who offers plans in CT, you need to understand the Medicare Savings Program CT 2023.  This can be a very useful tool for some clients who have a lower income.

The amount of extra help you receive depends on your gross income level.  Single people will use their gross income to determine eligibility and level of help.  Married couples’ eligibility depends on their combined gross income.  The monthly income limits in the chart below are effective as of March 1, 2022.

If your income falls either at or below the income levels listed below, If you are not sure if you are eligible to receive extra help; we have listed the income levels below:

There are 3 different levels of MSP:

The level of help you receive is based on your gross income.  Please see below for MSP levels and what they provide:

Click here for income level chart.

QMB – this level of extra help pays your Part B premium, all Medicare deductibles and co-insurance.

Income levels for QMB are as follows:  Individual, $2,390 of gross income per month,  couples, $3,220 per month.

SLMB – this level pays your Part B premium only.

The income levels for SLMB are as follows:  Individual, $2,617 of gross income per month, couples, $3,525 per month.

ALMB – this level will provide payment of your Part B premium and is subject to availability of program funds. If you receive Medicaid, you cannot participate in this program.

Income levels for ALMB are as follows:  Individual, $2,786 gross income per month and couples, $3,754 per month.

To apply online, please visit www.connect.ct.gov, under ‘Apply for Benefits.’

Formulario de Renovación de programas de ahorro de Medicare (W-1QMBS)

Click here to download a CT MSP application

If you receive any of these levels of MSP coverage, you are automatically enrolled in the Low Income Subsidy (LIS), also called “Extra Help” with Medicare.  Once you are enrolled in LIS, Medicare pays the full cost of your Medicare (Part D) prescription drug coverage i fit is a benchmark plan.  Medicare will pay a portion of anon-benchmark plan.  They will also provide payment of your annual Part D deductibles, co-insurance or co-pays.  This does not change if you hi the coverage gap (donut hole).

Once you have LIS, you have a special enrollment period to change either Part D or Medicare Advantage plan.

If you need more information about the LIS, please visit www.socialsecurity.gov or call 1-800-Medicare (TTY: 1-800-325-0778).

Medicare savings program CT 2018

There have been major changes made to the Medicare Savings Program CT 2018.  The changes have substantially lowered the income guidelines for those receiving help with their Medicare Part B premium, drug co-pay costs and Medical cost shares.  Prior to 1-1-18 anyone that was under the monthly income levels below qualified for help. There is not an asset test on the programs.

Those who no longer qualify for programs based on the new income limits will notice changes for 2018. If you no longer qualify, you will start to again pay your Medicare part B premium which is $134 a month for most people.  If you are taking Social Security payments, they will start to take it out of your payment every month. Those not taking Social Security will be billed quarterly for it.

Anyone receiving drug help with co-pays will continue to receive that help throughout 2018 even if they no longer qualify for the program. Those receiving cost share help with co-pays and Medicare deductibles and coinsurance will cease getting that help as of 1-1-18. (assuming you no longer qualify based on the new income amount)  Anyone qualifying at any of the below levels does not pay the monthly part B premium, has help on drug costs and is not subject to the drug plan coverage gap. Those that qualify at QMB level also have help with medical costs.

Medicare Savings Program CT 2018 – Update

NOTE:  UPDATE: It has recently been decided the program will be extended under the 2017 income levels through the month of February 2018

**Please note: The chart below gives income levels for 2017 and the new income levels for 2018.  Allowable income levels for all program have dropped.

Medicare Savings Program Connecticut

Medicare Savings Program Connecticut (MSP) is a drug help program available to Connecticut residents on Medicare.   The program provides help for drug copays, deductibles and premium to those who qualify based on income.

MSP is available to individuals and couples making under stated income guidelines which have been provided here:

• QMB – $2,088.90 for a single person and $2,816.85 for a couple
• SLMB – $2,286.90 for a single person and $3,083.85 for a couple
• ALMB – $2,435.40  for a single person and $3,284.10 for a couple

MSP applications and brochures

Do you have questions or need more help?  Are you looking for more information? If you are, we can help with whatever you may need with MSP, Medicare plan choices or any other questions.  Call us at 203-796-5403 or email Edward@croweandassociates.com