Medicare Savings Programs (QMB, SLMB, and QI Programs)

The Qualified Medicare Beneficiary program (QMB), Specified Low-Income Medicare Beneficiary program (SLMB), and Qualified Individual program (QI), help Medicare beneficiaries of modest means pay all or some of Medicare's cost sharing amounts (ie. premiums, deductibles and co-payments). To qualify an individual must be eligible for Medicare and must meet certain income guidelines which change annually. These programs are administered by the State Department of Social Services (DSS).

All three levels pay the Medicare part B premium ($144.60 in 2020) and it eliminates any premium penalty. It also enrolls you automatically in Extra Help for your prescription coverage, which pays some or all of the Medicare part D premium costs and your co-pays are reduced to no more than $8.95 for each medication. Only QMB acts like a Medicare supplement and pays the out of pocket expenses for Medicare Part A and B.

  • The State pays the Medicare Part B premium ($144.60 Medicare Part B- monthly premium) for all 3 levels of the program.
  • In addition, MSP recipients, of all three levels, are automatically enrolled in the Extra Help/Low Income Subsidy (LIS) program, which helps pay Medicare Part D prescription costs.
  • For those who qualify for the QMB level recipients ONLY receive additional assistance to help with cost sharing (premiums, deductibles, co-pays and co-insurance for Medicare A & B covered services).

Benefits of the Extra Help/LIS:

Extra Help is a federal program that helps pay for some to most of the out-of-pocket costs of Medicare prescription drug coverage. It is also known as the Part D Low-Income Subsidy (LIS).

This program offers:

  • Financial assistance with prescriptions: The maximum amount that beneficiary will pay is:
  • $8.95 for Brand Names (Maximum)
  • $3.60 for Formulary Generics
  • Part D (PDP) Monthly Premium Subsidy = $34.77
  • Continuous Open Enrollment – Can Join or Change Plans Anytime without any fee or penalty.
  • No Deductible, No Penalty for Late Initial Enrollment
  • No Donut Hole.

To check if you are eligible please check the most up-to-date income levels by clicking on the following link. Medicare Savings Program

    Apply Online      

Paper Application

When a Medicare beneficiary applies and is granted the Medicare Savings Program, they are subsequently automatically granted a secondary program known as Full Extra Help or Low Income Subsidy. Beneficiaries on Full Extra Help are able to select a Part D Prescription Drug Plan known as a Benchmark Plan. There are 7 Benchmark plans being offered in Connecticut in 2019. The premium amount for this benchmark plan is set each year and is waived for those individuals who are on Full Extra Help. If an individual cannot find a benchmark plan that covers all of their prescription medications, they can enroll in another plan and Full Extra Help will then pay up the Benchmark rate of $34.77 and the beneficiary would pay the difference.

2020 Benchmark Plans (CT Approved Zero Premium for People on Extra-Help)

 

Medicare Savings Program (MSP) vs. Medicaid (Husky) 

HUSKY VS. GRAY CARD

* HUSKY also known as Medicaid, Title 19, MAABD (all these are the same).

* Husky is a state Health Insurance and MSP is a State Program that helps with Medicare expenses and more.

 

Medicaid covers:                                              MSP Does NOT cover:

* Dental Care                                                     * Dental Care

* Hearing Test                                                    * Hearing Test

* Hearing Aids                                                   * Hearing Aids

* Vision Care                                                     * Vision Care

* Vision Eyewear.                                             * Vision Eyewear.

                                  

Medicare Savings Program (MSP) vs. Medicaid