Connecticut Medicare Education and Advocacy Projects
For decades the Center for Medicare Advocacy has designed and implemented projects to assist Connecticut residents and their families obtain fair access to Medicare and necessary care. Our Connecticut assistance, outreach, and education work has been the foundation for much of the Center’s broader systemic advocacy. This work is increasingly important as Connecticut’s population is aging, more residents rely on Medicare to access health care, and the state and country continue to deal with the pandemic.
The overall goal of these projects is to help Connecticut residents and stakeholders know what Medicare should cover, help beneficiaries obtain appropriate coverage, reduce cost-shifting to families and Medicaid, and effect systemic change to benefit all who rely on Medicare – now and in the future. This work, and the Center’s mission, particularly focus on the needs and rights of people with lower incomes and longer-term, debilitating conditions. Our assistance is provided at no cost for residents of Connecticut and is supported by the Connecticut State Unit on Aging.
CHOICES – Connecticut’s State Health Insurance Assistance Program (SHIP)
CHOICES is a Connecticut program, part of a national network of State Health Insurance Assistance Programs (SHIPs) that offers free, confidential counseling, education and assistance about Medicare, Medicaid, and related programs. CHOICES counselors help Connecticut Medicare beneficiaries and their families make informed decisions about health care benefits. Since its inception, the Center for Medicare Advocacy has been a partner with the five Connecticut Area Agencies on Agency that administer CHOICES for their regions. The Center provides CHOICES’ staff and counselors with training, materials, and legal support. Overall, the program is administered by the Connecticut State Department of Aging and Disability Services.
Call CHOICES at 1-800-994-9422.
South Western CT Agency on Aging
1000 Lafayette Blvd., 9th Floor
Bridgeport, CT 06604
Agency on Aging of South Central Connecticut
117 Washington Ave., Suite 17
North Haven, CT 06473
Senior Resources Agency on Aging
19 Ohio Ave., Suite 2
Norwich, CT 06360
North Central Area Agency on Aging
151 New Park Ave.
Hartford, CT 06106
Western Connecticut Area Agency on Aging
84 Progress Lane
Waterbury, CT 06705
CHOICES Health Insurance Hot Line 1-800-994-9422
Medicare Savings Programs in Connecticut
The Medicare Savings Program (MSP) helps cover some Medicare-related expenses for people with lower incomes. Depending on the individual’s income, MSP can help cover all, or some of, Medicare’s premiums, deductibles and cost-sharing. Unlike in most states, there is no asset test in Connecticut. There are three levels of the MSP. All MSP level cover the Part B premium and provide automatic enrollment into Extra Help/Low income Subsidy (LIS) for Part D prescription coverage.
Qualifying For a Medicare Savings Program in CT (2020 Eligibility Figures. Updated Annually in March)
1. Qualifying at the Qualified Medicare Beneficiary (QMB) level:
- If one’s Gross Monthly Income is at, or below: $2,245.04 (single) $3,032.07 (couple)
- QMB pays the Part B premium, ($144.60), and all Medicare Deductibles, Part A ($1,408) and Part B ($198). In addition, QMB covers, flat rate co-pays and co-insurance (usually 20% of Medicare charges), similar to Medigap policies. QMB automatically enrolls the individual in Extra Help (LIS) to help pay for Prescription Costs.
2. Qualifying at the Specified Low Income Medicare Beneficiary (SLMB) level:
- If one’s Gross Monthly Income is at, or below: $2,457.84 (single) $3,319.47 (couple)
- SLMB pays the Part B premium, ($144.60) and automatically enrolls the individual in Extra Help (LIS) to help pay for Prescription Costs.
3. Qualifying at the Additional Low Income Medicare Beneficiary (ALMB) level:
- If one’s Gross Monthly Income is at, or below: $2,617.44 (single) $3,535.02 (couple)
- ALMB pays the Part B premium, ($144.60) and automatically enrolls the individual in Extra Help (LIS) to help pay for Prescription Costs. (Note: Access to the ALMB is subject to available funding for the program.)
Does MSP Help with the Costs of Prescription Drugs?
Individuals who qualify for any level of MSP, will automatically qualify for the Part D Low Income Subsidy (LIS), also called “Extra Help”
- LIS / “Extra Help” pays the full cost of a Medicare Part D (prescription coverage) basic “benchmark” plan, or a portion of a non-benchmark plan, yearly deductible, co-insurance, or co-pays. This coverage remains the same even if the individual reaches the Part D coverage gap.
- LIS / ”Extra Help” allows individuals to change their Medicare Part D or Medicare Advantage plans outside of the open enrollment period.
- LIS / “Extra Help” pays co-pays for formulary drugs. In 2020, individuals with LIS will pay no more than $3.60 for a generic drug and $8.95 for a brand name.
The Connecticut Medicare Savings Program is administered by the Connecticut Department of Social Services (DSS).
Program brochures and applications are available from DSS and can be downloaded from the DSS website at: https://portal.ct.gov/DSS/Health-And-Home-Care/Medicare-Savings-Program/Medicare-Savings-Program
For assistance and to apply, call the Connecticut CHOICES Statewide Health Insurance Hotline 1-800-994-9422, and review the material at these links:
- CHOICES: https://portal.ct.gov/AgingandDisability/Content-Pages/Topics-A-Z/Area-Agencies-on-Aging
Call CHOICES: 1-800-994-9422
- Connecticut Legal Services: https://ctlegal.org/
- Connecticut State Department of Aging and Disability Services: https://portal.ct.gov/AgingandDisability
- Connecticut State Department of Social Services: https://portal.ct.gov/dss
Ossen Medicare Outreach, Education and Advocacy Project
The Jeffrey P. Ossen Foundation and the Center for Medicare Advocacy have joined forces to advance access to Medicare and necessary home and community-based care. The two organizations are partnering to provide education and advocacy throughout the greater Windham area to help providers, discharge planners, and families understand and access Medicare-covered home health and community-based care.
The Center for Medicare Advocacy and Ossen Foundation plan to work closely with local health care providers, care managers, relevant community members and leaders to spread the word about Medicare coverage and the help available at the Center. The stories and challenges learned through the project will be gathered to encourage necessary systemic change to help all Medicare beneficiaries get the care they need.
The Center for Medicare Advocacy is grateful to the Ossen Foundation for supporting this important project.
Connecticut Dually Eligible Appeals Project
Since 1987 the Center for Medicare Advocacy has partnered with the Connecticut State Department of Social Services (DSS) to appeal Medicare denials for care provided to dually eligible patients that was paid for by Medicaid. Pursuant to agreements with DSS, the Center pursues thousands of Medicare appeals annually for dually eligible nursing home and home health patients. This work lessens the individual beneficiary’s Medicaid liability to the State, challenges inappropriate Medicare denials, and helps ensure Medicaid is the “payer of last resort”.
Over the course of the Connecticut dully-eligible project, the Center has recovered almost $400 million from Medicare appeals. This includes cases that were formally appealed, as well as cases that were part of a settlement with the Centers for Medicare & Medicaid services (CMS) to help resolve a backlog of cases waiting for Administrative Law Judge hearings. As part of this project, the Center also provides training and training materials for skilled nursing facility and home health providers and continuous legal and technical support.
In addition to the importance of this work for Connecticut’s Medicaid agency and population, the project also helps inform the Center’s other work, which includes helping beneficiaries access Medicare-covered care, assisting individuals in obtaining fair appeals, and monitoring federal policies, providers, and Medicare Advantage plans. We are able to use the insights we gain in the dually-eligible project to provide education and advocacy, track patterns of coverage and appeal problems, and communicate with CMS, Medicare contractors, and policy-makers about systemic issues.
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