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
If you have Medicare, Social Security deducts money from your check each month to pay for your Medicare Part B premium. If you are not receiving a social security benefit, you will pay your Part B premium directly to Medicare (CMS).
If you qualify for one of Connecticut’s three Medicare Savings Programs (MSP), the State of Connecticut will pay this monthly Part B premium on your behalf. Your Social Security check will then increase each month, or you will no longer have to send in a payment for the premium.
In addition to paying the Part B premium, one of the Medicare Savings Programs, called QMB, also pays all Medicare Part A and Part B co-pays, co-insurance and deductibles. To benefit from this program you must use providers that accept QMB or Medicaid insurance. With QMB, it may be unnecessary to pay for a Medigap policy to supplement Parts A and B of Medicare.
The Medicare Savings Programs are administered by the Connecticut Department of Social Services (DSS). Program brochures and applications are available from DSS or may be downloaded from the DSS website at https://portal.ct.gov/DSS/Health-And-Home-Care/Medicare-Savings-Program/Medicare-Savings-Program.
If you qualify for MSP, you will also automatically receive help with your prescription drug costs under Medicare Part D. This help comes in the form of a full subsidy under the Part D Low Income Subsidy (LIS), also known as “Extra Help.”
To apply, or for more information:
- Contact the Connecticut CHOICES program at 1-800-994-9422.
- Review the material at these links:
- CHOICES: https://portal.ct.gov/AgingandDisability/Content-Pages/Programs/CHOICES-Connecticuts-program-for-Health-insurance-assistance-Outreach-Information-and-referral-Couns
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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