The Department of Social Services (“DSS”) administers three separate Medicaid programs that help people pay their Medicare premiums and, in some cases, deductibles, and co-pays. They are called Qualified Medicare Beneficiary (“QMB”), Special Low Income Medicare Beneficiary (“SLMB”), and Additional Low Income Medicare Beneficiary (“ALMB”). Eligibility for each program is based on your income, not your assets.

 

What are the 2015 income limits?

  • For the QMB program, the monthly income limit is $2,069.11 for a single person and $2,802.08 for a couple.
  • For the SLMB program, the monthly income limit is $2,266.11 for a single person, and $3,067.68 for a couple.
  • For the ALMB program, the monthly income limit is $2,413.26 for a single person, and $3,266.88 for a couple.

These are the 2015 figures. They change every January 1.

 

What is covered?

  • The QMB program pays your Part B premium and all Medicare deductibles (the amount you pay before Medicare begins to pay anything) and co-insurance payments (usually 20% of the approved Medicare charge).
  • If you also are paying a Part A premium, this, too, will be paid by the QMB program.
  • The SLMB and AMLB programs pay your Part B premium only.
  • If you qualify for any of the programs, you also automatically receive a Low Income Subsidy (“LIS”). The LIS helps pay your Medicare D premium, deductibles, and co-insurance payments.

For a family with limited income, this can be a big help.

 

How does this differ from other Medicaid programs?

  • Your assets have nothing to do with your eligibility. As an example, if you own your home and have cash assets of $100,000.00, you still can qualify as long as your income does not exceed the income limits.
  • There is no pay-back obligation after you or your spouse have died.
  • There is no 5 year look back period for gifts made to family members.

 

Is there any down side?

  • Physicians are not required to see a patient covered by the QMB program.

You should ask your treating physicians, ahead of time, if that will be an issue.

 

How do I apply? You can get the application on the DSS web site which is www.ct.gov/dss. You also can call 1-800-994-9422. If you have questions about the programs or are having trouble with the application, feel free to call us. We would be happy to meet with you to help you through the process and to answer any questions you may have.