QMB Connecticut Legislative Changes Fact Sheet

What is QMB?

1. QMB (Qualified Medicare Beneficiary), SLMB (Specified Low-Income Medicare Beneficiary) and ALMB (Additional Low-Income Medicare Beneficiary) are Medicare Savings Programs by which the State of Connecticut (through the Department of Social Services) helps low income Medicare beneficiaries with the cost of health care.

What did the legislature change?

1. The 2017 session of the Connecticut legislature dramatically reduced the income a resident can have and still qualify for one of these Medicare Savings Programs. As a result, it is estimated that as many as 100,000 Connecticut residents may lose their eligibility for Medicare Savings Programs starting on January 1, 2018.

How does a Medicare Savings Program help me?

1. QMB. If you have QMB coverage, the State pays your Medicare A premium (if applicable), your Medicare B premium, and all Medicare co-insurance and deductible amounts.
   1. In 2017, the standard Medicare B premium is $134.00 per month.
   2. In 2017, the Hospital in-patient deductible is $1,316.00 per benefit period.
   3. In 2017, the Hospital in-patient co-insurance amount begins at $329.00 per day after 60 days in the Hospital.
   4. In 2017, the Medicare B deductible is $183.00.
   5. In 2017, the Medicare B co-insurance amount is 20% of the Medicare approved amount.
2. SLMB. If you have SLMB coverage, the State pays your Medicare B premium.
3. ALMB. If you have ALMB coverage, the State pays your Medicare B premium.
4. Extra Help with prescriptions. If the State is paying your Medicare B premium, you automatically also qualify for Extra Help (also called a Low-Income Subsidy) with the cost of prescription medicine. In most cases this means you will pay no more than $3.35 for a 30-day supply of a generic drug, or $8.35 for a 30-day supply of a brand-name drug.

What can I do?

1. If you were on QMB, you still may qualify for SLMB or ALMB. If you were on SLMB, you still may qualify for ALMB (check the income limits above). You may also qualify for “Extra Help/LIS.”
2. If you have no Medigap insurance (covers Medicare co-insurance and deductibles) because you had been on QMB, speak to a knowledgeable health-care insurance agent about purchasing Medigap coverage.
3. You can divert your “excess income” to what is called a “Pooled Trust” administered by a Connecticut non-profit corporation called Planned Lifetime Assistance Network of Connecticut, Inc. (“PLAN”). This will allow you to remain eligible for QMB, SLMB, or ALMB.

Example:

Assume a 70 year old widow whose only income is $1,850.00 per month from Social Security. For years, she has been eligible for QMB benefits. In 2018, she will have $825.00 per month of excess income ($1,850.00- $1,025.00). If she diverts the excess income to a PLAN Pooled Trust, this is how things will work:

1. She will need to pay PLAN an Enrollment Fee of $1,050.00 to get started.
2. Every month she will send PLAN a check for $825.00. This will make her eligible for continuing QMB coverage in 2018.
3. She will direct PLAN to use the $825.00 to pay bills she previously paid from her checking account. Examples are utilities, taxes, insurance, automobile payments, etc.
4. In addition to the Enrollment Fee, PLAN charges a monthly trust administration fee of $100.00 when PLAN actively pays bills and a one time closing fee of $300.00. Please note that there may be other fees assessed depending on how the trust is used.

Is it worth establishing a PLAN Pooled Trust?

• As often is the case, the answer is “it depends.”

• You need to weigh the cost involved in establishing and maintaining the Pooled Trust against the money you will save by not paying a Medicare B premium, possibly, not needing to have Medigap insurance, and having Extra Help with prescription costs.
• You also need to weigh whether it annoys you to need to use an intermediary (PLAN) to pay some of the monthly bills you previously paid yourself.