Medicare Savings Program Means Savings For More Residents

By Nancy K. Crevier

ConnPACE participants were notified June 1 that due to the Connecticut state budget, effective July 1 the state-funded program that helps residents pay for prescription drugs, insulin, and insulin syringes would no longer be available to individuals who are eligible for Medicare (a federal health plan available to all ages 65 and over). ConnPACE eligibility is based on state residence requirements; being 65 years old or more (or over 18 and disabled and not eligible for Medicare); and for those who have an adjusted gross income equal to or less than $25,100 if single, or $33,800 if married. Currently, anyone 65 years of age or older who receives Social Security or Railroad Retirement benefits is automatically eligible for Medicare Part A (hospitalization/hospice costs) and may enroll in Part B (covering doctor visits and some preventative services).

According to the letter mailed out from the State of Connecticut Department of Social Services, “Most current ConnPACE members, therefore, will no longer qualify of ConnPACE because they are eligible for Medicare. Medicare Part D will be the only insurance that covers their prescription drugs.”

Medicare Part D is a prescription drug program. Part D plans have four different coverage periods, including one known as the “doughnut hole,” during which the insured must pay half out of pocket for all drugs. The deductible period with some plans requires participants to pay for drugs in full until a deductible is reached; during the initial coverage period the plan partially covers drug costs after the deductible has been met; this is followed by the doughnut hole, and the fourth period, of catastrophic coverage when drug costs per year exceed $6,448, at which point only five percent of the cost of the drug or $6.30 for brand name or $2.50 for generic drugs is not paid by the plan.

ConnPACE members paid a yearly fee of $45 and no more than $16.25 for any prescription, for assistance in paying for Medicare Part D.

For those ConnPACE members with Medicare who do not have a low income subsidy, and are no longer eligible for ConnPACE, responsibility for Medicare Part D co-pays in full, and all Medicare D-excluded drugs, as well as the monthly Medicare Part D premium will become that of the individual, unless they enroll in the Medicare Savings Programs (MSP).

According to an April 2010 press release from the office of then-governor M. Jodi Rell encouraging enrollment in the MSP, “Funding for the Medicare Savings Programs is provided by Medicaid, the federal/state health coverage program. The federal government currently reimburses Connecticut for about 62 percent of up-front Medicaid expenditures.” That press release also indicated that in addition to putting money back in the pockets of Social Security recipients, by making more people eligible for the MSP the state would save money in the ConnPACE program.

The MSP, said Newtown Social Service Director Ann Piccini, helps pay Medicare deductibles and co-insurance, and Part B premiums, a cost previously deducted from a participant’s Social Security check each month, “from $96.40 up to $115.40 a month. It also pays the monthly charge for Part D, as well as paying for hospitalization costs, after Medicare pays.” Some individuals who are eligible for the MSP may even qualify to have their 20 percent co-insurance and Medicare deductibles covered by the state, according to the State of Connecticut ConnPACE notice.

Because there is no longer an asset limit, as there had been previously for the Qualified Medicare Beneficiary (QMB) plan, more Connecticut residents with monthly incomes falling between $1,943.12 and $2,260.92 for single people, or between $2,623.64 and $3,052.74 for couples, will be eligible to take part now. That income cap has risen several times in recent years, said Ms Piccini. “For the majority of senior citizens, even combining their Social Security checks, the new guidelines bring them in under the new income limits.”

“The MSP is good for many people who are asset rich,” said Ms Piccini, including many Newtown residents who previously did not qualify for assistance because even though they were within the income guidelines, they owned assets above the QMB limit of $4,000. “We have already seen a huge amount of new people signing up for the Medicare Savings Programs,” including, she said, several who were not ConnPACE members previously. Many transitioned in to MSP from ConnPACE over the winter. The MSP is not new this year, she said, but stressed that many who are eligible remain unaware of the program.

The QMB pays Part B premium and all Medicare deductibles and co-insurance. The Specified Low Income Medicare Beneficiary (SLMB) plan pays for the Part B premium only, as does the Additional Low Income Medicare Beneficiary (ALMB) plan. However, those somewhat higher income applicants who fall into the ALMB program are subject to program funding. Everyone on MSP is automatically eligible for the Part D Low Income Subsidy (LIS), according to Social Service Department literature.

Ms Piccini has run into some resistance from ConnPACE participants who are no longer eligible for ConnPACE, but need assistance paying for Part D. “People feel they are being forced into the Medicare Savings Program. They actually have enough money to pay for Part B and always have, so now they feel embarrassed to be taking the Part B assistance,” she said, especially at a time when the state is mired in financial difficulties.

 “It’s very confusing to understand, though, especially for seniors,” Ms Piccini said, and she encourages anyone who might believe they are now eligible for assistance, or who has received the ConnPACE notice and needs to apply for MSP, to stop in to the Social Services Department at Town Hall South. To get MSP, an application must be filled out. Based on monthly income, applicants may qualify for the Qualified Medicare Beneficiary (QMB), the Specified Low Income Medicare Beneficiary (SLMB), or the Additional Low Income Medicare Beneficiary (ALMB) plans.

Applications for the Medicare Savings Program are available at Social Services, and staff is available to assist in filling out the application and determining eligibility. There is no application fee, nor is there a monthly charge any longer for Parts B and D coverage. Processing the paperwork can take up to three months, so she encourages people to apply as soon as possible.

“So far, people are not required to cancel supplemental insurances if they apply for the MSP,” added Ms Piccini.

Questions regarding the ConnPACE changes can also be directed to 800-423-5026 or 860-269-2029. For detailed information on the Medicare Savings Program, visit www.ct.gov/dss/MedicareSavingsPrograms.