Financial Eligibility Criteria,
Benefits, and Related Information
Medicare
Effective January
1, 2008
| Part A Hospital deductible |
$1,024.00 per spell
of illness |
| Par A Hospital co-payment Days 1 - 60
Days 61 - 90
Days 91 - 150 |
zero
$256.00 per day
$512.00 per day |
| Part A SNF co-payment Days 1 - 20
Days 21 - 100 |
zero
$128.00 per day |
| Part A Premium |
$423.00 per month
(for those with less than 30 quarters of Medicare covered employment)
$233.00 per month (for those with 30-39
quarters of Medicare covered employment) |
| Part B Deductible |
$135.00 per year |
| Part B Premium |
$96.40 per mo. Amount will be higher if income exceeds:
$82,000 (single)
$164,000 (married couple)
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For more information on Medicare, visit the
Center for Medicare Advocacy
web site.
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Medicare Savings
Programs
Effective April 1,
2008 - December 31, 2008
Qualified Medicare
Beneficiary Program (QMB)
| Monthly income limit for one person Monthly income limit for a couple |
$1,108.00
$1,649.00 |
| Asset limit for one person Asset limit for a couple |
$4,000.00
$6,000.00 |
Specified Low-Income
Medicare Beneficiary Program (SLMB)
| Monthly income for one person Monthly income for a couple |
$1,281.40
$1,882.40 |
| Asset limit for one person Asset limit for a couple |
$4,000.00
$6,000.00 |
Additional Low-Income
Medicare Beneficiaries Program (ALMB)
| Monthly income for one person Monthly income for a couple |
$1,411.45
$2,057.45 |
| Asset limit for one person Asset limit for a couple |
no limit
no limit |
Enrollment in a
Medicare Savings Plan automatically qualifies an individual for a low-income subsidy (LIS)
- also called "extra help" - of the Medicare Part D prescription drug benefit!
In addition, eligibility for LIS allows one to change Medicare prescription drug
plans anytime throughout the year.
Connecticut allows deductions in determining the income
eligibility and most beneficiaries will be entitled to the "standard unearned income
disregard" if they receive Social Security benefits. The above income figures
for 2008 include a $241.00 per month per person unearned income disregard.
For more information on these programs, including application
forms, see Medicare Savings Programs on CTElderLaw.org.
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Medicaid
Effective January 1, 2008
Community Spouse Allowance Calculation
Chart
Insert
monthly shelter costs: rent, mortgage, taxes, insurance, maintenance fees, etc. |
|
Add
standard utility allowance |
$522.00
effective 10/1/07 |
Subtract
standard shelter allowance |
$525.00
effective 7/1/08 through 6/30/09 |
Insert
expenses related to exceptional circumstances resulting in significant financial duress |
|
Add
Minimum Monthly Needs Allowance (MMNA) |
$1,750.00
effective 7/1/08 through 6/30/09 |
Result equals
the Community Spouse’s Monthly Needs |
|
Subtract
community spouse’s income |
|
Resulting figure equals
Community Spouse Allowance (CSA) |
|
Spousal Impoverishment,
Transfer Penalty and Personal Needs Allowances Amounts
| Community Spouse Resource Amount (CSRA) -
maximum assets without a hearing or court order |
$20,880.00 or 1/2 up to $104,400.00
|
effective 1/1/08 through 12/31/08 |
| Maximum Monthly Needs Allowance (MMNA)
without a hearing or court order |
$2,610.00 |
effective 1/1/08 through 12/31/08 |
| Standard Utility Allowance |
$522.00 |
effective 10/1/07 |
| Average monthly long-term care cost for
purposes of determining transfer of asset penalty periods |
$9,464.00 |
effective 7/1/08 through 6/30/09 |
| Skilled nursing facility monthly personal
needs allowance (Medicaid) |
$65.00 |
effective 7/1/08 through 6/30/09 |
The basic Community Spouse Resource Amount (CSRA)
noted above may be increased in order to ensure that the Community Spouse has adequate
assets to generate income sufficient to increase the Community Spouse’s income to the
reach the Community Spouse Allowance (CSA) amount. A fair hearing or court order may
be required to establish the CSA amount and to increase the CSRA.
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Traditional
or "Community" Medicaid
Effective July 1, 2008
| Income limits Region A Single
Couple |
$ 610.61
$ 777.92 |
| Income limits Regions B & C Single
Couple |
$ 506.22
$ 672.10 |
| Asset limits Single
Couple
Life insurance (total face value)
Irrevocable funeral contract |
$1,600.00
$2,400.00
$1,500.00 per person
$5,400.00 per person |
Note that the above income limits do not
include any income disregard amounts. For an explanation, see the Medicare Savings
Program section above.
Medicaid recipients qualify for the full low-income
subsidy (LIS) of the Medicare Part D prescription drug benefit, whereby the State of
Connecticut pays for all prescription drug co-payments.
Region A is the current listing of towns: Bethel, Bridgewater,
Brookfield, Danbury, Darien, Greenwich, New Canaan, New Fairfield, New Milford, Newtown,
Norwalk, Redding, Ridgefield, Roxbury, Sherman, Stamford, Washington, Weston, Westport and
Wilton.
Regions B & C comprise the rest of the towns
of the state.
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State
Supplement
Effective January
1, 2008
| Standard
Unearned Income Disregard |
$241.00 |
| Boarding Home
Unearned Income Disregard - residential care homes and adult family living homes |
$148.70 |
| Special
Unearned Income Disregard |
$308.90 |
The standard unearned income disregard is used in
determining eligibility for the community Medicaid program and Medicare Savings Programs
(MSP) as well.
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CHCPE
- Connecticut Home Care Program for Elders
Effective January 1, 2008
| CHCPE |
Category 1 |
Category 2 |
Category 3 |
| Monthly Income |
no limit |
no limit |
ind.
- $1,911
couple - $3,822 |
| Assets:
single
couple
|
$31,320.00
$41,760.00
|
$31,320.00
$41,760.00
|
$1,600.00 - ind.
$3,200.00 - both as clients
$20,880.00 - one as client;
up to a maximum of $104,400.00 (or more subject to spousal impoverishment rules). |
For more information on CHCPE, see Medicaid and State-funded
Home Care or the state CHCPE web site or call 1-800-445-5394.
Anyone who would be eligible for Medicaid coverage in a nursing
home is eligible for home care services, subject to the asset limits noted
above. Individuals receiving Category 3 services receive full Medicaid
benefits.
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ConnMAP
- Connecticut Medicare Assignment Program
Effective January 1, 2008
Maximum income -
individual |
$39,105.00 per year $3,258.75 per mo. |
Maximum income -
married couple |
$52,635.00 per year $4,386.25 per mo. |
The Connecticut Medicare Assignment Program
(ConnMAP) is a program run by the Connecticut Department of Social Services. Doctors
and other Part B providers of supplies and services are prevented from charging those who
are enrolled in ConnMAP more than the rates set by Medicare. Without ConnMAP,
doctors and Part B suppliers may charge up to 115% of the Medicare approved rates.
For more information or an application call 1-800-443-9946.
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ConnPACE
- Connecticut Pharmaceutical Assistance Contract to the Elderly and Disabled
Effective January 1, 2008
| Maximum income Single person |
$23,700.00 per year $1,975.00 per mo. |
| Maximum income Married couple |
$31,900.00 per year $2,658.33 per mo. |
| Co-payment |
$16.25 |
| Annual registration fee |
$30.00 |
Please note in this program, "income" is
adjusted gross income for purposes of federal income tax plus any other income minus
Medicare Part B premium payments. ConnPACE has no asset test or estate
recovery provision. Please note that if eligible for Medicare,
Part D is a requirement for ConnPACE eligibility.
For more information and/or an application, call 1-800-423-5026 or
visit the ConnPACE web site.
Also see Prescription Drug Assistance within CTElderLaw.org.
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Supplemental Security
Income (SSI)
Effective January 1,
2008
Monthly Payment Standards
| Individual (living alone, SSI only) |
$637.00 |
| Couple (living together, SSI only) |
$956.00 |
Asset Limits
| Individual |
$2,000.00 |
| Couple |
$3,000.00 |
Student Exclusion Limits
| Monthly |
$1,550.00 |
| Annual |
$6,240.00 |
Visit the Social
Security Administration SSI Home Page for
more information.
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Social
Security Benefits (Title II)
Effective January 1, 2008
Cost of living
adjustment for 2008 |
2.3% |
Tax Rate -
Employee |
7.65% |
Tax Rate -
Self-employed |
15.30% |
Maximum Earnings
Subject to Social Security Tax |
$102,000
per year |
Earnings
necessary to be credited with one quarter of coverage |
$1,050 per mo. |
| Substantial gainful activity (SGA) non-blind)
blind |
$940 per mo.
$1,570 per mo. |
| Trial Work Period (TWP) |
$670 per mo. |
Under full
retirement age: One dollar ($1) in benefits will be withheld for every two dollars
($2) in earnings above the limit. |
$13,560 per year
$1,130
per mo. |
| Tax exempt earnings in the
months of the year prior to the month turning 65. One dollar ($1) in benefits will
be withheld for every three dollars ($3) in earnings above the limit. |
$36,120 per year
$3,010 per mo. |
Maximum Social Security
benefit for those workers retiring at full retirement
age. |
$2,185
per mo. |
Average Monthly Soc. Sec.
benefit for all retired workers |
$1,079 per mo. |
Visit the Social Security Administration's web site
for more information.
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should not be construed as legal advice.
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