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Medicaid and Medicare

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Medicaid and Medicare are two government programs that help individuals pay for health care services and medical expenses. There are significant differences in the way the programs work, who qualifies for them, how much the users pay, what services are covered, and how to apply. It's important to note that older adults with low incomes and younger people with disabilities may be eligible for both Medicaid and Medicare. Often referred to as "dual eligibles," they have most of their health care costs covered.

The information below will define the two programs and guide individuals to what information is most important to them.

What is Medicaid?

Medicaid is a joint federal and state health care program that provides coverage to children, pregnant women, parents, older adults, adults without children and people with disabilities with limited income and assets. Medicaid programs must adhere to federal guidelines but tend to vary from state to state. In Connecticut, Medicaid is referred to as HUSKY Health and is overseen by the State’s Department of Social Services (DSS).

Medicaid covers most health care services including:

  • Home care
  • Hospital stays
  • Hospice
  • Nursing home care
  • Lab tests and x-rays
  • Medical equipment like wheelchairs, eyeglasses, hearing aids and more
  • Most prescription drugs
  • Some dental care
  • Doctors' care
  • Foreign language interpreter services
  • Non-Emergency Medical Transportation

Learn More: Go to the Benefit Overview to see the comprehensive benefits offered.

HUSKY Health is comprised of four components: A, B, C, and D. Each program has different requirements and offers different benefits.

  • HUSKY A: Medicaid for parents, children, caregivers, and pregnant women

  • HUSKY B: The Children’s Health Insurance Program (CHIP) provides coverage for children and teens up to age 19 for families not income eligible for HUSKY A

  • HUSKY C: Coverage specific for people with disabilities, people receiving long-term services and supports, and older adults

  • HUSKY D: Coverage for adults who do not have children under the age of 19

Learn More: Find how to apply for HUSKY A, B, or D. For more information, or to sign up or manage your account, go to HUSKY Health Connecticut.

Medicaid Eligibility Criteria

HUSKY A & HUSKY B

  • Connecticut children and their parents or a relative caregiver; and pregnant women may be eligible for HUSKY A, depending on family income.
  • Uninsured children under age 19 in higher-income households who are not eligible for Medicaid may be eligible for HUSKY B (also known as the Children’s Health Insurance Program). Depending on specific income level, family cost-sharing applies.

When reviewing the HUSKY family income guidelines, it is important to keep in mind that the DSS may not count certain portions of an applicant's income and may also deduct certain expenses. The DSS recommends to simply apply and let their specialists determine an applicant's eligibility.

Go here to view qualifying annual income levels or qualifying monthly income levels, effective July 2018. Apply for services here.

HUSKY Plus Physical provides supplemental coverage of goods and services for HUSKY B medically eligible children with intensive physical health needs or special health care needs. Go here for information on HUSKY Plus Physical.

HUSKY C

Medicaid coverage under HUSKY C is for individuals over the age of 65 and between the ages of 18 and 65 who are blind or have another disability. Applicants must also meet certain income and asset levels, which vary by the specific part of HUSKY C a person qualifies for and geographic area within the State.

For many participants, the monthly amounts and limits are based on net incomes (after deductions) by geographic area.

To find which region you reside in, go here for Southwestern Connecticut and here for Northern, Eastern and Western Connecticut.

Long-Term Services and Supports Medicaid

Go here for information and application referral about Medicaid Long-Term Services and Supports.

Medicaid for Employees with Disabilities

Employed individuals with disabilities can earn up to $75,000 per year and still qualify for full Medicaid benefits. Go here for information and application referral about Medicaid for Employees with Disabilities, also known as MED-Connect. 

The Department of Social Services offers individuals several ways to apply for Medicaid. The online application may be the most convenient method; however, applications can be mailed in or submitted at a DSS office. For some health coverage, users can apply over the phone.

Applicants can apply for HUSKY C online or mail in to or completed at any DSS office. Use this list to find a field office near you. Office hours are Monday through Friday between 8:00 a.m. and 4:30 p.m. Download the W-1E Application form here.

HUSKY D

Connecticut residents aged 19 up to 64 without dependent children; who do not qualify for HUSKY A; who do not receive Medicare; and who are not pregnant may qualify for HUSKY D (also known as Medicaid for the Lowest-Income Populations).

Go here to view qualifying annual income levels or qualifying monthly income levels, effective July 2018. Apply for services here. Currently, there are no asset limits for HUSKY D.

Medicaid Services, Waivers & Fees

Several health care services are covered under Medicaid. For a full list of services covered and detailed explanations, consult the HUSKY Health Member Handbook. Download and/or print the handbook for your reference. HUSKY Health also includes enhanced services that have additional requirements. These benefits are below.

Community First Choice (CFC) is a program in Connecticut offered to active Medicaid members. It allows individuals to receive supports and services in their home. These services include but are not limited to help to prepare meals and doing household chores and assistance with activities of daily living (bathing, dressing, transferring, etc.). Go here for more information about Community First Choice, and start the CFC Application online here. 

Home and Community Based Services Medicaid Waivers help people who are financially and functionally eligible, receive long-term services and supports in their homes.

Money Follows the Person Program (MFP) is for Medicaid recipients in care facilities such as nursing homes, hospitals and other qualified institutions. The program can help people successfully transition back into the community.

What is Medicare?

Medicare is the national health insurance program for older adults and people with disabilities. The Centers for Medicare & Medicaid Services (CMS) is the federal agency which administers the program. The program serves people 65 or older, individuals with disabilities under 65, and people of any age with End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig's Disease.

Medicare is funded in part by Medicare taxes people pay on their income, through premiums Medicare members pay, and in part by the federal budget.

Medicare covers many basic health services including hospital stays, physician services, home health care, and prescription drugs.

Learn More: Go to the official Government site for Medicare or call 1-800-Medicare (1-800-633-4227).

People can also use Connecticut’s program for Health insurance assistance, Outreach, Information and referral, Counseling, Eligibility Screening (CHOICES). This assistance program helps people understand Medicare coverage and healthcare options. To receive health insurance counseling, application assistance, and educational resources, call CHOICES at 1-800-994-9422 or find a counselor near you.

Medicare Eligibility Criteria

Medicare covers individuals age 65 and older or permanently disabled, regardless of income, medical history, or health status who meet one of the following criteria:

  • Entitled to Social Security retirement insurance and 65 years of age and older; or
  • Entitled to Social Security disability benefits for no less than 24 months; or
  • Entitled to Railroad Retirement benefits or Railroad Retirement disability benefits; or
  • Diagnosed with End Stage Renal Disease; or 
  • Diagnosed with ALS; or 
  • A federal, state or local government employee who is not eligible for Social Security retirement or disability benefits but has worked and paid the Medicare Part A "hospital insurance" portion of FICA taxes for a sufficient period of time. (Federal employees became subject to the hospital insurance portion of FICA in January 1983. Most newly hired state and local employees, not otherwise covered under Social Security, started paying the hospital insurance portion as of April 1986).

Note: Individuals who are not otherwise eligible for Medicare, but who are 65 and older may purchase Medicare coverage by paying a monthly premium.

Individuals who are receiving Social Security benefits are automatically enrolled in Medicare effective the month of their 65th birthday. If not, contact the Social Security Administration online, in person or by phone to join. Call 1-800-Medicare (1-800-633-4227), or find an office near you.

It is important to note that Medicare recipients do not need to sign up for coverage each year. However, each year there is the chance to review your coverage and change plans.

Recipients will receive a red, white, and blue Medicare card in the mail to be used when hospital, medical or other health services are needed. Medicare cards show which program(s) members enrolled in and when coverage begins. The card will have a Medicare Number unique to the holder which should only be given to health care providers and trusted individuals.

Learn More: Use this tool to determine your eligibility for Medicare.

Medicare Services & Fees

Eligible recipients of Medicare have a choice. They may enroll into either ‘Original Medicare’ (also known as Part A and Part B,) or into a private health plan known as ‘Medicare Advantage’ (also called a Part C plan.) All plans cover the same basic Medicare-covered health services, but there are differences in premiums, deductibles, coinsurance, and provider networks. People should carefully consider their own situations before choosing. If their needs change, people may also change plans during the Open Enrollment period each year.

People enrolling in Original Medicare should also consider enrolling in a stand-alone Prescription Drug Plan (PDP), also known as “Part D,” to cover their outpatient prescription drugs. Most Medicare Advantage Plans already cover prescription drugs.

Below is more detail on coverage provided by Medicare parts A, B, C and D:

  • PART A: Inpatient hospital care, some home health care, some short-term stays in a skilled nursing facility and hospice care. There is no premium for Part A, but there are deductibles and copayments.
  • PART B: Physician visits, outpatient care, preventive care, some home health care, durable medical equipment and ambulance services. There is a monthly premium for Part B, and some services require deductibles and copayments.
  • PART C: Also known as “Medicare Advantage” (MA). Beneficiaries enroll in a private MA plan, rather than traditional Medicare, to receive Medicare-covered Part A and Part B benefits and often Part D benefits as well. Most states have a choice of 20-30 private MA plans. Plan cost and availability may vary by insurance company and by county.
  • PART D: Prescription Drug Coverage. Covers outpatient prescription drugs through private plans that contract with Medicare, including both stand-alone prescription drug plans and MA drug plans.

Original Medicare members can also enroll in Medicare Supplement Insurance, also called Medigap, which fills in the gaps not covered by Original Medicare. Medigap is offered by private, approved insurance companies. These plans pay for costs such as coinsurance, copayments, and deductibles.

In Connecticut, a Medigap cannot be used as a stand-alone plan and is designed to be used in combination with Parts A and B. These plans do not provide prescription drug benefits. The State offers up to 10 standardized policy options, each labeled with a letter. All plans of the same letter offer the same benefits, no matter which insurance company offers the plan.

Medicare Financial Options

Monthly premiums, coinsurance, and deductibles are generally private pay, out-of-pocket expenses, although Medicare Advantage plans and Medigap policies cover some coinsurance and deductibles.

Financial assistance is available to eligible Medicare enrollees through the State’s Medicare Savings Program. The Department of Social Services will pay qualifying applicants’ Part B monthly premiums. Some programs may offer additional financial assistance for deductibles and coinsurance.

 For more information or to apply for the Medicare Savings Program, fill out a W-1QMB form online.

 

 

 

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