Medicaid & Medicare

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. Visit our Dual Eligibility page for more information.

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

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:

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.

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.

Some health care services are covered under Medicaid. For a full list of services covered and detailed explanations, consult the HUSKY Health Program 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 & 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.

Spousal Impoverishment Standards: The cost of regular nursing home care can rapidly deplete an elderly couple’s savings. When one spouse is living in the community and the other spouse in nursing home care, there are spousal impoverishment provisions under Medicaid to ensure the spouse at home will be able to live their life with independence. Under these provisions, a portion of the Medicaid recipient’s income is transferred to support the income of the spouse at home.

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 to understand Medicare coverage and health care options. To receive health insurance counseling, application assistance and educational resources, call CHOICES at 1-800-994-9422.

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 are 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.

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: In-patient 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.

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 (MSP). The Department of Social Services will pay qualifying applicants’ Part B monthly premiums. Some programs may offer additional financial assistance for deductibles and coinsurance.

There are three different MSPs, based on income eligibility:

• Qualified Medicare Beneficiary (QMB): Pays both Medicare Part A and Part B premiums, deductibles and coinsurances.
• Special Low-Income Medicare Beneficiary (SLMB): Pays Medicare Part B premiums.
• Additional Low-Income Medicare Beneficiary (ALMB): Pays Medicare Part B premiums. Note that ALMB is not an entitlement program and the funding is limited. When available funds are exhausted, applications will be denied.

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