Medicaid & Medicare

Medicaid and Medicare Are Two Government Programs that Help Individuals Pay for Health Care Services and Medical Costs

There are important differences in the way the programs work, who qualifies for them, how much the members 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 you to other helpful resources.

What Is Medicaid?

Medicaid is a joint federal and state health care program that covers children, pregnant women, parents, older adults, adults without children, and people with disabilities with limited income and assets. Medicaid programs must follow federal requirements but these rules may be different from state to state. In Connecticut, Medicaid is referred to as HUSKY Health and is managed 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 a complete list of the benefits offered.

Medicaid: Husky Health

HUSKY Health is made of four parts: A, B, C and D. Each program has different requirements and benefits.

HUSKY A

Medicaid for parents, children, caregivers and pregnant women
Eligibility

Connecticut children and their parents or a relative caregiver, and pregnant women may be eligible for HUSKY A, depending on family income

When looking at the HUSKY family income requirements, it is important to remember that DSS may not count certain parts of an applicant’s income and may also reduce certain expenses. Once an application is submitted, a specialist from DSS will determine eligibility.

Learn more about qualifying yearly income levels and qualifying monthly income levels (effective March 2021), as well as how to apply for Medicaid.

HUSKY Plus provides additional coverage of goods and services for HUSKY B medically eligible children with intensive physical health needs or special health care needs. Learn more about HUSKY Plus.

HUSKY B

The Children’s Health Insurance Program (CHIP) covers children and teens up to age 19 for families who are not income eligible for HUSKY A
Eligibility

Uninsured children under age 19 in higher-income households who are not eligible for Medicaid, or Husky A, may be eligible for HUSKY B (also known as the Children’s Health Insurance Program, or CHIP). Depending on income level, family cost-sharing may be available.

Learn more about qualifying annual income levels and qualifying monthly income levels (effective March 2021), as well as how to apply for Medicaid.

HUSKY Plus provides additional coverage of goods and services for HUSKY B medically eligible children with intensive health needs or special health care needs. Learn more about HUSKY Plus.

HUSKY C

Coverage specific for people with disabilities, people receiving long-term Services & Supports and older adults
Eligibility

Medicaid coverage under HUSKY C is for people 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 may be different depending on the part of HUSKY C a person qualifies for and where they live within the state.

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

Medicaid Long-Term Services & Supports
Find more information about Medicaid Long-Term Services & Supports, and how to apply for them.

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

The Department of Social Services (DSS) offers individuals several ways to apply for Medicaid. The online application may be the easiest method, however applications can be mailed in or turned in at a DSS office. Use this list to find a field office near you. For some health coverage, people can apply over the phone. Office hours are Monday through Friday between 8:00 a.m. and 4:30 p.m.

HUSKY D

Coverage for adults who do not have children under the age of 19
Eligibility

Connecticut residents aged 19 to 64 without 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).

Learn more about qualifying annual income levels and qualifying monthly income levels, (effective March 2021), as well as how to apply for services. At this time, there are no asset limits for HUSKY D.

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 Services, Waivers & Fees
Some health care services are covered under Medicaid. For a full list of services covered and explanations, consult the HUSKY Health Program Member Handbook. Download and/or print the handbook for your reference. HUSKY Health also includes improved services that have more requirements. These benefits are below.

Community First Choice (CFC) is a program in Connecticut offered to active Medicaid members. It allows people to receive supports and services in their home. These services include, but are not limited to, help to prepare meals and do 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 and hospitals. The program can help people successfully return back to their community.

Spousal Impoverishment Standards: The cost of regular nursing home care can be costly for older couples. When one spouse is living in the community and the other spouse in nursing home care, there are spousal impoverishment standards or rules under Medicaid to make sure the spouse at home will be able to live independently. Under these standards, part of the Medicaid member’s income is used to support the income of the spouse at home.

What Is Medicare?

Medicare is the federal health insurance program for older adults and people with disabilities. The Centers for Medicare & Medicaid Services (CMS) is the federal agency that directs the program. Medicare 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.

This program is funded in part by Medicare taxes people pay on their income, through monthly costs paid by Medicare members and by the federal government.

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).

You can also use Connecticut’s program for Health insurance assistance, Outreach, Information and referral, Counseling, Eligibility Screening (CHOICES). This assistance program can help you 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 Eligibility

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

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

Note: People who are 65 and older but do not meet other Medicare requirements may buy Medicare coverage by paying a monthly premium, or cost.

Individuals 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 members do not need to sign up for coverage each year. However, each year there is the chance to look over your coverage and change plans.

Members will receive a red, white and blue Medicare card in the mail they can use 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 the member’s unique Medicare number on it, 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 two choices – 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 health services, but there are differences in monthly costs or premiums, deductibles, coinsurance and provider networks. Eligible individuals should carefully think about their own situations before choosing. If needs change, people may also change plans during the Open Enrollment period each year.

People enrolling in Original Medicare should also think about 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: Doctor visits, outpatient care, preventive care, some home health care, strong medical equipment and ambulance services. There is a monthly cost 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 Original 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 be different depending on the insurance company and local 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 helps you pay for additional costs not covered by Original Medicare. Medigap is offered by private 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 – it is designed to be used with Parts A and B. These plans do not provide prescription drug benefits. The state offers up to 10 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 or costs, coinsurance and deductibles are usually paid out-of-pocket, although Medicare Advantage plans and Medigap policies cover some coinsurance and deductibles.

Financial help 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 other 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 assistance through ALMB is not guaranteed and the funding is limited. When available funds are used up, applications will be denied.

Program	Status	Income Limit	Status	Income Limit
QMB	Single	$2196.51/mo	Couple	$2972.99/mo
SLMB	Single	$2404.71/mo	Couple	$3254.79/mo
ALMB	Single	$2560.86/mo	Couple	$3466.14/mo

Learn more about the Medicare Savings Program and how to apply.