Medicare in Connecticut
- Medicare can be confusing. Find out more about Medicare in Connecticut, including who is eligible and how you can apply.
What Connecticut Medicare Plans Are Available?
Medicare Part A
Original Medicare, which covered 385,663 Connecticut residents in 2020, is made up of Part A and Part B. Part A covers services received while admitted to a hospital or other medical facility. Examples include surgical procedures, nursing care, meals and medications administered during your stay. In most cases, there's no premium for Medicare Part A coverage. Even if you don't pay a premium, you still have to pay a deductible for each benefit period. You may also have to pay coinsurance.
Medicare Part B
Medicare Part B covers preventive services and medically necessary services. Preventive services include annual wellness visits, screening for heart disease and colon cancer, vaccinations and mammograms. Medically necessary services are the services needed to diagnose and treat medical conditions, such as laboratory tests and X-rays. To be considered medically necessary, a service must meet accepted standards of medical practice. Medicare beneficiaries must pay a monthly premium for Part B coverage, as well as an annual deductible and coinsurance for most medical services.
Medicare Part C
Medicare Part C, also known as Medicare Advantage, offers more flexibility in terms of Medicare coverage. While Original Medicare is administered by the federal government, Connecticut Medicare Advantage plans are sold by private insurance companies. These plans bundle the services covered by Original Medicare with prescription drug coverage; some insurers even cover additional services.
If you choose to enroll in Medicare Advantage, you'll pay a monthly premium that varies based on the type of plan and the insurer you select. In 2020, Connecticut had 303,909 residents covered by Medicare Advantage plans, bringing the state's total number of Medicare enrollees to 689,572. The following plan types are available to Medicare Advantage enrollees:
- HMO: A health maintenance organization plan covers services provided by medical professionals who are in the plan's network. If you have HMO coverage, you typically need to choose a primary care provider to manage your care. You may also need to ask your PCP for a referral to see a specialist.
- PPO: Preferred provider organization plans offer a little more flexibility than HMO plans. PPOs typically cover in-network and out-of-network care, but you'll pay more for out-of-network services. You also don't need to ask for a referral to see a specialist.
- SNPs: Special needs plans are designed for beneficiaries with chronic illnesses or certain health characteristics. An SNP is tailored to meet the specific needs of its members.
- PFFS: Private fee-for-service plans pay providers a set fee for each service provided. If you have a PFFS plan, you don't have to choose a primary care provider. You can also get care outside of the network; however, you need to be aware that out-of-network doctors may not be willing to accept the set fee for their services. If you want to continue seeing them, you may have to cover the costs yourself.
Medicare Advantage plans are available in all states with the exception of Alaska.
Medicare Part D
Medicare Part D is a supplemental plan that adds prescription coverage to your Original Medicare coverage, reducing your out-of-pocket costs. The premium charged for Part D coverage is separate from any premiums you pay for Medicare Part A and Part D. Part D plans also have separate deductibles and copay requirements. Medicare Advantage plans already include prescription coverage, so you can't purchase Medicare Part D if you have Part C.
Medicare Supplement Insurance
Medicare Supplement Insurance, commonly called Medigap, is designed to supplement your Original Medicare coverage. Like Medicare Advantage plans, Medigap plans are offered by private insurance companies. They can make your medical costs more manageable by covering things like deductibles and copays for medical services. If you sign up for Medigap, you'll pay a separate premium for the supplemental coverage. Connecticut is one of 47 states that standardize their Medigap plans the same way. Minnesota, Massachusetts and Wisconsin follow different standardization guidelines.
Who Is Eligible for Connecticut Medicare?
Some Connecticut residents are enrolled automatically in Original Medicare. You may qualify for automatic enrollment if you start receiving Social Security retirement benefits at least four months before your 65th birthday. Automatic enrollment also applies if you start receiving benefits from the Railroad Retirement Board before you turn 65. If you don't qualify for automatic enrollment, you can enroll during one of several enrollment periods.
- Initial Enrollment Period: The IEP is your first chance to sign up for Original Medicare. This period starts three months before you turn 65 and ends three months following your 65th birthday. It's best to sign up during the IEP to avoid the potential for late enrollment penalties.
- General Enrollment Period: If you didn't sign up for Original Medicare during your IEP, don't worry. You can still enroll, but you may have to pay a penalty for late enrollment in Medicare Part B. The GEP occurs once each year, from January 1 to March 31.
- Special Enrollment Periods: If you don't enroll during the IEP or GEP, you can't enroll until the next general enrollment period unless you qualify for a special enrollment period. You may be eligible for a special enrollment period if you lose your employer-provided health insurance or you're no longer eligible for Medicaid coverage.
- Open Enrollment: Open enrollment is your chance to make changes to your Medicare coverage. If you're enrolled in Medicare Advantage, you can switch back to Medicare Advantage. You can also switch from Original Medicare to Medicare Advantage or change Medicare Advantage plans during this period. Open enrollment lasts from October 15 to December 7 each year.
How Do I Enroll in Medicare in Connecticut?
To enroll in Original Medicare, do one of the following:
- Submit an online application.
- Apply in person at a Social Security office.
- Call 800-772-1213 to speak with a Social Security employee.
Contact Information for Connecticut Medicare, Medicaid and Insurance Help
The Connecticut Medicaid program provides health coverage for low-income residents.
CHOICES (Connecticut) Health Insurance Assistance, Outreach, Information and Referral, Counseling, Eligibility Screening serves as Connecticut's State Health Insurance Assistance Program. The program has trained counselors available to help people compare Medicare plans and make coverage decisions.
State Department of Aging and Disability
The State Department of Aging and Disability provides a wide variety of services to help older adults stay active and independent.
State of Connecticut Insurance Department
Any Connecticut resident with a complaint about their health insurance provider can contact the State of Connecticut Insurance Department to lodge a complaint.