Medicare is health insurance that’s provided through the federal government. It’s available to people who are age 65 or older or to people of any age who meet certain criteria.
Medicare plans in Connecticut fall into four categories:
- Part A and Part B, which make up original Medicare
- Part C, also known as Medicare Advantage
- Part D, which is prescription drug coverage
- Medigap, which are supplemental insurance plans
Different parts of Medicare cover different services, so it’s important to understand each one in order to determine which is best for you.
Original Medicare includes Part A and Part B coverage. It’s available to anyone eligible for Medicare. Each part covers different services.
Part A covers hospital or inpatient care, including:
- care when you are admitted to a hospital
- limited coverage of skilled nursing facility care
- hospice care
- some home health care
Here’s an overview of Part A costs:
- Most people don’t pay a premium for Part A; however, if you don’t meet eligibility requirements for premium-free coverage, you can purchase a plan.
- You usually pay a deductible for each benefit period.
- There is no out-of-pocket maximum for the year.
Part B covers outpatient and preventive care, including:
- doctor’s appointments
- screenings or diagnostic tests
- preventive care, such as vaccines and annual wellness checks
- some durable medical equipment
Here’s an overview of Part B costs:
- monthly premium
- annual deductible
- coinsurance for all care after the deductible (20 percent of the Medicare-approved amount)
- no out-of-pocket maximum for the year
Medicare Part C (Medicare Advantage)
Private insurance companies contract with Medicare to bundle all the coverage under original Medicare into Medicare Advantage plans. Many of these plans also include prescription drug coverage, as well as additional coverage for things like vision, dental, or hearing.
Part C costs include:
- Part B premium
- additional premiums for extra benefits for some plans
- annual out-of-pocket maximum set by the specific plan you choose
Part D (prescription drug coverage)
Everyone on Medicare may get a prescription drug coverage through a Part D plan from a private insurance carrier.
Here’s an overview of Part D costs:
- Costs vary based on the plan type and prescriptions covered.
- Original Medicare doesn’t include Part D. You must purchase it separately.
- Medicare Advantage plans often include prescription drug coverage.
Medigap supplement Insurance
If you need help paying for your costs under original Medicare, a supplemental insurance policy (Medigap plan) can help. There are 10 different Medigap plans that cover various combinations of deductibles, coinsurance, and copays. The 10 Medigap plans include plans A, B, C, D, F, G, K, L, M, and N.
But you can’t enroll in both Medigap and Medicare Advantage (Part C). You must choose one or the other if you want this additional coverage.
To get a Medicare Advantage plan, you must first enroll in original Medicare (parts A and B). Then, you can select from available Medicare Advantage plans in your area by comparing costs and coverage options.
There are three types of Medicare Advantage plans available in Connecticut:
Health Maintenance Organizations (HMOs) let you to choose a primary care provider (PCP) from the HMO network. That provider will coordinate your care. This means that:
- Care outside the plan is not usually covered, unless it’s for an emergency.
- You must get a referral from your PCP to see a specialist.
Preferred Provider Organizations (PPOs) allow you to get care from any doctor or facility with the plan’s network. But keep in mind:
- If you go outside the network, the care will usually cost more.
- While not required, it’s recommended that you choose a PCP.
- You do not need a referral from your PCP to see a specialist.
Special Needs Plans (SNPs) are designed for people who need coordinated care management. You must meet certain criteria to be on an SNP:
- You must have a chronic or disabling condition like diabetes, dementia, or end stage renal disease (ESRD).
- You must be eligible for both Medicare and Medicaid (dual eligible).
- You must live and receive care in a nursing home.
These insurance carriers offer Medicare Advantage plans in Connecticut:
- Aetna Medicare
- Anthem Blue Cross and Blue Shield
- CarePartners of Connecticut
Your choice of plans will vary depending on where you live in Connecticut, as not all plans are available in every area.
You’re eligible for Medicare in Connecticut if you:
- are age 65 or over
- are a citizen of the U.S. or a legal resident for 5 or more years
If you are not 65 years old, you can also qualify for Medicare if you:
- received Social Security Disability Insurance (SSDI) or Railroad Retirement Board (RRB) benefits for at least 24 months
- have amyotrophic lateral sclerosis (ALS)
- have ESRD
- received a kidney transplant
You must enroll in Medicare during the correct period, unless you meet the qualifications to be automatically enrolled.
Initial enrollment period
Your initial enrollment period begins 3 months before the month of your 65th birthday, then continues through your birthday month and for 3 months after.
If possible, sign up before you turn 65, so your benefits begin in your birthday month. If you wait until later in the initial enrollment period, your benefit start date could be delayed.
During this period, you may sign up for Medicare parts A, B, C, and D.
Special enrollment periods
Special enrollment periods allow you to sign up for Medicare outside of standard enrollment windows. They occur when you lose your health coverage for a qualifying reason, such as losing employer-sponsored coverage when you retire or moving out of your plan’s coverage area.
January 1 to March 31
- General enrollment. If you miss your initial enrollment period, you can enroll each year during general enrollment; however, your coverage will not begin until July 1. You may also have to pay a late sign-up penalty if you miss your initial enrollment and don’t have other coverage (such as an employer-sponsored plan). During general enrollment, you can sign up for original Medicare (parts A and B) or switch between original Medicare and Medicare Advantage plans.
- Medicare Advantage open enrollment. During this time, you can change your Medicare Advantage plan or drop your plan and switch to original Medicare instead.
October 15 to December 7
- Medicare open enrollment. During open enrollment, you may change your coverage for original Medicare, as well as sign up for or change Part D coverage. If you didn’t sign up for Part D during your initial enrollment period and you didn’t have other coverage (such as an employer plan), you may pay a lifetime late sign-up penalty.
Before you decide which Medicare plan is right for you, review each one carefully to see if it:
- includes the doctors and facilities where you want to get care
- has affordable premiums, deductibles, copays, and coinsurance
- is highly rated for quality care and patient satisfaction
These resources can help you get more information about Medicare in Connecticut.
Connecticut Insurance Department (860-297-3900)
Connecticut CHOICES (800-994-9422)
Other sources of help include:
- MyPlaceCT. This is a virtual “No Wrong Door,” a resource for older adults and people with disabilities sponsored by the Connecticut Department of Social Services.
- Medicare. Visit the Medicare website or call 800-633-4227 to speak to a person trained to help you navigate Medicare.
- State Health Insurance Assistance Program (SHIP) Connecticut. SHIP offers outreach, information, referrals, counseling, eligibility screening, and more for Connecticut residents.
To enroll in Medicare Connecticut plans:
- Determine what coverage your plan should include, based on your healthcare and financial needs.
- Compare original Medicare and Medicare Advantage plans for costs, coverage, and provider networks.
- Set a reminder to help you keep track of enrollment periods that apply to you.
This article was updated on November 20, 2020, to reflect 2021 Medicare information.