Medicare in Connecticut

Medicare is the federal health insurance program for seniors aged 65 and over and for adults with certain qualifying disabilities. Original Medicare was the first path to benefits for program participants. It is divided into three main parts, known as A, B and D. Medicare Part A is the inpatient benefit seniors automatically get at age 65, while Parts B and D are optional. Part B pays most of the cost for outpatient services and medical equipment. Part D is Medicare’s prescription drug benefit, which helps seniors pay for their medications at the pharmacy. Costs vary for Part D, but Extra Help is available to seniors with low incomes.

Medicare Advantage is sometimes called Part C, and since its adoption in 2003, it has rapidly grown to become the most popular path to Medicare services in Connecticut, even outstripping the 48% adoption nationwide. These plans are issued by private insurance companies and offer the same benefits as Parts A and B for a single monthly premium. Most Part C plans include a drug benefit that’s competitive with Part D and some extra coverage options Original Medicare doesn’t pay for, such as hearing aids, dental care and vision services.

As of 2023, 721,000 seniors in Connecticut are enrolled in at least one Medicare program, with 45% of enrollees choosing to get their benefits through Original Medicare and the other 55% through Medicare Advantage. Medicare Advantage participation in Connecticut grew by 6.34% just in the period 2022-23, a rate more than double the growth in Medicare-eligible seniors during the same period. Connecticut Medicare costs amount to $6,103 a year per enrollee, or $4.4 billion in total.

This guide explains some of the vital details seniors need to know about Medicare and Medicare Advantage. It discusses costs and coverage areas, and it lists helpful insurance-related issues seniors can use when researching their health care options in Connecticut. The goal is to help seniors and their families make an informed choice about which health care option is right for them.

Options for Medicare Coverage in Connecticut

Although Original Medicare provides many benefits for enrollees, it may not provide all the coverage required. Fortunately, the federal program isn’t the only option available. Connecticut residents looking for more comprehensive coverage can enroll in alternative plans offered by private health insurance companies approved by Medicare. These plans can be tailored to suit the individual’s specific health care needs.

Original Medicare (Parts A & B)

Original Medicare is available to Connecticut seniors aged 65 and over, as well as people with specific disabilities and end-stage renal disease (ESRD). Part A is free for enrollees with a qualifying work history, but a $1,600 deductible is due for each hospitalization. Part B is optional and comes with a standard monthly premium of $164.90 a month. Part B also has a $226 annual deductible, after which it covers 80% of qualifying outpatient expenses. Part D plans vary by type and coverage limits. Many Original Medicare enrollees also sign up for Medigap supplemental coverage to help with out-of-pocket costs.

Who Should Consider Original Medicare

Original Medicare may be a good option for those who:

• Travel frequently within the United States
• Don’t need extra benefits such as home-delivered meals and coverage for over-the-counter medication
• Want to choose their own prescription drug coverage

Medicare Advantage (Part C)

Unlike Original Medicare, Medicare Advantage Plans are issued by private companies and vary enormously in their coverage limits, monthly premiums and types of care covered. Most plans are organized as HMOs, PPOs or PFFS options, but special needs plans (SNPs) are also available for beneficiaries with specific medical conditions requiring long-term care. 

Because Medicare Advantage Plans tend to be state-specific, they may not travel well. Many plans offer out-of-network coverage, but this option tends to add to the cost of the plan. Unlike Original Medicare participants, Medicare Advantage beneficiaries are not eligible to enroll in Medigap.

Who Should Consider Medicare Advantage

Medicare Advantage may benefit those who:

• Want lower premiums, and can get them because they’re generally healthy
• Prefer an annual out-of-pocket expenses limit
• Are satisfied with managed care
• Want coverage for Original Medicare gaps

The Top Medicare Advantage Plans in Connecticut

The following table reveals the top Medicare Advantage providers in Connecticut based on their enrollment statistics. As the majority offer multiple plans, this information displays costs from August 2023 as a range and merges the enrollee stats of all plans to find the total. For more information, visit Medicare Advantage Plans in Connecticut. 

Medicare Prescription Drug Coverage (Part D)

Original Medicare doesn’t pay for most prescription drugs through Part A or B coverage. Instead, seniors purchase separate prescription drug policies, also called Part D coverage. Medicare contracts with private health insurance companies to provide this coverage. There are multiple plans to choose from with varying monthly premiums, which beneficiaries pay in addition to their Original Medicare premiums. While seniors don’t have to purchase prescription drug coverage when they’re first eligible for Medicare, not obtaining this coverage at this time may result in late enrollment penalties they pay for as long as they have Medicare if they enroll later.

Each prescription drug plan has its own formulary, or list of covered drugs. Formularies are typically split up into tiers. The tier a medication is in determines how much the insurance company pays and how much the beneficiary pays for it. Lower-level tiers are usually made up of generic and low-cost brand name drugs, while higher tiers are composed of more expensive brand name and specialty drugs. In most cases, the lower the tier, the lower the policyholder’s cost-sharing responsibility.

Who Should Consider Medicare Prescription Drug Coverage

Seniors who may benefit from prescription drug coverage include those who:

• Currently take prescription medication or expect to in the future
• Want to avoid late enrollment penalties
• Want to reduce out-of-pocket prescription drug expenses

Medicare Supplement Insurance (Medigap)

While Original Medicare provides coverage for many medical costs, seniors may still have significant out-of-pocket expenses. These may include copays, coinsurance and deductibles. Seniors may be able to reduce their cost-sharing obligations by purchasing a Medigap plan. These plans can only be used with Original Medicare. It’s illegal for private insurance companies to sell Medigap plans to those with Medicare Advantage plans.

For more information on Medigap plans, seniors can refer to the Best Medicare Supplement Companies of 2023 page.

Who Should Consider Medicare Supplement Insurance

Good candidates for Medigap may be those who:

• Have ongoing health issues and expenses
• Travel overseas often
• Want to access an expanded network of health care providers
• Expect to need health services not covered by Original Medicare

Medicare Resources in Connecticut

Comparing the options offered by Medicare and finding answers to questions raised during enrollment can be challenging and occasionally disconcerting for some residents in Connecticut. Fortunately, they needn’t feel isolated as there are many organizations that can support and guide them through every stage of the enrollment process. Help is usually delivered one-on-one and in confidence and will likely cover every aspect of Medicare, including making decisions based on the pros and cons of Original Medicare/Medicare Advantage and considering supplemental benefits available in the resident’s area, such as Medigap.