Medicare in Connecticut

Medicare is a federal health insurance program that covers specific costs for adults aged 65+, as well as those who have certain disabilities or end-stage renal disease (ESRD). Connecticut’s 2022 Medicare enrollment figures show that 700,256 residents (about 19.5% of the population) have joined one or more Medicare plans. Original Medicare beneficiaries made up 55.2% of enrollees, followed by 44.8% with Medicare Advantage. The figures reveal over 610,000 residents enrolled by reason of age, over 75,000 because of a disability and over 4,800 due to ESRD. Connecticut spends approximately $10,412 on each recipient. Its Medicare Advantage enrollments have, as of 2022, overtaken Original Medicare.

Original Medicare has two parts: Part A covers hospital stays and limited time in a nursing home or hospice, as well as some home health care costs, and Part B covers everyday medical services, such as doctor’s visits, outpatient care and some medical supplies. The premium amount for Part A depends on how long the applicant, or their spouse, worked (most individuals get premium free part A) and paid Medicare taxes. The standard premium amount for Part B in 2022 is $170.10. 

Part C is often referred to as Medicare Advantage. Offered by Medicare-approved private health insurance companies, it’s an alternative option that effectively combines Parts A and B (minus hospice care, which Part A always covers). Most recipients of Part C also have Part D, which covers prescription drugs. Medical Supplement Insurance, better known as Medigap, is private health insurance that covers gaps in Original Medicare’s medical supplies and care services coverage. These gaps may include coinsurance, copayments and deductibles.

This guide covers content specific to Connecticut’s Medicare. It also discusses how to customize coverage and lists insurance-related resources that may help seniors make more informed choices. 

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 administered by the Centers for Medicare & Medicaid Services (CMS)vand is open to seniors aged 65 and over, along with those under 65 years old, but with certain disabilities or end-stage renal disease. It includes two parts. Part A covers inpatient hospital care, nursing home and skilled nursing care, hospice and home health care. Part B, or medical coverage, pays for medically necessary goods and services such as durable medical equipment, mental health services and emergency medical transportation. 

Unlike most private Medicare plans, Original Medicare’s provider network isn’t limited to the beneficiary’s geographic region, making it easier to obtain services while traveling within the country. In most cases, Medicare doesn’t pay for health services the individual receives outside the United States. 

Under this program, seniors pay for services as they receive them. They must pay an annual deductible, which is $1,556 for Part A and $233 for Part B in 2022. After they’ve paid this amount, Medicare covers all eligible services at 80%. Beneficiaries pay the remaining 20% out of pocket.

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)

Medicare Advantage provides more coverage options than Original Medicare and is administered by private insurance companies subject to the same levels of control from CMS. Excluding hospice care (which is covered by Part A), Part C combines all the benefits of both parts of Original Medicare. Part C also offers supplemental benefits, such as prescription drugs, gym memberships, and routine dental, hearing and vision services. Additionally, it establishes out-of-pocket limits to protect beneficiaries from excessive costs if their treatments become too expensive. 

As of 2022, there are 57 Medicare Advantage plans available in Connecticut, but residents can only apply for plans obtainable in their areas. Monthly premiums start from $0, but the 2022 average is $19.95 due to beneficiaries including supplemental benefits in their plans. There may also be copayments for some expenses, such as doctor visits, and it shouldn’t be assumed these will mirror Original Medicare copayments.

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 10 Medicare Advantage Plans in Connecticut

The following table reveals the top 10 Medicare Advantage providers in Connecticut based on their enrollment statistics. As the majority offer multiple plans, this information displays costs from April 2022 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 2022 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.