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Medicare in Connecticut

October 6, 2016

Once you reach the traditional retirement age of 65, you’re typically eligible to receive health insurance coverage under Medicare if you meet residency requirements. You might also qualify for Medicare before you turn 65 in some cases. In Connecticut, as in the other states, your Original Medicare benefits include medical insurance and hospital insurance. You can also choose to enroll in a Medicare plan option through the Medicare Advantage (Medicare Part C) or Medicare Part D (prescription drug coverage) programs, or Medicare Supplement (Medigap) insurance.

Original Medicare for Connecticut beneficiaries

As a new Medicare beneficiary, you will want to become familiar with the kind of benefits that Original Medicare offers in the state of Connecticut (as in every state). Original Medicare includes both Medical Part A (hospital insurance) and Medicare Part B (medical insurance). Original Medicare doesn’t generally include prescription drug coverage (except in certain situations, like when you’re a hospital inpatient).

To be eligible for automatic enrollment into Original Medicare, you must already receiving benefits from Social Security or the Railroad Retirement Board when you qualify for Medicare.

If you’re not eligible for automatic enrollment, you can enroll in Original Medicare during your seven-month Medicare Initial Enrollment Period, or IEP (typically starting three months before the month you turn 65, including your birthday month, and continuing for three more months). Your Medicare IEP may be different if you qualify for Medicare before age 65. If you don’t enroll in Original Medicare during that time, you can still enroll in coverage during the General Enrollment Period, which runs from January 1 – March 31 each year in Connecticut, as it does in the rest of the United States. However, if you miss your Initial Enrollment Period and end up enrolling in Medicare at a later date, you may have to pay a late-enrollment penalty.

In Connecticut, as in all states, enrollment in Medicare Part A comes with no premium if you’ve worked at least 10 years while paying Medicare taxes. Otherwise, you may have to pay a monthly premium. Medicare Part A offers the following benefits to Medicare beneficiaries:

  • Hospital care
  • Skilled nursing facility care
  • Nursing home care
  • Hospice care
  • Limited home health services

Medicare Part B offers medical insurance. In Connecticut and the rest of the United States, you typically pay a monthly premium for Medicare Part B. You may also have to pay an income-related monthly adjustment fee, depending on your annual income. As a Medicare Part B beneficiary, you’re eligible for coverage such as (but not limited to):

  • Clinical research
  • Ambulance services
  • Durable medical equipment
  • Mental health (inpatient, outpatient, and partial hospitalization)
  • Second opinion before surgery
  • Limited outpatient prescription drugs

Medicare plan options in Connecticut

As a Medicare beneficiary, you may have several Medicare insurance options through private companies that contract with Medicare. Here’s a quick summary of these choices.

Medicare Advantage plans offer an alternative way to receive Original Medicare coverage. Medicare Advantage plans provide your Medicare Part A and Part B benefits (except for hospice care, which Part A covers directly). Many Medicare Advantage plans in Connecticut, as in the rest of the country, offer additional benefits as well, like routine dental, vision, and hearing benefits.

Many Medicare Advantage plans include prescription drug coverage; these are known as Medicare Advantage Prescription Drug plans. This type of plan combines Medicare health and drug coverage into one plan.

Whether you enroll in a Medicare Advantage plan or a Medicare Advantage Prescription Drug plan, you have to have Medicare Part A and Part B to qualify, and you must continue paying the Medicare Part B premium (as well as the Medicare Advantage plan premium, if any) in order to keep your health insurance coverage. You’re welcome to read more about Medicare Advantage in Connecticut.

Original Medicare doesn’t cover your prescription medications in most situations, so you have the option of adding a stand-alone Medicare Part D Prescription Drug Plan to your Original Medicare coverage. Prescription drug coverage is included in a Medicare Advantage Prescription Drug plan, so if you have Medicare Advantage, in most cases you wouldn’t be able to add a separate Medicare Part D policy. To find out more, read about Medicare prescription drug coverage in Connecticut.

If you decide to stay with Original Medicare, another option you may have is to sign up for a Medicare Supplement (Medigap) plan to help pay for Original Medicare’s out-of-pocket costs. Different Medigap plans pay for different amounts of those costs, such as copayments, coinsurance, and deductibles.  You can read more about Medigap plans in Connecticut.

Costs for Medicare plan options in Connecticut may vary, but they may require payment of a monthly premium, annual deductible, and copayment or coinsurance.

As a Connecticut resident, you may have different Medicare plan options available depending on what county you live in. If you live in Bridgeport, in Fairfield County, for example, you may have different Medicare plan options available than a resident of New Haven in New Haven County. Considering the variety of Medicare plans available in Connecticut, it may be a good idea to customize your search for plans based on your individual health and prescription needs, and on the local area in which you reside.

Connecticut resources for Medicare beneficiaries

Medicare.gov lists resources designed to help Medicare beneficiaries in Connecticut with issues and concerns. Here are some of the resources that may be helpful to you:

 

Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program.