At a glance: Medicare health insurance in Connecticut
- Nearly 672,000 residents are enrolled in Medicare in Connecticut.
- More than one-third of Connecticut Medicare beneficiaries were enrolled in Medicare Advantage plans as of 2018, but that had grown to 45 percent by mid-2020 (Medicare Advantage enrollment has been growing much faster than overall Medicare enrollment in Connecticut)
- All counties in Connecticut have at least 29 Medicare Advantage plans available in 2020.
- 14 insurers offer Medigap plans in Connecticut; all plans are guaranteed-issue and community-rated at all times. Connecticut requires Medigap insurers to offer at least Plan A (and Plans B and C if the insurers sells them) to beneficiaries under age 65.
- There are 25 stand-alone Medicare Part D prescription plans available in Connecticut in 2020, with premiums that range from about $13 to $128 per month. About 40 percent of Connecticut Medicare beneficiaries have stand-alone Medicare Part D plans.
- Per-enrollee spending for Original Medicare in Connecticut is a little higher than the national average.
Medicare enrollment in Connecticut
As of mid-2020, Medicare enrollment in Connecticut stood at 689,134 people, amounting to about 19 percent of the state’s population. As is the case nationwide, Medicare enrollment in Connecticut is comprised mostly of people who are eligible due to their age (i.e., being at least 65).
But younger Americans gain Medicare eligibility after they have been receiving disability benefits for 24 months, or have ALS or end-stage renal disease. In Connecticut, 13 percent of beneficiaries are eligible due to disability rather than age (nationwide, it’s 15 percent).
Medicare beneficiaries can chose among several options to access Medicare coverage. The first choice is between Medicare Advantage, where an individual enrolls with a private health plan that is under contract with the federal government to provide Medicare coverage, or Original Medicare, where coverage is paid for directly by the federal government. Medicare beneficiaries also have options around Medigap policies and Medicare Part D (prescription drug) coverage.
Original Medicare includes Part A (also called hospital insurance, which helps pay for inpatient stays at a hospital, skilled nursing facility, or hospice center) and Part B (also called medical insurance, which helps pay for outpatient care like a doctor appointment or a preventive healthcare service, such as most vaccinations). Medicare Advantage plans bundle Parts A and B under a single monthly premium and often include other services like prescription drugs and vision coverage.
Private Medicare Advantage plans are an alternative to Original Medicare. There are pros and cons to either option, and the right solution is different for each person.
Medicare Advantage in Connecticut
Connecticut’s Medicare Advantage market is particularly robust, with at least 29 plan options available throughout the state. Service from a particular insurance company or plan varies by county.
Nationwide, 34 percent of all Medicare beneficiaries were enrolled in Medicare Advantage plans as of 2018, although it varied from a low of 1 percent in Alaska to a high of 56 percent in Minnesota. Medicare Advantage enrollment in Connecticut was right on par with the national average, however, with 34 percent of the state’s Medicare beneficiaries enrolled in Medicare Advantage plans.
By mid-2020, there were 310,703 Connecticut residents with private Medicare coverage, amounting to more than 45 percent of the state’s Medicare population. A similar trend has been happening nationwide, with increasing Medicare Advantage enrollment every year since 2004. Medicare Advantage growth in Connecticut has been particularly robust. According to CMS data, nationwide Medicare coverage enrollment increased by a little less than a million people from August 2019 to July 2020, while private Medicare enrollment (almost all of which is Medicare Advantage) grew by about 2 million people. In Connecticut, from August 2019 to July 2020, the total Medicare population grew by 6,624 people, while the state’s Medicare Advantage enrollment grew by 26,023 people.
Medicare’s annual election period (October 15 to December 7 each year) allows Medicare beneficiaries the chance to change between Medicare Advantage and Original Medicare (and add, drop, or switch to a different Medicare Part D prescription plan). And people who are already enrolled in Medicare Advantage also have the option to update their Medicare Advantage plan selection or switch to accessing benefits under Original Medicare during the Medicare Advantage open enrollment period, which runs from January 1 to March 31.
Medigap in Connecticut
Original Medicare does not limit out-of-pocket costs, so most enrollees maintain some form of supplemental coverage. Nationwide, more than half of Original Medicare beneficiaries get their supplemental coverage through an employer-sponsored plan or Medicaid. But for those who don’t, Medigap plans (also known as Medicare supplement plans, or MedSupp) will pay some or all of the out-of-pocket costs they would otherwise have to pay if they had only Original Medicare.
Although Medigap plans are sold by private insurers, the plans are standardized under federal rules, with ten different plan designs (differentiated by letters, A through N). The benefits offered by a particular plan (Plan G, Plan K, etc.) are the same regardless of which insurer sells the plan.
Unlike other private Medicare coverage (Medicare Advantage and Medicare Part D plans, which cover prescription drugs), federal rules do not grant an annual open enrollment window for Medigap plans. Instead, federal rules provide a one-time six-month window when Medigap coverage is guaranteed-issue, starting when a person is at least 65 and enrolled in Medicare Part B. But consumer protections are much stronger in Connecticut: All Medigap plans in Connecticut are sold on a guaranteed-issue basis at all times, and with community rating. So Connecticut residents have the option to switch from one Medigap plan to another, regardless of their health.
People who aren’t yet 65 can enroll in Medicare if they’re disabled and have been receiving disability benefits for at least two years (the 24-month wait does not apply if they have ALS or ends-stage renal disease), and 13 percent of Connecticut Medicare beneficiaries are under age 65. Federal rules do not guarantee access to Medigap plans for people who are under 65, but the majority of the states — including Connecticut — have implemented rules to ensure that disabled Medicare beneficiaries have at least some access to Medigap plans. Connecticut law (Chapter 700c, Section 38a-495c) requires Medigap insurers that offer Plans A, B, and/or C to offer those plans to disabled beneficiaries under age 65.
Connecticut Medicare Part D
Original Medicare does not provide coverage for outpatient prescription drugs. This gap in increasingly needed coverage — given the growing cost of prescription drugs — was addressed under the Medicare Modernization Act of 2003, which was signed into law by President George W. Bush.
More than half of Original Medicare beneficiaries nationwide have supplemental coverage via an employer-sponsored plan (from a current or former employer or spouse’s employer) or Medicaid, and these plans often include prescription coverage. Medicare beneficiaries who do not have drug coverage through Medicaid or an employer-sponsored plan can enroll in a Medicare Part D plan to get coverage for prescriptions. Medicare Part D enrollment is available via stand-alone plans (prescription drug plans — PDPs) or via integrated Medicare Advantage and prescription drug plans (MAPDs).
There is widespread availability of stand-alone prescription drug plans in Connection: In fact, there 25 stand-alone Medicare Part D plans operating in Connecticut in 2020, with premiums that range from about $13 to $128/month. Availability does vary by county.
280,651 beneficiaries Medicare in Connecticut had stand-alone Medicare Part D plans as of mid-2020. Another 273,086 of Connecticut’s Medicare beneficiaries had Medicare Part D coverage as part of their Medicare Advantage plans. Stand-alone Medicare Part D enrollment has been decreasing in Connecticut (as has been the case in many states), while enrollment in Part D coverage integrated with Medicare Advantage plans has been increasing. This is due to the increase in the percentage of Medicare beneficiaries — in Connecticut and nationwide — who are choosing Medicare Advantage plans.
Medicare spending in Connecticut
Per-beneficiary spending for Original Medicare in Connecticut was a little higher than the national average in 2018, at $10,729 (the national average was $10,096). The spending amounts are based on data that were standardized to eliminate regional differences in payment rates, and did not include costs for Medicare Advantage.
How does Medicaid provide financial assistance to Medicare beneficiaries in Connecticut?
Many Medicare beneficiaries receive financial assistance through Medicaid with the cost of Medicare premiums, prescription drug expenses, and services not covered by Medicare – such as long-term care.
Our guide to financial assistance for Medicare enrollees in Connecticut includes overviews of these benefits, including Medicare Savings Programs, long-term care coverage, and eligibility guidelines for assistance.
Helpful resources for Connecticut Medicare beneficiaries and their caregivers
These resources provide free assistance and information about Medicare programs and availability in Connecticut.
- CHOICES (Connecticut’s program for Health insurance assistance, Outreach, Information and referral, Counseling, Eligibility Screening) answers questions about Medicare coverage in Connecticut.
- Our guide to Medicare’s annual open enrollment period is a summary of what you need to know about the fall enrollment window for Medicare Part D plans and Medicare Advantage plans.
- Connecticut’s overview of Medicare Savings Programs is helpful for Connecticut Medicare beneficiaries with modest incomes and assets.
- The Medicare Rights Center website provides information geared to Medicare beneficiaries, caregivers, and professionals.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.