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Medicare in Connecticut

Connecticut has among the strongest Medigap consumer protections laws in the country

At a glance: Medicare health insurance in Connecticut

Medicare enrollment in Connecticut

2020 Medicare enrollment datesAs of late 2018, there were 671,988 Connecticut residents with Medicare overage. In most cases, people become eligible for Medicare when they turn 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 Medicare beneficiaries are eligible due to disability rather than age (nationwide, it’s 16 percent).

Read about Medicare’s open enrollment period and other important enrollment deadlines.

Medicare Advantage in Connecticut

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. Plan availability varies by county, but Connecticut’s Medicare Advantage market is particularly robust, with at least 27 plan options available throughout the state.

Nationwide, about a third of all Medicare beneficiaries were enrolled in Medicare Advantage plans as of 2017. In Connecticut, it was 28 percent. As of December 2018, however, there were 260,370 Connecticut residents with private Medicare coverage — nearly 39 percent of the state’s Medicare population.

Nationwide, Medicare Advantage enrollment continues to make up an ever-increasing segment of the total Medicare population, but Medicare Advantage growth in Connecticut far outpaced the national average from 2017 to 2018. According to CMS data, nationwide Medicare enrollment increased by a little more than a million people from January 2018 to December 2018, while private Medicare enrollment (almost all of which is Medicare Advantage) grew by about 631,000 people. But in Connecticut, private Medicare coverage growth far outpaced overall Medicare enrollment growth: From January to December 2018, Connecticut’s total Medicare population grew by 11,340 people, while the state’s Medicare Advantage enrollment grew by 27,780 people.

Although about a third of all Medicare beneficiaries nationwide choose Advantage plans, their popularity varies widely from one state to another. In Minnesota, more than half (56 percent) of the state’s Medicare population is enrolled in Advantage plans, whereas only 1 percent of Alaska Medicare beneficiaries have Advantage plans (and those are via employer-sponsored coverage, as there are no Medicare Advantage plans available for individuals to purchase in Alaska).

Medicare’s annual election period (October 15 to December 7 each year) allows Medicare beneficiaries the chance to switch between Medicare Advantage and Original Medicare (and add, drop, or switch to a different Medicare Part D prescription plan). Starting in 2019, people who are already enrolled in Medicare Advantage also have the option to switch to a different Advantage plan or to 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.

There are 13 insurers that offer Medigap plans in Connecticut. And according to an AHIP analysis, 155,219 Connecticut residents had Medigap coverage as of 2016.

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 A, Plan F, etc.) are the same regardless of which insurer sells the plan.

Prices do vary from one insurer to another, but Connecticut law (Chapter 700c, Section 38a-473) requires insurers to use community rating; rates cannot vary based on age, gender, or health status.

Unlike other private Medicare coverage (Medicare Advantage and Medicare Part D plans), 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, 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.

Part D coverage in Connecticut

Original Medicare does not provide coverage for outpatient prescription drugs. 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.

But Medicare beneficiaries who do not have drug coverage through Medicaid or an employer-sponsored plan need Medicare Part D in order to have coverage for prescriptions. Part D can be purchased as a stand-alone plan, or integrated with a Medicare Advantage plan. Part D was created under the Medicare Modernization Act of 2003, which was signed into law by President George W. Bush.

There are 26 stand-alone Part D plans for sale in Connecticut in 2019, with premiums that range from about $14 to $128/month.

295,542 Connecticut Medicare beneficiaries had stand-alone Part D coverage as of the end of 2018. Another 232,325 Medicare beneficiaries in Connecticut had Part D prescription coverage as part of their Medicare Advantage plans.

Medicare spending in Connecticut

Original Medicare’s average per-beneficiary spending in Connecticut was a little higher than the national average in 2017, at $9,976 (the national average was $9,761). 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.

Per-beneficiary Medicare spending was highest in Louisiana, at $11,542, and lowest in Hawaii, at just $6,690.

You can read more about Medicare in Connecticut in our state Medicare guide. You can also contact CHOICES (Connecticut’s program for Health insurance assistance, Outreach, Information and referral, Counseling, Eligibility Screening) with questions related to Medicare coverage in Connecticut.

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 Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.