Medicare in Connecticut

Connecticut’s Medicare Advantage market is particularly robust, with at least 44 plan options available throughout the state for 2023 coverage. The service areas for a particular insurance company or plan vary by county; some areas of Connecticut have as many as 58 Advantage plans available for 2023.

Nationwide, 34% of all Medicare beneficiaries were enrolled in Medicare Advantage plans as of 2018, although it varied from a low of 1% in Alaska to a high of 56% in Minnesota. Medicare Advantage enrollment in Connecticut was right on par with the national average, however, with 34% of the state’s Medicare beneficiaries enrolled in Medicare Advantage plans at that point.

By mid-2023, there were 396,496 Connecticut residents with private Medicare coverage, amounting to more than 54% of the state’s Medicare population. A similar trend has been happening nationwide, with increasing Medicare Advantage enrollment every year since 2004, although nationwide, a little more than half of all Medicare beneficiaries still have Original Medicare (although that includes people who have only Medicare Part A or Part B; when we only consider people who have both Medicare Part A and Part B, and are thus eligible to enroll in Medicare Advantage, more than half have done so). Medicare Advantage growth in Connecticut has been particularly robust, with more than half the state’s Medicare beneficiaries now covered by Medicare Advantage plans.

Medicare’s annual election period/open enrollment 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.

Original Medicare does not limit out-of-pocket costs, so most enrollees maintain some form of supplemental coverage. For those who don’t have access to supplemental employer-sponsored coverage or Medicaid, 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 (12 offer individual plans and one offers group plans). And according to an AHIP analysis, 152,255 Connecticut residents had Medigap coverage as of 2021.

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.

Prices 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, 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 end-stage renal disease), and almost 11% 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.

Under Connecticut law (Chapter 700c, Section 38a-495c) Medigap insurers that offer Plans A, B, and D (or C if the beneficiary became eligible for Medicare prior to 2020) must offer those plans to disabled beneficiaries under age 65. This page shows which plans each insurer offers; note that many of them do not offer plans B, D, or C, meaning that the only plan they would offer to beneficiaries under 65 would be Plan A.

Original Medicare does not provide coverage for outpatient prescription drugs. This gap in coverage 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), and these plans often include prescription coverage. Medicare beneficiaries who do not have drug coverage through an employer-sponsored plan can enroll in a Medicare Part D plan to get coverage for prescriptions (beneficiaries who are dual-eligible for Medicare and Medicaid also get their drug coverage through Part D, rather than through Medicaid).

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 are 24 stand-alone Medicare Part D plans available in Connecticut for 2023 coverage, with premiums that range from about $7 to $127/month.

More than 604,000 Medicare beneficiaries in Connecticut had Part D coverage as of mid-2023. As of late 2020, Part D coverage in Connecticut had been split nearly equally between stand-alone Part D plans (PDPs) and Medicare Advantage plans with integrated Part D coverage (MA-PDs). But by mid-2023, the balance had tipped significantly in favor of MA-PDs. At that point, about 377,000 Connecticut Medicare beneficiaries had Part D coverage via MA-PDs, while only about 227,000 had stand-alone PDP coverage.

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.

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.

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.