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Medicare in Connecticut: Coverage, Plans, and More

March 9, 2022

Medicare in Connecticut: Coverage, Plans, and More

Medicare enrollment can make it easier to cover many of the costs of healthcare for people who are struggling due to age-related diseases or disabilities, or for others who may suffer serious medical complications and need the assistance provided by the program.

There are over 3.3 million people with a Medicare Advantage plan in Connecticut and approximately 3.9 million people with a Prescription Drug plan. Are you eligible for Medicare? What does the plan actually cover? Understanding Medicare coverage can be a complicated process. Luckily, you do not have to try to figure it out on your own. In this article, we’ll answer some of the most common questions about Medicare in Connecticut.

What Does Medicare Cover in CT?

Connecticut residents have several Medicare options to choose from that may influence exactly what is covered and which providers are likely to accept their coverage. Below is a brief overview of the different parts of Medicare.

Original Medicare

Original Medicare coverage consists of Part A, hospital insurance and Part B, medical insurance. Original Medicare covers basic medical services, including:

  • Hospital stays
  • Physician visits
  • Home healthcare
  • Physical therapy
  • Durable medical equipment

The specific coverage offered by your Original Medicare plan may depend on the specific program you choose. Make sure you take look at your coverage each calendar year to ensure that you understand the latest coverage updates, including various costs and what coverage you may have for things like durable medical equipment or physical therapy if needed.

Part D Coverage

Medicare Part D Coverage is prescription drug coverage. While Part A and Part B coverage are automatic, individuals will need to opt into Part D coverage. Prescription drug coverage can make it easier to manage many of the medication costs associated with managing chronic conditions often associated with aging and should be carefully considered by anyone who is eligible for Medicare for the first time.

Medicare Advantage (Also Called Part C)

Medicare Advantage, or Medicare Part C, is run through private health insurance companies. It may offer extended benefits and advantages, including vision and dental services.

How Old Do You Have to Be to Be on Medicare in Connecticut?

In Connecticut, as in most states, you must be 65 or older to qualify for Medicare. However, Connecticut residents may also qualify for Medicare early if they have received Social Security Disability or if they have a qualifying disabling condition, including end-stage kidney disease or ALS.

Most of the time, if you receive Social Security benefits or Railroad Retirement benefits, you will automatically be enrolled in Medicare, as well. You should receive your documents approximately three months before your 65th birthday. The period around your birthday is known as your initial enrollment period. It begins three months before your birthday and lasts three months after your birthday. During that period, you can enroll in Part A and Part B coverage without penalty. If you miss your initial enrollment period, you can either wait for the next open enrollment or pay a penalty to get coverage until the next open enrollment period.

What is the Best Medicare Plan in CT?

When choosing a Medicare plan in Connecticut, it's important to take your specific insurance needs into consideration: the type of coverage you need, how much you can afford to pay, and more. Make sure you consider questions like: Is there a specific provider, or group of providers, that you'll need your Medicare insurance to cover?

Perhaps you have been working with a particular specialist to manage your condition, and you know that the specific provider you have used has the best understanding of your condition. Unfortunately, that specialist or provider does not accept Medicare patients. Medicare usually negotiates specific rates with the care providers that use it, and some care providers will not accept Medicare-based rates. Medicare Advantage, on the other hand, is negotiated separately, and some care providers who do not accept regular Medicare will accept Medicare Advantage plans.

If you know that you want to use a specific provider, especially one that you will need to see on a regular basis, determine whether there is a Medicare Advantage plan that includes that specific provider.

You should carefully consider where you are likely to pursue medical treatment and make sure the providers that you use the most often are covered by the Medicare plan you choose. If you have multiple providers that you see on a regular basis, especially specialists with whom you have a standing relationship, you may need to do your research ahead of time to make sure you have selected a plan that will cover your medical needs.

Before deciding which insurance plan you want, carefully consider what your medical insurance budget looks like. For most Medicare Part A plans, you can expect to pay a $0 premium. You may also be able to find Medicare Advantage plans that have a $0 premium, depending on what type of coverage you need and what you're looking for.

On the other hand, many Medicare Advantage plans and additional coverage options also include increased premiums. For example, if you opt for Part D coverage for prescription drugs, you may expect to pay a higher premium for those services. You may also want to consider when you're signing up for Medicare. If you sign up once your eligibility window has closed after your 65th birthday, for example, you can expect to pay increased premiums for the rest of the calendar year. On the other hand, during open enrollment, you may be able to find a plan that has lower overall costs.

Contact Us to Learn More About Medicare in Connecticut

Choosing a Medicare plan can be a complicated process, especially if you aren't sure what to look for as you choose your coverage and select the right options for your needs. We're here to help! Contact us today to learn more about the best Connecticut Medicare options for your needs.

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