Medicare is the National Health Insurance Program for:
- Individuals 65 years of age and older
- Individuals under the age of 65 with certain disabilities
- People of any age with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant)
The Medicare Program is comprised of four parts.
Medicare Part A (Hospital Insurance)
- Covers inpatient care in hospitals
- Covers skilled nursing facility, hospice and home healthcare for a limited time period
- Generally, the Part A is *premium free; individuals throughout their work history paid into Medicare and you are eligible to enroll at age 65. Hospital coverage is not covered 100% *for more about premiums, please see the section entitled “Medicare Premiums and cost shares for A and B”
Medicare Part B (Medical Insurance)
- Covers doctors services, outpatient hospital care, and some home health care
- Covers some preventive services
- Durable Medical Equipment
- Individuals must choose to elect Part B, you are not automatically enrolled. There is a monthly *premium for Part B. Generally, medical coverage is not covered 100%. If you choose not to enroll in Medicare Part B when you are first eligible then decide at a later time to enroll, you might be assessed life-long penalties. *for more about premiums, please see the section entitled “Medicare Premiums and cost shares for A and B”
Medicare Part C (Medicare Advantage Plans)
- Plans are administered by Medicare-approved private insurance companies
- Includes Part A and B benefits and sometimes D (prescription drugs) benefits, sometimes for an extra cost
- Some plans can offer more benefits for an extra cost (for example vision and dental coverage)
- You must still continue to pay your monthly Part B *premium; plans do not cover 100%. *for more about premiums, please see the section entitled “Medicare Premiums and cost shares for C and D”
Medicare Part D (Prescription Drug Plan)
- Prescription Drug plans are available through Medicare approved insurance companies
- Is available to a Medicare beneficiary enrolled in Medicare Part(s) A and/or B.
- Plans have monthly *premiums and cost-shares *for more about premiums, please see the section entitled “Medicare Premiums and cost shares for C and D”
- Individuals with limited income and assets may be eligible for Extra Help through the Social Security Administration.
- Part D is optional; however, if you do not enroll when you are first eligible and later decide to join a plan, you might be assessed life-long late enrollment premium penalties.
Enrolling in Medicare
The Medicare Program is very specific regarding when you can enroll into Medicare Parts A, B, C and/or D. – keep in mind – Social Security is the only agency that enrolls individuals into Medicare Parts A and B. Medicare Parts C and D are self-enrollment procedures.
Types of situations when an individual is automatically enrolled:
- If you are already receiving Social Security benefits or Railroad Retirement Board, your benefits will start the first day of the month you turn 65. (However, if your birthday falls on the 1st day of the month, your benefits will start the 1st of the previous month)
- If you are under 65 and disabled, you will automatically get Part A and B after your receive Social Security benefits for 24 months or certain disability benefits from the Railroad Retirement Board.
- With auto-enrollment, you will receive your red, white and blue Medicare Card along with a “Welcome to Medicare” brochure. This brochure is important. This brochure gives you specific instructions on what you should do now.
Types of situations when an individual is NOT automatically enrolled:
- If you are not receiving Social Security benefits or Railroad Retirement Board, contact the Social Security administration 3 months prior to your 65th birthday to enroll – this is your Initial Enrollment Period (IEP)
- If you have End Stage Renal Disease – you must contact Social Security directly.
| 3 months before you turn 65 | 2 months before you turn 65 | 1 month before you turn 65 | The month you turn 65 | 1 month after you turned 65 | 2 months after you turned 65 | 3 months after you turned 65 |
| Sign up before the month you turn 65 to avoid a delay in coverage! | If you wait, your coverage will be delayed! See chart below |
If you wait until the month you turn 65 or the 3 months after you turn 65 your Medicare Coverage will begin:
| If you enroll in this month of your Initial Enrollment Period | Your coverage starts: |
| The month you turn 65 | 1 month after enrollment |
| 1 month after you turn 65 | 2 months after enrollment |
| 2 months after you turn 65 | 3 months after enrollment |
| 3 months after you turn 65 | 3 months after enrollment |
Enrollment Periods Names and Meanings
Initial Enrollment Period (IEP)
- This is your time to enroll into Medicare A, B, C and/or D!
- This period lasts for seven months. It begins the three months before the month you turn 65, includes the month you turn 65, and ends three months after the month you turn 65.
- By enrolling into Medicare A and B three months prior to your 65th birthday, your coverage will start the 1st day of the month you turn 65.
- If you enroll in the month you turn 65 or the three months after you turn 65, your enrollment date will be delayed.
General Enrollment Period (GEP)
- If you did not sign up for Medicare Parts A and/or B during your initial enrollment period, you can sign up January 1st – March 31st each year
- Your coverage will not start until July 1st.
- You are not able to join a Prescription Drug plan during this time; you will need to wait until the Annual Election Period.
- You may have to pay Part A, B and/or D higher (lifetime) premiums for failure to enroll in your initial enrollment period.
Special Enrollment Period (SEP)
- If you did not sign up for Medicare Part A, B and/or D when you were first eligible because you or your spouse were currentlyemployed and you had a group health plan, you can enroll:
- Anytime you are still covered by the group health plan
- During the eight month period that begins the month after the employment ends or the healthcare coverage ends – whichever comes first!
- You generally are not assessed a lifelong penalty because you had creditable health insurance coverage.
- There are Special Enrollment Periods for Medicare Part C that will allow you to join, switch or drop a Medicare Advantage plan if:
- You move out of your plan’s service area
- You have Medicaid
- You qualify for Extra Help (please see the Section entitled “Extra Help”)
- You live in an institution
- There are Special Enrollment Periods for Medicare Part D that will allow you to join, switch or drop a Medicare Prescription Drug plan if:
- You move out of your plan’s service area
- You lose other creditable prescription drug coverage
- You live in and institution
- You qualify for Extra Help (please see the Section entitled “Extra Help”)
Medicare Part C and D Annual Enrollment Periods (AEP) – Changes take effect the 1st of the year.
October 15th – December 7th is the Medicare Part C and D annual enrollment. Unlike Medicare Part A and B in which you do not need to re-enroll in every year, you may want to make changes to your Medicare Advantage Plans or stand alone prescription Drug plans.
During this time you can:
- Change from Original Medicare (A and B) to a Medicare Advantage Plan
- Change from a Medicare Advantage Plan to original Medicare (A and B)
- Switch from one Advantage Plan to another Advantage Plan
- Join a Medicare Prescription Drug Plan (penalties may apply if you did not sign up during your initial enrollment period)
- Switch from one Prescription drug plan to another Prescription Drug Plan
- Drop your Medicare prescription drug coverage completely (keep in mind, if you drop your drug coverage and do not have any other source of drug coverage, you might incur lifelong penalties should you wish to sign up for a drug plan during the next annual enrollment period)
Medicare Advantage Plan Open Enrollment Period
Must be enrolled in a Medicare Advantage Plan with or without drug coverage as of January 1st to use this period. Between January 1st – March 31st each year, you can make a one time plan change during the Medicare Advantage Open Enrollment Period:
- Switch from one Medicare Advantage Plan to another Medicare Advantage Plan
- Switch from a Medicare Advantage Plan to Original Medicare by selecting a standalone Medicare Part D Prescription Drug Plan.
During this period YOU CANNOT:
- Switch from Original Medicare to a Medicare Advantage Plan
- Join a Prescription Drug plan if you are in Original Medicare
- Switch from one Medicare Prescription Drug plan to another Prescription Drug plan
Medicare Premiums and Cost-share for Parts A and B
The Medicare Program does not offer 100% coverage. There are in many cases deductibles and co-shares that you are responsible for.
Medicare Part A for 2023:
- No monthly premium if you have worked enough quarters
- Per benefit deductible $1,600
- Cost shares for inpatient hospital stay:
- Days 1-60: $0 (Medicare pays in full after the deductible for your room and board)
- Days 61-90 $400 per day
- Days 91-150 $800 per day
- Skilled Nursing Facility Care (after a 3 day qualifying inpatient stay in a hospital)
- Days 1-20 $0 (Medicare pays in full)
- Days 21-100 $200 per day
- Home Health Care
- Medicare pays 100% *must meet certain criteria to receive home health care
Medicare Part B for 2023:
- The standard Part B premium will be $164.90 – the premium will automatically be deducted from your social security benefit. ** Individuals earning over $97,000 per year and couples earning over $194,000 per year will pay higher premiums
- Annual deductible of $226
- Most services covered at 80%; you are responsible for 20%
- Most Preventative Services covered at 100%
Medicare Premiums and Cost-shares for C and D
Medicare Part C for 2023:
- You must continue to pay your monthly Medicare Part B premium (this is not optional)
- Plans range in monthly premiums in addition to your Part B premium
- Some plans you may add vision/dental/hearing coverage for an additional premium
- Most plans have per day copays for inpatient hospital stays as well as per day copays for skilled nursing facility charges. LOOK AT EACH PLAN CLOSELY BEFORE YOU DECIDE.
Medicare Part D for 2023:
- You must have either Medicare A and/or B to enroll in a Prescription Drug Plan.
- Plans range in monthly premiums in addition to your Part B premium
- Deductibles range from $0 – $505 per year
The Medicare Savings Program and Extra Help
Medicare Beneficiaries in Connecticut can get financial assistance with paying Medicare Part A, B and D premiums and cost-shares, by applying to the Medicare Savings Program (MSP) if you have limited income.
The Medicare Savings Program (MSP) will:
- Pay your monthly Medicare Part B premium
- In some cases protect you from your Medicare Part A and B cost-shares
- Automatically enroll you into the Extra Help (LIS)
| Income limits as of March 2023 | |
| If your gross monthly income is at or below these levels…. | You may qualify for this level of MSP: |
| $2,564.00 Single $3,468.00 Couple | QMB – This program will pay your monthly Medicare Part B premium. QMB will also pay all Medicare Part A and B deductibles and cost-shares. |
| $2,807.00 Single $3,797.00 Couple | SLMB – This program will pay your monthly Medicare Part B premium. |
| $2,989.00 Single $4,043.00 Couple | ALMB- This program will pay your monthly Medicare Part B premium. This program is subject to available program funding. |
You will automatically be granted Extra Help with your prescription drug plan if you qualify for MSP. Extra Help is a Medicare program to help people with limited income pay Medicare prescription drug costs.
For an informational video, click here.
Extra help will:
- Pay in full or partially pay your monthly Medicare Part D premium
- Protect you from your Medicare Part D yearly deductible
- Protect you from the Coverage Gap (formerly the Donut Hole)
- Lower your copays for covered generic drugs to no more than $4.15 and covered name brand drugs to no more than $10.35 per 30 day supply in 2021.
Traditional Medicare VS. Medicare Advantage Plans (Part C)
It is up to you how you would like to receive your Medicare Benefits. Your Medicare Benefits come in two different ways and you must understand each way in order to make a final decision. Path #1 is Traditional Medicare. This section will provide you information about Medicare, Medicare Supplemental Plans and Medicare Part D. Path #2 will discuss Medicare Advantage Plans. For a quick synopsis, please download our “Know the Paths to Medicare Coverage” here.
Path #1 – Traditional Medicare/Medicare Supplement Policy/Medicare Part D
As you previously ready, Medicare Part A and B does not cover 100%. Here is a recap of what Medicare Part A and B coverage is and what YOUR responsibilities will be:
Medicare Part A Hospital Insurance:
- Per benefit deductible of $1,600
- Days 0-60 – covered 100%
- Days 61-90 – there will be a per day copay of $400
- Days 91-150 – there will be a per day copay of $800
Skilled Nursing Facility Care (must have a 3 day qualifying inpatient stay in the hospital)
- Days 1-20 – covered 100%
- Days 21-100 – there will be a per day copay of $200
- Days 100+ – NO COVERAGE. MEDICARE PAYMENT ENDS. If you or your loved one will need more than 100 days, then other payment arrangements will need to be made.
Home Health-must meet certain requirements to obtain home health care. Please see page 42 of the Medicare & You 2021 Book.
Medicare Part B – Medical Insurance:
- Annual deductible of $226
- Most services are paid at 80%
Medicare Supplemental Insurance Plans (Medigap Plans)
As you can see above, Medicare A and B do not pay 100%. Some individuals find it necessary to purchase additional health insurance in the form of a Supplemental Plan. For a list of the most current monthly rates and plans available in CT, please see the links below to download the most current rate sheet.
Supplemental plans range in premiums and coverage. In Connecticut, plans are standardized and lettered A, B, C, D, F, G, K, L, M and N. By plans being standardized, it makes it easier to compare the plans as a Supplemental Plan G is a Plan G no matter what insurance company you decide to purchase this plan from. Here is an example of a Plan G compared to a Plan N:
| SUPPLEMENTAL PLAN G | |||
| Service | Medicare Pays | Plan Pays | You Pay |
| (Part A) Hospitalization – first 60 days | All but $1,600 | $1,600 | $0 |
| Days 61-90 | All but $400/per day | $400/per day | $0 |
| Days 91- and lifetime reserve days | All but $800/per day | $800/ per day | $0 |
| (Part B) Medical Expenses : Annual Deductible of $198 | $0 | $0 | $226 |
| After annual deductible is met | 80% | 20% | $0 |
| Part B Excess Charge (above Medicare approved amounts) | $0 | 100% | $0 |
| SUPPLEMENTAL PLAN N | |||
| Service | Medicare Pays | Plan Pays | You Pay |
| (Part A) Hospitalization – first 60 days | All but $1,600 | $1,600 | $0 |
| Days 61-90 | All but $400/per day | $400/per day | $0 |
| Days 91- and lifetime reserve days | All but $800/per day | $800/ per day | $0 |
| (Part B) Medical Expenses : Annual Deductible of $198 | $0 | $0 | $203 |
| After annual deductible is met | 80% | Balance, other than up to $20 per office visit and up to $50 for ER visit | $20 per office visit and $50 per ER visit |
| Part B Excess Charges (above Medicare approved amounts) | $0 | $0 | All charges |
You must have Medicare Part A and B in order to select and enroll into a Supplemental Plan. You may enroll into the plan of your choice by calling the phone number listed to the right of the insurance plan on the Rate Sheet.
Supplemental plans DO NOT HAVE NETWORKS, as long as you are seeing a healthcare provider that accepts Medicare it does not matter what supplemental plan you enroll into.
But…….you are not finished yet! You still need to enroll into a Medicare Part D plan.
Medicare Part D – Prescription Drug Coverage
If you do not have creditable coverage through an alternate source (i.e. retiree drug plan, Tricare for Life etc.) you must enroll into a drug plan during your initial enrollment period to avoid penalties.
In 2023, there are 27 plans to choose from and you must choose wisely. All plans range in premiums per month and some plans range in annual deductible from $0 – $505.
Please visit www.Medicare.gov and click on FIND HEALTH AND DRUG PLANS.
CHOICES counselors are available to help assist you with finding the right drug plan to suit your needs and help with plan enrollment. Please call 1-800-994-9422 for assistance.
OR YOU MAY WANT TO ENROLL INTO A MEDICARE ADVANTAGE PLAN (Medicare Part C)
Path #2 – Medicare Advantage Plans
Another alternative way to receive your Medicare benefits is through a Managed Care Plan, for example and HMO or a PPO Plan.
You must enroll into Medicare Part A and B (and continue to pay your monthly Medicare Part B Premium) in order to obtain a Medicare Advantage Plan.
You cannot purchase a Supplemental Plan if you are enrolled in a Medicare Advantage Plan.
A Medicare Advantage Plan replaces your Traditional Medicare coverage. By enrolling into an Advantage Plan, the Advantage Plan becomes your only source of insurance. Most Advantage Plans have the drug benefit added in, so there is NO NEED TO PURCHASE A PART D PLAN. Again if you DO NOT have a creditable drug plan and wish to enroll into Managed Care, you must select a Managed Care plan with drug coverage; otherwise, you may face penalties later on if you decide you now need drug coverage.
Medicare Advantage Plan Premiums:
Remember, you must still pay your monthly Medicare Part B premium in addition to and Medicare Advantage Plan premiums.
Medicare Advantage Plan Cost-share/Co-pays:
By enrolling into an Advantage plan, you must use the healthcare providers that are in the plans network. Some plans offer out-of-network coverage. Each service may have a co-pay/co-insurance due at the time of service.
Medicare Advantage Plans Drug Coverage:
Annual deductibles for prescription drugs range from $0 – $505.
Questions to ask yourself BEFORE you enroll into a Medicare Advantage Plan:
Please see the Medicare Rights Center article here.
This article provides a list of questions that you need to know the answers to BEFORE you enroll into a particular plan.
To learn more about the Medicare Advantage Plans, please visit www.Medicare.gov and click on FIND HEALTH AND DRUG PLANS. Again, Medicare offers a video to guide you through the plan finder tool.