CHOICES – Medicare Counseling

CHOICES – Medicare Counseling

Connecticut’s State Health Insurance Assistance Program (SHIP), called CHOICES in Connecticut, provides free, unbiased, in-depth, one-on-one Medicare counseling to Medicare beneficiaries, their families, and caregivers.

The CHOICES Program certifies volunteers and in-kind professionals who are employed or volunteering at community-based organizations who provide direct contact with Medicare beneficiaries to become Medicare Counselors.  CHOICES Counselors are free from conflict, are not insurance agents and do not gain financially from decisions made by Beneficiaries.  For more information about becoming a certified CHOICES Counselor, please reach out to Laura Crews, Director of Benefits Access at LJCrews@SeniorResourcesEC.Org

CHOICES Counselors will:

  • Provide benefits counseling on all part of Medicare, including Original Medicare (Parts A&B), Medicare Advantage Plans (Part C), Medigap Plans, and Prescription drug plan (Part D)
  • Provide enrollment assistance and plan comparisons for Medicare Part C and D
  • Provide eligibility screenings and application assistance with cost-assistance program to help make Medicare affordable such as HUSKY (Medicaid) and/or the Medicare Savings Program and the Low-Income Subsidy Program
  • Provide virtual and in-person presentations at local community-based organizations.

The following information is basic information on Medicare, and we do encourage you to call and speak with a certified CHOICES Counselor for in-depth Medicare counseling. You may do so by:

CHOICES is a partnership between the state’s five Agencies on Aging and the Center for Medicare Advocacy and is administered by CT’s Department of Aging and Disability Services. 

What is Medicare and who is eligible?

Federal health insurance program for:

  • US Citizens (or permanent residents) aged 65 and older; AND
    • Have worked 40 quarters (10 years full time work) and are eligible to collect Social Security or Railroad retirement benefits; OR
  • Certain younger people with disabilities approved by the Social Security Administration; AND
    • Been collecting Social Security Disability benefits for 24 months; OR
  • People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or transplant)

If you do not have enough working quarters Social Security will screen you to determine if you can collect Medicare benefits from your spouse (or divorced spouse).

What are the parts of Medicare?

  • Medicare Part A – Hospital Insurance – covers inpatient hospital stays, care in skilled nursing facilities, hospice care and some home health care.
  • Medicare Part B – Medical Insurance – covers certain doctors services, outpatient care, medical supplies and preventive services – including some vaccines.
  • Medicare Part D – Prescription drug coverage – helps cover the cost of prescription drugs (including many recommended shots/vaccines)
  • Medicare Part C – Medicare approved plans from private insurance companies that offers an alternative to Original Medicare.  These types of plans are called Medicare Advantage Plans which “bundle” Medicare Parts A/B and many times D.

Where do I enroll in Medicare Parts A&B?

The Social Security Administration is agency who handles enrollment in Medicare Parts A&B and collects premiums for Medicare Part B and for some, Medicare Part A. 

Medicare has various enrollment periods; however, for individuals who are collecting Social Security monthly benefits will be automatically enrolled in Medicare Parts A&B three months prior to the effective date.  If you are not receiving Social Security benefits, it is your responsibility to enroll in Medicare during your initial enrollment period, which begins three months before your 65th birthday month and ends three months after your birthday months. 

Please visit: to apply for Medicare benefits only.

Please see the section Enrollment Periods for more information.

Your Medicare Options:

Disclaimer: If you are a retiree and as part of your retirement package, you have health insurance benefits, consult your retirement division before you choose options.  Please see Retirement Insurance section for more information. 

To get started, download a copy of the Medicare and You 2024 handbook:

When you first sign up for Medicare (and during certain times of the year) you can choose how to get your Medicare coverage.  There are two ways to receive Medicare; however, either way you receive Medicare, you must have both Medicare Parts A&B.

Original Medicare  Medicare Advantage Plan (Part C)  
Medicare Part A – Hospital insurance Medicare Part B – Medical insuranceMedicare Part A or B does not cover services routine services for dental/vision/hearing. Add by purchasing a Medicare Part D plan – for prescriptions.Add a Medigap Plan (for additional purchase) to help pay for some of your Part A&B deductibles, copays and coinsurances.  Bundles your Medicare Part A & B and usually Part DMany cases you must use healthcare providers that are in-network.May need to get prior approval for some services.Plan may offer extra benefits that original Medicare does not cover, such as dental/vision/hearing services
Original Medicare CostsMedicare Advantage Plan costs
Medicare Part A is premium free for most.Medicare Part A has a per benefit deductible and per day copays for some inpatient hospital days and skilled nursing facility days.*Medicare Part B – base premium which can change each January 1st and may be more if you are a higher earner (IRMMA).  Medicare Part B – per calendar deductible, then 80% coverage for most services**Medigap Plans – monthly premium depends on the type of standardized plan you choose to purchase Medicare Part D – plans range in premiums and premiums may be subjected to IRMMA, may have a calendar year deductible, plus copays/coinsurance for covered drugsMust be enrolled in both Medicare Parts A & B and pay the monthly Medicare Part B premium. Some plans do not have an additional health plan or drug plan premium; some plans do.Some plans may have a premium for added benefits such as dental/vision/hearing.May have lower out of pocket costs than Original Medicare.
*For more information about IRMMA – Income Related Monthly Medicare Adjustment, visit: **For most recent Medigap Rate sheet, please visit the Department of Aging and Disability Services website at: CHOICES Connecticuts program for Health insurance assistance Outreach Information and referral Couns  

Enrollment Periods

It is very important to understand your Medicare enrollment dates to avoid enrollment premium penalties (for some, lifetime late enrollment penalties) and to avoid lack of insurance coverage.

Initial Enrollment Period

If collecting Social Security Benefits, you will be automatically enrolled in Medicare Parts A&B three months prior to your 65th birthday month.  It will be your responsibility to decide if you need to keep Medicare Part A and/or B due to active employer group health plan, and also to decide how you want to receive Medicare.  If you are not collecting Social Security and you must enroll in both Medicare Parts A&B, you may do so during the Initial Enrollment Period (IEP).  The IEP begins three months before your 65th birthday month, the month of your 65th birthday and the three months following your 65th birthday.  The IEP is also used for you to enroll in a Medicare Part C or D plan.  Use this time wisely to determine if you need to enroll in Medicare.  Being employed with an Employer Group Health Plan (EGHP) based on your active work status or your spouse’s work status.  Employer size is a factor, and in addition if you are contributing to a Health Savings Account.  Please consult with a CHOICES Counselor regarding the IEP.

Special Enrollment Period for Medicare Part B after Employment ends

You might have delayed Medicare Part B, even possibly Medicare Part A due to an active Employer Group Health Plan (EGHP).  During the Special Enrollment Period (SEP), you have eight (8) months to enroll in Medicare Part B penalty free.  There are forms to be completed in which you will need to provide the Social Security Administration. Please note, you cannot go 63 days without a Medicare Prescription drug plan (Part D).  If you do not select a drug plan (whether through a Medicare Advantage Plan or through a standalone Part D Plan) you may be assessed a permanent late enrollment Part D penalty.  Please consult with a CHOICES Counselor regarding the SEP.

General Enrollment Period

If you missed your opportunity to enroll in Medicare Part B during your IEP or SEP, you are limited to enrolling into Medicare Part B during the General Enrollment Period (GEP).  This period begins January 1st and ends March 31st.  Your medical coverage will begin the following month after your application to Social Security.  In addition, you may face a permanent late enrollment premium penalty.  In addition, if you do not enroll in a Part D plan when first eligible, you may enroll in a Part D plan (whether through a Medicare Advantage Plan or standalone Part D Plan) between April 1st through June 30th.  Coverage will begin on the first of the following month of enrollment, late enrollment penalties may apply.  Please consult with a CHOICES Counselor regarding the GEP.

Annual Enrollment Period

The Annual Enrollment Period (AEP) is for those who are already enrolled in Medicare and have or do not have a drug plan or advantage plan.  Each year Medicare provides the AEP for you to review your current plan and decide if it is still a good choice for you next year.  The AEP begins October 15th and ends December 7th.  If you choose to make a new plan selection, your new plan will begin January 1st.  During this time, you can:

  • Enroll in a Part D plan for the first time (penalties may apply)
  • Switch from one Part D plan to another Part D plan
  • Switch from Part D plan to a Medicare Advantage Plan
  • Switch from a Medicare Advantage Plan to another Medicare Advantage Plan
  • Switch from Medicare Advantage Plan to Original Medicare and choose a Part D plan.
  • Drop drug coverage all together (not recommended)

CHOICES counselors use the website to review your prescriptions and provide counseling regarding the plans available.  CHOICES uses the website to facilitate the enrollment into the new plan.  Beneficiaries are able to use this website too, to manage your Medicare coverage.  Please consult with a CHOICES Counselor regarding the AEP.

Medicare Advantage Plan Open Enrollment Period

The Medicare Advantage Plan Open Enrollment Period (MAOEP) begins January 1st and ends March 31st.  To use the MAOEP, you must already be enrolled in a Medicare Advantage Plan.  During this time, you can make one plan change.  You can:

  • Switch from a Medicare Advantage Plan to another Medicare Advantage Plan; or
  • Switch from a Medicare Advantage Plan to Original Medicare by enrolling in a Medicare Part D plan.

This MAOEP is very limited to what you can do.  Please consult with a CHOICES Counselor to review the MAOEP. 

Medicare Savings Program (MSP)

You may qualify for premium assistance and possible Medicare Part A&B cost-share assistance.  The Medicare Savings Program (MSP) is administered by the State of Connecticut Department of Social Services (DSS).  MSP eligibility is based on gross income from you and your spouse.  DSS does not look at assets, only income.  MSP pays your monthly Medicare Part B premium.  MSP also allows you to obtain Medicare Part B benefits outside of the normal enrollment periods, and, in some cases, pay for Medicare Part A when you do not qualify for premium free Part A. 

There are three levels of MSP and are all based on income. Income levels change each March.   All three levels will eliminate the Medicare Part B penalty if you are paying one. 

Low Income Subsidy Program (LIS)

 All three levels will automatically enroll you in the Low-Income Subsidy Program (LIS).  LIS is a federal program that pays up to a certain amount for your Medicare Part D plan; or if you have your drug benefits through a Medicare Advantage Plan that has a premium for your drug coverage.  In addition, LIS will lower you out of pocket costs for covered prescriptions and will pay the drug deductible.  LIS will eliminate the late enrollment premium penalty if you are paying one. 

Please consult with a CHOICES Counselor to discuss MSP and LIS.