Resources for Connecticut beneficiaries
State Health Insurance Assistance Programs (SHIPs) provide free, in-depth, one-on-one insurance counseling and assistance to Medicare beneficiaries, their families, friends, and caregivers. SHIPs operate in all 50 states.
In Connecticut you can reach SHIP at 1-860-424-5274 or online here.
Snapshot of Medicare in Connecticut
Total Medicare enrollment in Connecticut
In 2015 there were 630,333 Medicare beneficiaries in Connecticut, which is 18 percent of its total population. That compares with 17 percent of the United States population enrolled in Medicare.
The states with the highest percentage of beneficiaries are West Virginia and Maine with about 23 percent each. Those with the lowest percentage are Alaska (11 percent) and Utah (12 percent). In raw numbers, Alaska has the least recipients at 83,863 and California (which has about an eighth of the country’s population within its borders) has the most at 5.6 million (14 percent of its population). This doesn’t count the US Territories, which mostly have low total enrollment in Medicare (Northern Mariana Islands had just 2,075 Medicare enrollees in 2015).
Breakdown of the aged vs. disabled
Individuals who qualify by virtue of their age alone make up 87 percent of Connecticut Medicare recipients. The balance — 13 percent — are on Medicare as the result of a disability. Kentucky has the highest percent of Medicare recipients listed as disabled (25 percent), followed by Alabama, Mississippi, West Virginia and Arkansas. Hawaii has the smallest percentage at 10 percent, followed by New Jersey, and North and South Dakota at 13 percent each.
Medicare spending per recipient
As of 2014, Medicare spent about $9,151 annually per enrollee in Connecticut. That’s according to a standardized spending report from CMS, which eliminates spending differences that stem from strictly geographic differences in costs (eg, higher labor costs or overhead expenses in higher cost-of-living areas). The report only considers spending in Original Medicare, as opposed to Medicare Advantage.
Medicare spending overall
Total Medicare spending in Connecticut in 2009 was $6.19 billion. With the largest and smallest numbers of recipients, itʼs no surprise that California accounted for $50.6 billion of overall Medicare spending while Medicare spending in Alaska was only $553 million. Total Medicare spending for all states and the District of Columbia was $471 billion in 2009 (latest available data).
Medigap in Connecticut
Medigap is the only form of private insurance for Medicare beneficiaries that lacks a federally-mandated annual open enrollment period. Medigap coverage is guaranteed issue nationwide only during a six month window when beneficiaries first turn 65 and enroll in Original Medicare. During that time, enrollees can select any Medigap plan available in their area, with no medical underwriting.
But after that six month window ends, enrollees often find themselves locked into the plan they initially selected – regardless of how the premium changes – because in most states, switching to another plan can be unaffordable – or impossible – due to medical underwriting (federal guidelines allow for guaranteed issue plan changes triggered by seven limited circumstances, but there is no general annual open enrollment window for Medigap the way there is for Medicare Advantage and Medicare Part D).
In response to the lack of a nationwide annual open enrollment period for Medigap, some states have implemented legislation that makes it easier for seniors to switch from one Medigap plan to another. Connecticut is one of them, with among the strongest consumer protections in the nation. Medigap coverage is guaranteed issue year-round in Connecticut for seniors and three plans are guaranteed issue for younger Medicare beneficiaries who are disabled. Medigap carriers can impose a six month pre-existing condition waiting period for enrollees who were not previously insured, but coverage is guaranteed issue and community rated, which means all current enrollees pay the same premium, regardless of age.
Medicare Advantage in Connecticut
Medicare Advantage offers health benefits for Medicare beneficiaries through private plans instead of through Original — or traditional — Medicare (the federal government’s fee-for-service program). These plans are one option for consumers who desire additional benefits beyond what Original Medicare offers, but are not considered a wise option by some consumers who are concerned that government spends more per enrollee on the private plans than it does on Original Medicare. Some Medicare Advantage plans are available with no premium other than the cost of Part B, but they also have provider networks that are more limited than Original Medicare, and total out-of-pocket costs can be considerably higher than enrollees would pay if they had Original Medicare plus a Part D plan plus Medigap.
In 2015 in Connecticut, 25 percent of all Medicare recipients chose a Medicare Advantage plan. Alabama and Kentucky also have 25 percent of their Medicare beneficiaries enrolled in Medicare Advantage plans. Nationwide, 31 percent of Medicare beneficiaries are enrolled in a Medicare Advantage program.
Minnesota is the only state where more than half (53 percent) of Medicare eligibles enrolled in a Medicare Advantage plan. Alaska, with only 56 Advantage enrollees, is the only state to have zero percent enrolled in Medicare Advantage. Five more states have Medicare Advantage enrollment (as a percentage of the state’s Medicare enrollees) in the single digits: Wyoming with 3 percent, New Hampshire and Vermont with 7 percent, and Delaware and Maryland with 8 percent.
Stand-alone Medicare Prescription Drug plans
Connecticut had 317,693 Medicare beneficiaries – just over half of the state’s total – enrolled in stand-alone prescription drug plans in 2015. The state has 26 plans with premiums ranging from about $18 to $128 per month.
Medicare prescription drug coverage — called Medicare Part D — was the result of legislation passed in 2003 and signed into law by President George W. Bush in 2006. It is a bit of a controversial program because it was an unfunded liability — meaning that the vast majority of costs fell on taxpayers — and the law also barred Medicare from negotiating lower drug prices with drug makers.
But by the end of its first decade, Medicare Part D was providing coverage for almost three quarters of all eligible Medicare beneficiaries, including those who have Part D coverage as part of their Medicare Advantage plan).