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Medicare

Medicare is the national health insurance program for older adults and people with disabilities. It covers many basic health services including, but not limited to: inpatient hospital services, physician services, some home health care, prescription drugs, durable medical equipment and hospice. The program serves people aged 65 or older, individuals with disabilities under age 65, and people of any age with End-Stage Renal Disease (ESRD).

The Centers for Medicare & Medicaid Services (CMS) administers the program. Medicare is funded in great part by general revenues, payroll tax revenues, premiums paid by beneficiaries, and taxes on Social Security benefits.

Eligibility Criteria

Medicare covers individuals aged 65 years or older or permanently disabled, regardless of income, medical history, or health status who meet one of the following criteria:

  • Entitled to Social Security retirement insurance and are 65 years of age or older
  • Entitled to Social Security Disability Insurance (SSDI) for not less than 24 months
  • Entitled to Railroad Retirement benefits or Railroad Retirement disability benefits
  • Diagnosed with End Stage Renal Disease (ESRD)
  • Diagnosed with Lou Gehrig's disease (ALS)
  • A federal, state or local government employee who is not eligible for Social Security retirement or disability benefits, but has worked and paid the Medicare Part A "hospital insurance" portion of their FICA taxes for a sufficient period of time. (Federal employees became subject to the hospital insurance portion of FICA in January 1983. Most newly hired state and local employees, not otherwise covered under Social Security, started paying the hospital insurance portion as of April 1986).

Note: Individuals who are not otherwise eligible for Medicare, but who are aged 65 years or older may purchase Medicare coverage by paying a monthly premium.

Learn More: Use this tool to determine your eligibility for Medicare.

Types of services and supports that can be used for Medicare

There are four parts to your Medicare benefits:

  • PART A: Also known as "Original Medicare" covers inpatient hospital care, some home health and hospice care.
  • PART B: Also known as "Original Medicare" covers physician services, outpatient and preventive care, some home health care, durable medical equipment and ambulance services.
  • PART C: Also known as “Medicare Advantage” (MA). Beneficiaries may choose to enroll in a private MA plan, rather than traditional Medicare, to receive Medicare-covered Part A and Part B benefits and often Part D benefits as well. MA plan cost and availability may vary by county. MA plans have a network of providers to receive care.
  • PART D: Prescription Drug Coverage is an optional benefit when added to Original Medicare (Part A & B) or you can receive it as part of your Medicare Advance Plan (Part C).

Medicare beneficiaries will receive a red, white and blue Medicare card in the mail to be used when hospital, medical or other health services are needed. Medicare cards show which program(s) members enrolled in and when coverage begins. The card will have a Medicare Number unique to the holder which should only be given to health care providers and trusted individuals.

Apply

Medicare can be a complex program to understand. Visit Medicare.gov or call 1-800-Medicare (1-800-633-4227) to learn more.

Individuals can also use Connecticut’s Health Insurance Assistance, Outreach, Information and referral, Counseling, Eligibility Screening (CHOICES). CHOICES helps people understand Medicare coverage and healthcare options. To receive health insurance unbiased, free counseling, application assistance, and educational resources, call CHOICES at 1-800-994-992 or find a counselor near you.

Finally, for in-depth information about eligibility, services covered, your rights and how to enroll, go to the Center for Medicare Advocacy website.

If you are not enrolled automatically, you can contact the Social Security Administration online, in person or by phone to join. Call 1-800-Medicare (1-800-633-4227), or find an office near you.

It is important to note that Medicare beneficiaries do not need to sign up for coverage each year. However, plans and coverage should be reviewed annually as there could be changes to coverage.

Medicare Supplement Insurance

Medicare beneficiaries can also enroll in Medicare Supplement Insurance, also called Medigap, which fills in the gaps not covered by Original Medicare. Medigap is offered by private, approved insurance companies. These plans pay for costs such as coinsurance, co-payments, and deductibles.

In Connecticut, Medigap cannot be used as a stand-alone plan and is designed to use in combination with Original Medicare (Parts A and B). It helps fill in the gaps of Original Medicare such as premiums, coinsurance, co-payments, and deductibles, which are generally private pay, out-of-pocket expenses. The State offers up to 10 standardized policy options, each labeled with a letter. All plans of the same letter offer the same benefits, no matter which insurance company offers the plan.

Visit the Connecticut Insurance Department for the names, rates and contact information for Medigap insurers.

Connecticut's Medicare Savings Program

Financial assistance is available to eligible Medicare enrollees through the State’s Medicare Savings Program, funded by Medicaid. The Department of Social Services will pay qualifying applicants’ Part B monthly premiums. Some programs may offer additional financial assistance for deductibles and coinsurance.

Go here for more information or to apply for the Medicare Savings Program. The W-1QMB form can also be downloaded and completed to apply.


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