On this page, we're asking about whether the people in your household are on Medicare

You may want to have their Medicare card to answer these questions.

Enter the effective date printed on your Medicare card.

Medicare Claim Number/Medicare Beneficiary Identifier

Enter your Medicare Claim Number/Medicare Beneficiary Identifier. This can be found on the front of your Medicare card. If you don't have your Medicare Card with you, leave these fields empty.


To close this window and return to ConneCT without saving, click the CANCEL & EXIT button.


To save your application and return to ConneCT, click the SAVE & EXIT button.