Medicare Advantage Plans in Connecticut

checkmark Fact checked Contributing expert: Roseann Birch; Reviewed by: Leron Moore - Published: February 24, 2021

 

Seniors looking for health insurance options may want to consider Medicare Advantage plans in Connecticut. Also known as Medicare Part C, Medicare Advantage extends the coverage of Original Medicare. It adds more flexibility than what Parts A and B, hospital and medical, respectively, encompass. Beneficiaries have the opportunity to include hearing, dental, vision, and prescription drug resources in their plans. Rather than the federal government managing the plans, these health plans are supervised by Medicare-approved private insurance companies. Each policy is individually priced according to the specific coverages.

Key Points

  • 1 In 2019, there were 28 Medicare Advantage plans available in Connecticut.
  • 2 34% of the total Medicare population in Connecticut is enrolled in Medicare Advantage plans as of 2018.
  • 3 In 2018, Original Medicare spent an average of $10,729 per beneficiary in Connecticut, which is 6% higher than the national average.
  • 4 Available Medicare Advantage plans range from 29 to 38 across Connecticut’s eight counties.

Connecticut seniors interested in Medicare Advantage programs can compare each plan’s cost and coverage before committing to a policy. Even though private insurers manage Medicare Advantage plans, beneficiaries enjoy the same protections that govern Original Medicare. The availability of specific plans is determined by the enrollee’s geographic location and the carrier; however, seniors have a wide range of options. Their selections may include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-For-Service, and Special Needs Plans.

Medicare Advantage Plans in Connecticut

Types of Medicare Advantage Plans

Seniors may select from a variety of HMOs, PPOs, PFFSs, and SNPs provided by Connecticut’s Medicare Advantage program, and all managed through private insurance companies. Although each plan has specific coverage stipulations, the private insurers are required to follow Medicare’s guidelines regarding eligibility and enrollment. There are local resources available to help individuals evaluate all that the Original Medicare and Medicare Advantage plans have to offer, so they can choose the coverage that best fits their needs.

Health Maintenance Organizations (HMO)

Because hospitals, physicians, and other healthcare providers within a certain network have a prearranged payment schedule with insurance carriers, HMOs are able to pass on lower premiums and deductibles to their members. With the cost savings comes a more restrictive program than with other types of health insurance. Enrollees are required to select a primary care physician to manage all care, including specialist referrals. The insured must also receive services through approved network providers to ensure coverage. A few exceptions apply for acceptable out-of-network services, such as emergency care and out-of-area dialysis.

Preferred Provider Organizations (PPO)

Like HMOs, PPOs offer a network of providers that have agreed to provide healthcare to members at a predetermined rate. Unlike HMOs, however, PPOs do not require its beneficiaries to choose a primary care physician, and they do not need a referral to see a specialist. Individuals also have the flexibility of receiving care through providers that are in- or out-of-network, although there is a cost-saving with choosing an in-network provider. Seniors who want prescription coverage should choose a Medicare Advantage PPO plan that includes it. Trying to add Medicare Part D will result in being dropped from Medicare Advantage and automatically enrolled in Original Medicare.

Private Fee-For-Service (PFFS)

PFFS plans establish how much they will pay healthcare providers and how much their members are required to pay. It’s not necessary to choose a primary care physician or seek referrals for specialists. Not all plans specify a particular network of healthcare professionals; however, when individuals opt for a network, they receive lower rates by staying in-network for services. While many PFFS plans offer prescription drug coverage, not all do. Enrollees may also choose to receive Medicare Part D coverage if their plan doesn’t include a prescription drug option.

Special Needs Plans (SNP)

Although SNPs are the most limiting concerning who they cover, they also tailor their plans to meet individuals’ specific needs. The beneficiaries of SNPs may have chronic health conditions, such as HIV/AIDS, heart failure, dementia, or End Stage Renal Disease (ESRD). Other eligible individuals include those living in nursing homes as well as enrollees eligible for both Medicare and Medicaid. SNPs are required to provide prescription drug coverage. Members are expected to choose a primary care physician, and they must receive care within the network to qualify for full coverage. There are a few exceptions for acceptable out-of-network healthcare, including emergency medical attention and out-of-area dialysis. Premiums are higher for SNPs than other Medicare Advantage options, and they are limited by geographical locations. However, SNPs provide coverage for individuals with unique situations. 

Enrollment & Eligibility for Medicare Advantage Plans in Connecticut

Eligibility

Seniors and select others can apply for Connecticut’s Medicare Advantage plans if they meet the following eligibility requirements:

  • Seniors who are at least 65 years old and younger individuals with qualifying disabilities
  • Those entitled to receive Medicare Parts A and B
  • Individuals not enrolled in a Medigap plan
  • U.S. citizens as well as permanent residents who can show proof of residence for five consecutive years
  • Those living within a specific service area

If Connecticut seniors have been receiving Social Security or Railroad Retirement benefits prior to their 65th birthday, they are automatically enrolled in Medicare Parts A and B. They have the option of changing plans or enrolling in Medicare Advantage during open enrollment.

Enrollment

Eligible seniors who enroll during Medicare Advantage’s designated times avoid paying penalties. 

  • Those enrolling for the first time during the initial enrollment period are allowed three months prior to their 65th birthday and three months after to choose a plan.
  • The annual Medicare election period, between October 15th and December 7th, is the allocated time frame for current Medicare members to submit their initial enrollment in a Medicare Advantage program and for current Medicare Advantage beneficiaries to change plans.
  • The Medicare Advantage open enrollment period extends from January 1st through March 31st. Individuals currently enrolled in a Medicare Advantage plan have the option of switching plans or returning to Original Medicare during this time.
  • An additional general enrollment period runs from April 1st through June 30th and is restricted to those who want to enroll in a Medicare Advantage plan. They must be currently enrolled in Medicare Part A and completed the registration for Part B during open enrollment.

Prescription Drug Coverage

Medicare Advantage plans in Connecticut offer prescription drug coverage through Medicare-approved private insurance companies. Those Medicare Advantage programs that include a prescription plan are called MA-PDs, and the specifics of each plan dictates its drug coverage. Members are not permitted to purchase a separate Medicare Part D plan if their Medicare Advantage HMO or PPO does not have prescription drug coverage. Individuals who opt to purchase Part D are dropped from Medicare Advantage and enrolled in Original Medicare. PFFS plans may or may not include prescription coverage; however, they do allow beneficiaries to enroll in Medicare Part D. SNPs are required to include a prescription drug plan with their coverage.

Medicare Advantage Resources in Connecticut

Medicare Advantage programs in Connecticut offer seniors and other qualifying individuals the opportunity to receive necessary healthcare. However, applicants may often feel overwhelmed by the mass of information, especially new enrollees. That’s why Connecticut has a variety of free counseling resources to help qualified individuals navigate the system and choose the coverage that best meets their needs. The following agencies offer support:

State Health Insurance Assistance Programs (SHIPs)

SHIPs’ volunteers provide seniors and other eligible Medicare recipients and their families with unbiased assistance with choosing an appropriate Medicare plan. The counselors help clients evaluate all aspects of coverage, including premiums and other out-of-pocket costs. They also compare coverages and eligibility requirements as well as enrollment periods. The assistance program’s counselors have no affiliation with any insurance companies. They’re available to educate and offer advice about the various Medicare plans.  SHIPs’ counselors also assist with organizing records, so they’re better equipped to determine specific needs.

Contact Information: Website | 877-839-2675

The CHOICES Program

CHOICES is a cooperative program that pools the professional resources from Area Agencies on Aging, the State of Connecticut Department on Aging and Disability Services, The Center for Medicare Advocacy Inc. The program is funded through such entities as the Administration on Aging through the Older Americans Act, the U.S. Department of Health and Human Services, and the Administration for Community Living. Like SHIPs, its unbiased staff and volunteers are unaffiliated with any insurance company. In addition to offering individualized attention to seniors and other Medicare-eligible individuals who require assistance with understanding the different coverages and requirements, CHOICES’ counselors also deliver outreach presentations. They provide explanations and enrollment assistance with the various Medicare options, including supplements, prescription drug plans, savings programs, and Medicare Advantage.

Contact Information: Website | 800-537-2549

State of Connecticut Insurance Department

Seniors who have complaints or are concerned about the validity of their proposed Medicare Advantage plan can check with the advisors at the Consumers Affairs Unit of the state’s Insurance Department. Seniors can file a complaint or ask questions online, by mail, or over the phone. The organization also provides updated consumer alerts on healthcare and other types of insurance.

Contact Information: Website | 800-203-3447

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Contributing Expert:

Roseann Birch, Medicare Consultant

With experience in the insurance field since 1986, Roseann Birch is a seasoned Medicare consultant who is passionate in educating and guiding seniors through their Medicare and Medicare Advantage journey.

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Reviewed by:

Leron Moore, Medicare Consultant

With over 10 years of experience in the Medicare industry, Leron Moore has dedicated his career to effecting change, educating, informing, and resolving issues for Medicare patients and their families.