- In 2019, there were 28 Medicare Advantage Plans available in Connecticut.
- 34% of the total Medicare population in Connecticut was enrolled in Medicare Advantage Plans as of 2018.
- In 2018, Original Medicare spent an average of $10,729 per beneficiary in Connecticut, which is 6% higher than the national average.
- Available Medicare Advantage Plans range from 29 to 38 across Connecticut’s eight counties.
Medicare Advantage Plans have different premiums and fee structures for copays and other out-of-pocket expenses. Where you live and the insurance provider determines what plans are available. In Connecticut, you can only choose between Medicare Advantage Plans that are offered in your county. Fortunately, every county in the state has a broad choice of plans so you can select one to suit your health care needs and budget.
Medicare Advantage Plans in Connecticut
Types of Medicare Advantage Plans
There are four main types of plans available through the Connecticut Medicare Advantage program. Each type of plan has different levels of coverage, premiums, and restrictions. At a minimum, each one must offer the same coverage as Original Medicare, although many include prescription drug coverage and various other benefits.
Health Maintenance Organizations (HMO)
HMOs are typically the least expensive type of Medicare Advantage Plan available. However, these plans also have more restrictions. You must use the HMO’s in-network health care providers and choose a primary care physician. You also need to get a referral from your PCP to see a specialist. Many Medicare Advantage HMO plans include extra benefits, such as vision and dental coverage, hearing care and fitness programs. Some HMO plans also provide prescription drug coverage, while others require you to pay the premium for Medicare Part B.
Preferred Provider Organizations (PPO)
Medicare Advantage PPOs give you greater flexibility about your health care choices compared to HMOs. You won’t need to choose a primary care physician or obtain a referral from your PCP to see a specialist. You can use the Medicare Advantage PPO’s in-network providers to save money on your health care costs. You can see out-of-network providers when you want, although you may pay higher fees to do so. Many PPO plans offer prescription drug coverage and most offer benefits similar to HMO plans.
Private Fee-For-Service Plans (PFFS)
With a PFFS, the insurance company decides how much it pays providers for your health care services and how much you will pay. With a PFSS, you don’t need to select a primary care doctor or get a referral if you want to see a specialist. You can use the plan’s in-network providers, but you can visit any health care provider who accepts your plan. However, not every provider may accept the plan’s terms and conditions. Most PFFS plans offer prescription drug coverage.
Special Needs Plans (SNP)
These plans are designed for specific groups with certain conditions in common, such as individuals eligible for Medicare and Medicaid or living in an institutional nursing home setting, or those suffering from AIDS, cancer, or End-Stage Renal Disease (ESRD) or other chronic conditions. Usually, you’re required to use the SNP’s network of providers, choose a primary care physician, and obtain referrals to see specialists. It’s required by law that all SNPs provide prescription drug coverage.
Enrollment and eligibility for Medicare Advantage Plans in Connecticut
To be eligible for a Medicare Advantage Plan, you must be at least 65 years old or have been deemed disabled. You also must be a U.S. citizen or a permanent resident for the past five years. Additionally, you must be enrolled in Original Medicare Part A and Part B, but you can’t be currently enrolled in a Medigap or Medicare Supplemental Insurance plan.
Medicare defines specific periods when you can enroll in a Medicare Advantage Plan:
- Your initial enrollment period lasts for seven months and includes the three months before you turn 65, the month you turn 65, and the three months after your birth month.
- The annual open enrollment period occurs between October 15th and December 7th. During this period, you can switch to a new Medicare Advantage Plan available in your county. You also can switch from Original Medicare to a Medicare Advantage Plan or return to Original Medicare.
- The Medicare Advantage open enrollment period takes place between January 1st and March 31st each year. At any time during this period, you can move between available Medicare Advantage Plans or return to Original Medicare. If you’re not currently enrolled in an MA plan, you can’t sign up. However, if you haven’t done so already, you can sign up for Medicare Part B during this period then choose a Medicare Advantage Plan between April 1st and June 30th. Your coverage will start on July 1st.
Certain life events or circumstances can trigger a special enrollment period when you can make changes to your Medicare Advantage coverage. Such events can include moving, losing your insurance coverage or your eligibility for an SNP, or becoming dually eligible for Medicare and Medicaid.
Prescription drug coverage
Many HMO and PPO plans include prescription drug coverage. If you enroll in an HMO or PPO plan that doesn’t include this coverage, you can’t sign up for a separate Medicare Part D plan. If you sign up for a PFFS plan that doesn’t include prescription drug coverage, you can purchase a Medicare Part D plan without incurring a penalty. All SNPs are legally obligated to provide prescription drug coverage.
Medicare Advantage Resources in Connecticut
Deciding between Original Medicare and Medicare Advantage and comparing Medicare Advantage Plans isn’t an easy task. Fortunately, Connecticut has numerous resources that offer free, unbiased information and counseling to help guide you in choosing the best health insurance option for your budget and needs.
Connecticut Area Agencies on Aging (CAAA)
Connecticut’s five AAA offices work to support senior services throughout the state. The agencies offer numerous programs for older adults and organize senior activities in the communities they serve. Workers offer counseling for seniors about health insurance options, including Original Medicare and Medicare Advantage Plans, and guidance on programs that may help an individual lower their out-of-pocket costs.
Contact Information: Website | 860-424-5055
CHOICES is the State Health Insurance Assistance Program. SHIP agencies provide free, unbiased counseling to seniors and others eligible for Medicare regardless of income level. The program’s trained counselors educate and assist seniors, their families, and caregivers in making informed decisions about their health care options. This includes Original Medicare, Medicare Advantage, Medicare Supplement, and prescription drug coverage.
Contact Information: Website | 800-994-9422
Connecticut Department of Insurance
If you, your family members, or caregivers have questions or a complaint about a Medicare Advantage Plan, Medicare Supplemental Insurance plan or Medicare Part D prescription drug plan, you can talk to an advisor with the Department of Insurance’s Consumer Affairs unit. The department also offers a guide to help you find an approved health insurance plan in the state.
Contact Information: Website | 800-203-3447
Learn More from Our Sources
- HHS.gov | What is Medicare Part C? | Last accessed June 2021
- Medicare | What Part A covers | Last accessed June 2021
- Medicare | What Part B covers | Last accessed June 2021
- Medicare | Part D | Last accessed June 2021
- Medicare | Health Maintenance Organizations (HMO) | Last accessed June 2021
- Medicare | Preferred Provider Organizations (PPO) | Last accessed June 2021
- Medicare | Private Fee-for-Service Plans (PFFS) | Last accessed June 2021
- Medicare | Special Needs Plans (SNP) | Last accessed June 2021
- Medicare | Special Circumstances (Special Enrollment Periods) | Last accessed June 2021