If you’re a Medicare beneficiary residing in Connecticut, you may have the option to get your Original Medicare (Part A and Part B) benefits under the Medicare Advantage (Medicare Part C) program. You would then receive your health benefits through a private, Medicare-approved insurance company rather than directly through the federal Medicare program. Plan availability and costs may vary.
How Medicare Advantage works in Connecticut
The Medicare Advantage program offers beneficiaries their Original Medicare, Part A and Part B benefits through a private insurance company that contracts with Medicare. Hospice benefits, however, are provided directly under Medicare Part A. Some Medicare Advantage plans in Connecticut may offer additional benefits, like routine vision, hearing, and dental services, and in some cases even fitness programs for seniors, and many plans offer prescription drug coverage as well.
As a Medicare beneficiary in Connecticut, as in the other states, you might be automatically enrolled in Medicare when you’re eligible for the program. If you’re not automatically enrolled, you can enroll in Original Medicare, Part A and Part B, during your Initial Enrollment Period, which begins three months before you turn 65, includes your birthday month, and ends three months after that month. Failure to sign up for Original Medicare during this seven-month span may result in a late-enrollment penalty for as long as you remain enrolled in Medicare. You may enroll in Original Medicare at a later time, during the General Enrollment Period, which runs from January 1 to March 31 each year, but you might have to pay a penalty fee.
If you enroll in a Medicare Advantage plan in Connecticut and for some reason decide that you need to switch health plans to obtain different coverage, you can make this change during the Annual Election Period, also called the Fall Open Enrollment Period, which runs from October 15 to December 7. Your new coverage then goes into effect on January 1 of the following year.
If you go through certain life-changing events, like losing your current coverage, qualifying for other coverage, experiencing changes in your current plan that affect your health benefits, or moving to a new address where your old plan may not be available, you may be allowed to switch Medicare Advantage plans in Connecticut during a Special Election Period. These periods vary according to your health plan and the reason you want to switch plans.
You are also able to leave Medicare Advantage and switch back to Original Medicare, Part A and Part B, during the Medicare Advantage Open Enrollment Period, which runs from January 1 to March 31 each year in Connecticut and the rest of the United States. During this period, you also can enroll in a stand-alone Part D Prescription Drug Plan to go alongside your Original Medicare.
Types of Medicare Advantage plans in Connecticut
To make an informed decision when selecting a Medicare Advantage plan, you may want to review the Medicare Advantage plans available in Connecticut. Here’s a look at the main types of existing health plans:
- Health Maintenance Organizations (HMOs): Under an HMO, you’re usually required to visit doctors, health-care providers, and hospitals included in your plan’s network. You may also have to get a referral from your primary doctor to receive coverage for a number of health services.
- HMO Point-of-Service (HMO-POS): More flexible than an HMO, an HMO-POS plan sometimes lets you go out-of-network for certain health services, but usually at a higher cost.
- Preferred Provider Organization (PPO)*: A PPO offers even more flexibility than an HMO-POS plan, letting beneficiaries choose doctors, health-care providers, and hospitals outside of the plan’s network, but generally at a higher cost.
- Private Fee-for-Service (PFFS): This Medicare Advantage plan reserves the right to decide how much it will pay for your doctor, health-care provider, and hospital visits. A PFFS plan also determines your share of each expense.
- Medical Savings Account (MSA): An MSA plan combines a high deductible with a savings account that beneficiaries use to pay for their health-care expenses.
- Special Needs Plan (SNP): A Medicare SNP limits enrollment to people with special health needs, those living in institutions, and people who qualify for both Medicare and Medicaid. SNPs offer coverage tailored to suit those specific needs. There are Medicare SNPs for patients with HIV/AIDS, chronic heart failure, and dementia, among others.
- Medicare Advantage Prescription Drug (MAPD) plan: An MAPD plan combines health and prescription drug coverage (also available under stand-alone Medicare Part D Prescription Drug Plans) into a single insurance plan.
Comparing Medicare Advantage plans available in Connecticut
As a Medicare beneficiary in Connecticut, it may be a smart idea for you to compare all available options when selecting a Medicare Advantage plan.
The availability and cost of Medicare Advantage plans generally varies depending on your state and county of residence. It’s common for premiums of a Medicare Advantage plan with similar coverage and benefits to vary between different counties within the state of Connecticut. You may find that some Medicare Advantage plans in Connecticut offer premiums as low as $0, but always keep in mind that you must continue paying your Medicare Part B premiums, no matter which Medicare Advantage plan you choose, in order to keep your Medicare insurance coverage.
Some Medicare Advantage plans may offer additional benefits beyond what is included in Original Medicare, Part A and Part B, so you may want to take these benefits into account, as well as whether or not you want prescription drug coverage with your Medicare Advantage policy through a Medicare Advantage Prescription Drug plan. With all these options available in Connecticut, you can see why it can be a good idea to compare plans with the benefits and costs that may be suited for your individual health requirements.
To start comparing Medicare Advantage plans in Connecticut today, enter your zip code above for a customized list of plans available in your area. You can also enter your prescription drug needs to further customize your search and cost estimates.
Access the following resources in order to get more information about Medicare insurance plans in Connecticut:
- Medicare in Connecticut
- Medicare Part D in Connecticut
- Medicare Supplement plans (Medigap) in Connecticut
*Out-of-network/non-contracted providers are under no obligation to treat Preferred Provider Organization (PPO) plan members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.