Medicare Advantage Plans in Connecticut

Medicare Advantage plans are an alternative to Original Medicare, offered by private insurance companies approved by Medicare. These plans include Part A (hospital) and Part B (medical), and most also include Part D (prescription drug coverage). Many plans offer added benefits like routine dental, vision, hearing, and fitness programs.

Medicare Eligibility

To enroll in a Medicare Advantage plan, you must first sign up for Original Medicare (Parts A and B). Most people become eligible for Medicare enrollment at age 65, but some qualify earlier due to disability or conditions like ALS or ESRD. The key enrollment periods include Initial, General, and Special Enrollment. Missing deadlines could lead to penalties or premium charges if you’re not eligible for free coverage.

What Types of Medicare Advantage Plans Are Available in Connecticut?

Connecticut offers the following MA plan types:

• Health Maintenance Organizations (HMOs): Require you to use in-network providers and obtain referrals for specialists.
• Preferred Provider Organizations (PPOs): Offer more flexibility with out-of-network providers at higher costs and typically don’t require referrals.
• Private Fee-for-Service (PFFS) Plans: Allow any provider who accepts the plan’s terms; some plans have networks.
• Special Needs Plans (SNPs):
  • C-SNPs: For chronic conditions like diabetes, heart disease, or cancer.
  • I-SNPs: For those living in institutions or requiring nursing care.
  • Dual Eligible Special Needs Plans (D-SNPs): For individuals eligible for both Medicare and Medicaid. These plans may offer drug coverage, dental, and care coordination—often at no cost.
• Medical Savings Accounts (MSAs): Combine a high-deductible MA plan with a medical savings account funded by the insurer.

What Are Your Prescription Drug Options with Medicare Advantage?

Most MA plans in Connecticut include Part D drug coverage. However, MSAs and some PFFS plans do not. If your plan lacks drug coverage, you may:

• Enroll in a separate Part D plan (allowed for some MA plans).
• Be subject to a late enrollment penalty if you go without creditable coverage.

How Do You Choose a Medicare Advantage Plan?

Before enrolling, understand the Medicare Advantage costs:

• Premiums: Some plans offer $0 premiums; others have monthly fees.
• Deductibles, Coinsurance & Copays: Out-of-pocket costs vary by plan.
• Out-of-Pocket Maximums: These protect you from catastrophic costs.
• Extra Benefits: Dental, vision, hearing, telehealth, fitness memberships, and even OTC allowances may be included.

When and How Do You Enroll in a Medicare Advantage Plan?

You can enroll in Medicare during these specific enrollment periods:

• Initial Enrollment: 3 months before to 3 months after your 65th birthday.
• Annual Open Enrollment (Oct 15–Dec 7): Switch, drop, or join MA plans.
• General Enrollment (Jan 1–Mar 31): If you missed enrolling in Part B.
• Medicare Advantage Open Enrollment (Jan 1–Mar 31): Switch MA plans or return to Original Medicare.
• Special Enrollment Periods: For events such as:
  • Moving outside your plan’s area
  • Losing employer or union coverage
  • Plan termination
  • New qualifying medical conditions

What If You Want to Change Your Medicare Advantage Plan?

You can switch plans during:

• Open Enrollment (Oct 15–Dec 7)
• Medicare Advantage Open Enrollment (Jan 1–Mar 31)

Your current coverage ends when the new plan starts.

Understanding Medicare Advantage Star Ratings

The CMS star ratings system is how the Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage (MA) plans using a 5-star quality scale. These ratings help consumers compare the performance of different plans based on a standardized set of measures.

CMS Star Ratings Overview

• 1 star: Poor performance
• 2 stars: Below average
• 3 stars: Average
• 4 stars: Above average
• 5 stars: Excellent

These ratings are updated annually and reflect data collected from Medicare Advantage (Part C) and Medicare Advantage Prescription Drug Plans (Part D).

What Are Medicare Resources in Connecticut?

Connecticut offers several helpful programs:

• CHOICES Program: Offers free Medicare counseling on coverage and plan options.
• Connecticut SMP Program: Helps Medicare beneficiaries detect and prevent healthcare fraud.
• Connecticut Insurance Department: Handles Medicare complaints.
• HUSKY Health: Connecticut’s Medicaid program. Visit ct.gov/husky or call 1-877-284-8759 for details. Learn more about the differences between Medicare and Medicaid.

Other Medicare Plan Options to Help with Out-of-Pocket Costs

Medicare Supplement Plans, also called Medigap, help cover costs not paid by Original Medicare, such as coinsurance, copays, and deductibles.

• You must be enrolled in Parts A and B.
• The best time to enroll is during the six-month Medigap Open Enrollment Period, which begins when you start Part B.
• After that, insurers may require medical underwriting.
• Medigap doesn’t include drug coverage—you’ll need a separate Part D plan.
• There are 10 standardized plans. The most popular include:
  • Medicare Supplement Plan G: Highest enrollment in 2023
  • Plan N: A fast-growing option
  • Plan F: No longer available to new Medicare enrollees after 2020

Medigap plans offer nationwide coverage, predictable costs, and no referrals.

Learn more about Medicare Supplement plans in Connecticut.

Next Steps

If a Medicare Advantage plan in Connecticut is right for you, compare options in your area. Review premiums, provider networks, extra benefits, and out-of-pocket caps—then be ready to enroll when you’re eligible.