Medicare, made up of Part A (hospital insurance) and Part B (outpatient insurance), is the government-run healthcare program for seniors. This basic coverage is also called Original Medicare. Original Medicare won’t cover prescription drugs, and it doesn’t limit your out-of-pocket medical expenses.
You can also choose a Medicare Advantage plan, or Medicare Part C. Medicare Advantage (MA) plans in Connecticut are provided by private insurance companies and must provide the same coverage as Original Medicare. Most plans provide coverage for prescription drugs and cap your out-of-pocket expenses.
What You Need to Know
Medicare Advantage plans include the same basic coverage as Original Medicare.
Most MA plans limit your out-of-pocket medical expenses.
You can switch your Medicare Advantage plan each year during one of the open enrollment periods.
What Types of Medicare Advantage Plans Are Available?
Most Medicare Advantage plans in Connecticut work with a network of doctors and healthcare facilities to provide care at lower costs. Different types of plans include:
- Health Maintenance Organization (HMO): You’ll need to pick a primary care physician (PCP). Plan to use an in-network doctor for most of your care. Except in certain emergencies, you’ll likely pay more out-of-pocket if you go to an out-of-network doctor.1
- Preferred Provider Organization (PPO): You won’t need to designate a PCP for this plan. However, you can generally save on the cost of care by visiting an in-network healthcare facility or doctor.
- Special Needs Plans (SNP): These plans are designed for certain health conditions.2
- Chronic Condition SNP (C-SNP): This plan type is available if you’re diagnosed with a chronic condition, such as diabetes or cancer.
- Institutional SNP (I-SNP): This is available if you live in a nursing home or other institution, or if you require in-home nursing care.
- Dual-Eligible SNP (D-SNP): You can join this plan if you qualify for both Medicare and Medicaid.
- Private Fee-for-Service (PFFS): You won’t need to choose a PCP for this plan. The plan provider will decide how much to pay doctors for services. The plan will also decide the amount you’ll pay when you receive care.
- Medicare Medical Savings Accounts (MSA): This plan includes a high-deductible insurance plan and an MSA to help cover out-of-pocket expenses.
With most Medicare Advantage plans, you’ll save money by using in-network providers.
What Are Prescription Drug Options with Medicare Advantage?
Original Medicare doesn’t include prescription drug coverage, or Medicare Part D. Most Medicare Advantage plans in Connecticut do include prescription drug coverage.
Make sure any prescriptions you need are included in your plan’s drug formulary, or list of covered medications, before joining the plan.
How Do You Choose Medicare Advantage Plans?
Carefully consider plan costs and benefits when choosing an MA plan, including:
- Premiums: This is the amount you’ll pay for your plan each month. You’ll probably need to pay the Medicare Part B premium ($148.50 for most people in 2021) in addition to your plan’s premium. You can choose a zero-premium plan. Be aware, however, that you may pay more out-of-pocket in other areas, such as the deductible or coinsurance.
- Other Costs
- Deductible: This is the annual amount you’ll pay out-of-pocket before your plan starts paying for services.
- Coinsurance: The portion you’ll pay for a medical service after you’ve paid your deductible, often as a percentage of the total cost.
- Copay: The fixed price for each medical service.
- Out-of-Pocket Maximum: The yearly limit on the amount you’ll pay out-of-pocket for care.
- Plan Benefits
- Vision: Covers services including eye exams and frames.
- Dental: Covers services such as teeth cleaning and checkups.
- Telehealth: Provides coverage for remote health services, usually including doctor’s visits and phone consultations.
- Additional Perks: Most MA plans include benefits such as reimbursement for gym memberships or transportation services.
In addition to prescription drug benefits, most MA plans also offer vision and dental coverage.
When and How to Enroll in Medicare Advantage?
You can’t join an MA plan in Connecticut until you’ve enrolled in Medicare Part A and B. You can join Original Medicare during your Initial Enrollment Period. This period begins the three months before you turn 65 and ends the three months after you turn 65.
You can still enroll if you miss your Initial Enrollment Period. The General Enrollment Period for Medicare runs from January 1 to March 31 each year. You may have late penalties on your Medicare premiums if you enroll after your Initial Enrollment Period. You can enroll in Medicare over the phone, in person at a local Social Security office or online.
After enrolling in Original Medicare, you can find and join a Medicare Advantage plan. Enrollment periods for MA plans include:
- Initial Enrollment Period: You can join an MA plan when you enroll in Original Medicare.
- Medicare Annual Election Period: Sign up for a Medicare Advantage plan during the yearly open enrollment period from October 15 to December 7.
- Medicare Advantage Open Enrollment Period: Change your current MA plan or switch back to Original Medicare each year from January 1 to March 31.
- Special Enrollment Period: Certain circumstances make you eligible to enroll in an MA plan outside of normal open enrollment periods, including:
- You’re moving outside of your current plan’s service area.
- You receive healthcare coverage from a union or employer.
- You’re going to lose your coverage, including becoming ineligible for Medicaid.
- Your plan is being terminated or leaving Medicare.
- You need an SNP after being diagnosed with a health condition.
How Much Do Medicare Advantage Plans Cost in Connecticut?
Several factors affect how much you’ll pay for a Medicare Advantage plan, such as your location. The average monthly cost of a Medicare Advantage plan in Connecticut is $21.42.3
Plans in Hartford and New Haven, for example, could have a monthly premium between $0 and $241.4 Remember to consider other costs, like your deductible or copays, when comparing plans.
What If You Want to Change Your Medicare Advantage Plan?
The easiest time to change your Medicare Advantage plan in Connecticut is during one of the yearly open enrollment periods. Your old plan is automatically terminated when coverage from your new plan begins.
What Are Alternatives to Medicare Advantage?
You don’t have to choose a Medicare Advantage plan to get insurance coverage through Medicare. Consider your other options, including:
- Original Medicare: You can stick with Medicare Part A and B if this provides the coverage you need.
- Medicare Supplement: Also called Medigap, these policies are private supplemental insurance that help fill the gaps in Original Medicare.
- Medicare Supplement with Part D: Medigap policies don’t include Part D coverage, so you’ll need to purchase a separate prescription drug plan.
What Are Medicare Resources in Connecticut?
- Connecticut’s program for Health insurance assistance, Outreach, Information and referral, Counseling, Eligibility Screening (CHOICES): A free resource offering unbiased counseling on Medicare options.5
- State of Connecticut Insurance Department: This department provides resources to help you understand Medicare.6
- HUSKY Health: Connecticut’s Medicaid program, which is available to certain low-income seniors.7
If a Medicare Advantage plan in Connecticut is the right choice for you, start researching plan options so you’re ready to sign up when you enroll in Medicare.
1. U.S. Government Website for Medicare. “Health Maintenance Organization (HMO).” medicare.gov (accessed December 11, 2020).
2. U.S. Government Website for Medicare. “Special Needs Plans (SNP).” medicare.gov (accessed December 11, 2020).
3. Centers for Medicare & Medicaid Services. “Medicare Advantage Average Monthly Premiums, 2007-2021.” cms.gov (accessed December 11, 2020).
4. U.S. Government Website for Medicare. “Find a 2021 Medicare Plan.” medicare.gov (accessed December 11, 2020).
5. Connecticut State Department of Aging and Disability Services. “CHOICES.” portal.ct.gov (accessed December 11, 2020).
6. State of Connecticut Insurance Department. “Medicare Supplement and Medicare Info.” portal.ct.gov (accessed December 11, 2020).
7. HUSKY Health for Connecticut Children and Adults. “How to Qualify.” portal.ct.gov (accessed December 11, 2020).