Medicare plans vary depending on the state you live in; for example, someone on a Medicare plan in California will have different options and coverages than someone on a Medicare plan in Connecticut. This is because each state has different programs separate from the federal Medicare program.
Medicare Advantage, otherwise known as Part C, is a type of Medicare plan offered by private insurance companies. In this post, we’ll discuss the different Medicare Advantage Plans offered in the state of Connecticut.
What’s Medicare?
Medicare is the federally funded health insurance program for people 65 years or older, some younger people with disabilities, and people with End-Stage Renal Disease (ESRD). Medicare offers numerous plans, each with different coverage.
Plan A: This is the most basic plan and covers inpatient hospital care, skilled nursing facility, hospice, and home health care.
Plan B: Also known as medical insurance, this plan helps cover doctor visits, preventive services, outpatient care, durable medical equipment, and more.
Plan C: Private insurance companies offer Medicare Advantage plans and must cover everything that Original Medicare (Parts A and B) covers. These plans can offer extra coverage, such as routine dental, vision, and prescription drug benefits.
Plan D: Also known as prescription drug coverage, this plan helps cover the cost of outpatient prescription drugs.
What Are Medicare Advantage Plans?
Medicare Advantage Plans are an alternative to Original Medicare. They’re offered by private insurance companies that have a contract with Medicare. You must have Medicare Part A and Part B to join a Medicare Advantage Plan.
These plans provide all or some benefits available through standard (Parts A & B) without adding to your existing plan costs. You can enroll in an Advantage plan at any time. Your coverage begins on the first day of the month following your enrollment. You may not be required to change plans during the annual Open Enrollment Period unless you wish to use your Original Medicare benefits for other coverage.
Difference between a Medicare Advantage Plan and Original Medicare?
When researching whether Medicare Advantage is the right fit for you, you may have received a lot of information about Original Medicare. Understanding the similarities and differences between the two is important before deciding on your coverage.
Let’s take a close look at the main differences between the two:
Cost: Medicare Advantage plans typically have lower out-of-pocket costs than Original Medicare. This is because they often include prescription drug coverage and routine dental and vision care.
Coverage: Medicare Advantage plans must cover all the same services as Original Medicare, but they can also provide additional coverage, like home health care or wellness programs.
Network of providers: Medicare Advantage plans usually have a network of doctors, hospitals, and other health care providers that you must use for your care. Original Medicare does not have a network, so you can see any doctor or hospital that accepts Medicare.
If you’re still trying to decide which type of Medicare coverage is right for you, contact a Medicare Advantage plan agent directly to get more information.
Medicare Advantage Plan Types
There are four different types of Medicare Advantage Plans: Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for-Service Plans (PFFSs), and Special Needs Plans (SNPs).
Each type of plan has its unique set of rules and regulations, making it hard to understand which one is right for you. However, with a little research and guidance, you can make an informed decision about the type of plan that best suits your needs. Let’s take a closer look at each one:
HMO Plans
Health Maintenance Organization plans to require you to receive care from in-network doctors, other health care providers, and hospitals. Unless you have a life-threatening condition or an emergency, you will likely need a referral from your primary care doctor to see a specialist.
PPO Plans
Preferred Provider Organization plans allow you to receive care from any Medicare-approved doctor or health care provider, but you will usually pay less if you use in-network providers. You do not need a referral to see a specialist.
PFFS Plans
Private Fee-for-Service plans let you go to any Medicare-approved doctor or health care provider that accepts the plan’s terms and conditions. You do not need a referral to see a specialist.
SNP Plans
Special Needs Plans are designed for people with specific diseases or characteristics, such as diabetes, chronic heart failure, or Alzheimer’s.
How Many Advantage Plans Are Available In The State Of Connecticut?
As of 2022, 57 Medicare Advantage Plans are available to Connecticut residents– An increase from 2021 when there were only 47 plans available in the state.
How Do You Decide Which Plan Is Best For You?
When selecting a plan for yourself, it’s important to understand everything that is and isn’t covered by the plan. For example, some plans may cover dental and vision care, while others do not. In addition, you’ll want to make sure that the doctors and hospitals you wish to use are included in the plan’s network.
Consider The Cost
You should also consider how much you are willing to pay for your coverage. Some plans have low monthly premiums, while others have higher premiums but offer more comprehensive coverage.
Change Your Plan According To Your Needs
Finally, it’s important to remember that you can change your Medicare Advantage Plan each year during the Annual Election Period (AEP), which runs from October 15 – December 7. If you find that your needs have changed or you are unhappy with your current plan, you can switch to a different plan during this time.
What Are The Benefits Of Each Type Of Plan
Each plan type comes with its own set of benefits. Let’s look at each plan again and look at the benefits each plan offers:
HMO Plans
- Lower monthly premiums
- In-network care only
- No referrals needed to see a specialist
- Preventative care is covered
PPO Plans
- Cover out of network providers, but at a higher cost
- No referrals needed to see a specialist
- Preventative care is covered
PFFS Plans
- Can see any Medicare-approved provider that accepts the plan
- No referrals needed to see a specialist
- Preventative care is often covered
SNP Plans
- Designed for people with specific diseases or characteristics
- Allowing people to get the care they need
What Is The Cost Of A Medicare Advantage Plan In Connecticut?
The cost of a Medicare Advantage plan in Connecticut varies depending on your chosen plan. However, the monthly average of Medicare Advantage in Connecticut is $19.95 as of 2022–This is a 1% decrease from $20.15 in 2021.
How Do You Enroll In A Medicare Advantage Plan In Connecticut?
To enroll in Connecticut, you must:
- Be a resident of Connecticut.
- Be enrolled in Medicare Part A and/or Part B.
- Not having End-Stage Renal Disease (ESRD).
If you meet the above criteria, you can enroll in a Medicare Advantage plan during one of the following enrollment periods:
Initial Enrollment Period: When you first become eligible for Medicare.
Annual Enrollment Period: October 15 – December 7 each year.
Special Enrollment Period: If you have a change in your health coverage or other life events that qualifies you for a Special Enrollment Period.
To enroll in a Medicare Advantage plan, you can:
- Visit the plan’s website.
- Call the plan’s customer service number.
- Work with a Medicare insurance broker.
If you have any questions about enrolling in a Medicare Advantage plan, make sure you reach out to the customer service representatives for the plan you’re interested in. They can help guide you through the process and answer any questions you may have.
What Should You Look For When Comparing Plans?
When you’re comparing Medicare Advantage plans, it’s important to consider the features that are most important to you. Some things you may want to look for include:
Prescription Drug Coverage
Most Medicare Advantage plans include prescription drug coverage, but some don’t. If you take medication regularly, make sure the plan you’re considering covers the drugs you need.
Extra Benefits
Some Medicare Advantage plans offer extra benefits that Original Medicare doesn’t cover, like routine dental and vision care. If these benefits are important to you, make sure the plan you’re considering offers them.
Provider Network
Most Medicare Advantage plans have a network of doctors, hospitals, and other health care providers that you must use for your care. If you have a doctor you want to keep seeing, make sure they are in the plan’s network.
Cost
Medicare Advantage plans typically have lower out-of-pocket costs than Original Medicare. But, plans can vary widely in the costs they charge. Make sure to compare the monthly premium, annual deductible, copayments, or coinsurance for each plan you’re considering.
Once you’ve considered all of these factors, you should know which Medicare Advantage plan is right for you.
Get The Plan For Your Needs
If you’re looking for Medicare Advantage plans in Connecticut, Nesso Senior Benefits can help you. Our team of experts can provide all the information necessary to ensure the plan you choose meets your needs.
At Nesso Group, we understand that choosing a Medicare Advantage plan can be overwhelming, but our team is here to help. Don’t hesitate to reach out now to learn more about what we can do for you.
