Medicare Advantage (MA) has grown more popular every year since its introduction, with membership doubling over the past decade. More than one-third of all Medicare beneficiaries now choose to receive their benefits through a Medicare Advantage plan. This page explains Medicare Advantage plans in Connecticut, including and how the program works and what to consider to help ensure you get the best plan for your unique needs.
What is Medicare Advantage in Connecticut?
Private insurance companies offer Medicare Advantage plans in Connecticut, just as they do across the country.
Also known as Medicare Part C, every Advantage plan must provide the same benefits you get with Original Medicare. This includes:
- Medicare Part A, hospital insurance
- Medicare Part B, medical insurance
Original Medicare does not include prescription drug coverage. You must join either a standalone Medicare Part D plan or an Advantage plan that covers prescription medications.
Please note that, even if you join a Medicare Advantage plan, you are still responsible for the Medicare Part B premium.
Medicare Advantage plans with prescription drug coverage in Connecticut
Medicare Advantage Prescription Drug plans (MA-PD) combine your benefits under Medicare Parts A, B, and D into a single policy.
Many Advantage plans also offer additional coverage. Popular add-on benefits include:
- Fitness programs
- Hearing aids
- Routine dental care
- Routine vision care
Coverage varies according to the plan you choose.
Who is eligible for Medicare Advantage in Connecticut?
If you have Medicare Parts A and B, you're eligible for Medicare Advantage.
American citizens and permanent legal residents become eligible for Medicare once they turn 65. Enrollment in Parts A and B is only automatic for those who began collecting Social Security benefits at least 4 months before turning 65.
If you collect Railroad Retirement Board (RRB) or Social Security disability benefits for 24 months, you may qualify for Medicare before your 65th birthday. Enrollment occurs automatically in month 25.
Finally, if you've been diagnosed with amyotrophic lateral sclerosis (ALS, also known as Lou Gehrig's disease) or end-stage renal disease (ESRD), you qualify for Medicare.
When can you sign up for a Medicare Advantage plan in Connecticut?
Signing up for a Medicare Advantage plan in Connecticut is restricted to specific enrollment periods.
Your Initial Enrollment Period (IEP) lasts for 7 months, beginning 3 months before you qualify for Medicare. For example, if your 65th birthday or 25th month of collecting disability occurs in August, your IEP starts on May 1 and ends on November 30.
The General Enrollment Period is for people who did not sign up for Medicare Part A and/or Part B during their Initial Enrollment Period. It lasts from January 1 until March 31. After General Enrollment ends, you may join a Medicare Advantage plan from April 1 until June 30.
Medicare's Annual Enrollment Period (AEP) runs from October 15 through December 7. During this time, you may make any changes needed to your Medicare coverage. This includes joining an Advantage plan.
The Medicare Advantage Open Enrollment Period runs from January 1 through March 31. During this 3-month window, current Advantage enrollees may either join a new MA plan or return to Original Medicare. If making that change means you lose your prescription drug coverage, you can also enroll in a standalone Part D plan.
Finally, Special Enrollment Periods are available to people who experience special circumstances, such as moving or losing their current coverage. Find the full list of qualifying circumstances on Medicare.gov.
Types of Medicare Advantages plans in Connecticut
There are four main types of Medicare Advantage plans in Connecticut.
- Health maintenance organizations: HMO plans have a provider network and require plan members to choose a primary care doctor who coordinates care and provides referrals to specialists. Services received from out-of-network providers are generally not covered by an HMO.
- Preferred provider organizations: PPO plans also use provider networks but allow members to use an out-of-network provider for a higher out-of-pocket cost. Plan members also don't need a primary doctor or referrals with a PPO plan.
- Private fee-for service: PFFS plans determine what they will pay for covered services, including a set amount that plan members pay. Most PFFS plans have a provider network. But, as with PPO plans, members may use an out-of-network provider for a higher cost.
- Special needs plans (SNPs) limit enrollment to Medicare beneficiaries who meet certain criteria. These vary by plan, but generally amount to having a chronic condition, living in an institution, or being eligible for both Medicare and Medicaid. Most SNPs also require beneficiaries to choose a primary doctor. If you qualify for an SNP, you may join the plan at any time.
How to choose a Medicare Advantage plan in Connecticut
To ensure you get the best Medicare Advantage plan for your particular needs, consider these four metrics:
- Costs: These may include an annual deductible, monthly premiums, and copays or coinsurance.
- Coverage: Benefit vary widely, so compare your options carefully. Don't forget the drug formulary for MA-PD plans.
- Network: If your providers aren't on the plan's network, you may want to keep looking.
- Ratings: Medicare plans are rated on a 5-point scale to help members compare their options.
It's easy to compare Medicare Advantage plans in Connecticut with our Find a Plan tool. Just enter your location information and estimated coverage start date to review the Medicare plan options in your area.
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