Figuring out how Medicare works can be a challenge. If you qualify for Medicare, you may decide that you want to enroll in a Medicare Advantage plan. Before you start comparing plans, use Benzinga’s comprehensive guide to Medicare in Connecticut to learn about who qualifies and how to enroll.
What is Medicare?
Medicare is a type of federal health insurance program for senior citizens and those with disabilities. You may qualify for Medicare if you have a disability, are at least 65 years old or suffer from end-stage renal disease.
There are currently 4 different parts of Medicare insurance. Each part helps you pay for different health care needs.
Part A covers stays in a medical facility. This can include a nursing home, the hospital and hospice stays. In some instances, it can also cover some care at home for people who would otherwise need to be in a medical facility.
Part B is for the care and supplies you would get from a doctor’s office. This includes preventive care, outpatient procedures and even some medical supplies. Medicare Part A and B together make up the Original Medicare.
Part C is a little different. Medicare Part C plans are private insurance plans approved by Medicare. Medicare Part C plans bundle Part A and Part B benefits. Many of these plans also include Part D coverage. You may hear an insurance provider or sales representative refer to Medicare Part C as a Medicare Advantage Plan.
Part D. A Medicare Part D plan helps you pay for prescription drugs. Like Medicare Part C, these plans are offered by private insurance companies and regulated by Medicare. These plans act as Medicare supplemental insurance to complement your Original Medicare or Part C plan.
Legalities of Medicare in Connecticut
Original Medicare is a federally-run program. The federal government regulates who qualifies for Medicare and who can enroll. The Connecticut Department of Insurance oversees and regulates companies that offer Medicare Part C and Part D plans. The Connecticut Department of Insurance also ensures that companies that provide supplemental plans and Advantage plans meet federal regulations for enrolled parties.
Contact Medicare directly if you have an issue with your Medicare Part A or B coverage. If you have an issue with your Part C or D plan, contact the company that offers the plan. If you can’t find a solution with your insurance company, your final step is to contact the Connecticut Department of Insurance and report the plan provider.
Not everyone qualifies for Medicare. In order to apply for Medicare, you must meet any one of the following qualifications:
- Be 65 years old or older.
- Be under the age of 65 with a permanent disability that limits your ability to work.
- Have end-stage renal disease, a type of permanent kidney failure that requires dialysis or a transplant.
Not sure you’re eligible? You can use Medicare.gov’s eligibility tool to learn more about who qualifies.
Types of Medicare Advantage Plans
Like independent health insurance plans, there are 2 main types of Medicare Advantage plans: an HMO and PPO. You’ll need to choose which type of plan you want and your choice will affect which doctors and specialists you can see.
HMO: A health maintenance organization (HMO) plan has a defined network of doctors and specialists you can see. If you go outside of your network to receive care (except in an emergency) you might be responsible for 100% of your care costs. HMOs are usually much more affordable than PPO plans.
PPO: A preferred provider organization (PPO) allows you to see any doctor or specialist you’d like, regardless of whether they’re in your network or not. Though you can save money if you choose to see an in-network provider, you can use your benefits at your preferred medical facility. PPOs are usually more expensive than HMOs but can be worth the expense if you have a doctor you want to continue seeing.
How to Sign Up for Medicare in CT
Enrollment in Medicare Part A and B is automatic in many cases. If you’re already collecting Social Security benefits before you turn 65, you’ll automatically be enrolled in Original Medicare. If you are under the age of 65 and receive disability benefits, you’ll automatically be enrolled in Medicare after 24 months.
You can enroll in Medicare Parts A and B in 1 of 3 ways:
- Visit SocialSecurity.gov and create a profile.
- Call Social Security at 1-800-772-1213. Customer service is available Monday through Friday from 7 a.m. to 7 p.m. EST.
- Visit your local Social Security office and enroll in person.
Begin by researching health insurance companies offering these plans if you’d like to enroll in a Medicare Part C or D plan. Not every health insurance provider is licensed to offer Medicare Part C or D plans in every state. You can enroll directly through the insurer’s website when you find a plan you like. You can cancel Original Medicare by following the instructions on the back of your red, white and blue Medicare card.
Average Cost of Medicare Advantage Plans in CT
You have a number of choices when you enroll in a Medicare Advantage plan. Let’s take a look at what you might expect to pay for a few different Medicare Advantage plans.
| Plan Name | Company | Plan Type | Health and Drug Costs |
|---|---|---|---|
| Anthem MediBlue Dual Advantage Select (HMO D-SNP) | Anthem Blue Cross Blue Shield | HMO | $0 |
| ConnectiCare Choice Plan 2 | ConnectiCare | HMO | $0 |
| Aetna Medicare Elite Plan | Aetna | PPO | $1,000 deductible, $0 monthly premium and $0 drug costs |
| UnitedHealthcare Medicare Advantage Plan 3 | UnitedHealthcare | HMO | $0 health care deductible, $0 monthly premium, $175 drug deductible |
| WellCare Value | WellCare | HMO | $175 health plan deductible, $0 drug deductible |
Best Medicare Insurance Providers in Connecticut
Now that you understand how Medicare in Connecticut works, it’s time to take a look at a few Medicare Advantage plan choices. If you think that Medicare Part C might be right for you, consider these top Medicare Advantage providers in Connecticut.
- Same day coverage available
1. Best Overall in CT: UnitedHealthcare
UnitedHealthcare is one of the largest health insurance providers in the United States — and it also offers comprehensive Medicare Advantage plans. UnitedHealthcare offers a variety of options that allow you to balance your Medicare benefits and keep your monthly premium expense within your budget. All Medicare Advantage plans from UnitedHealthcare include free preventive care visits and $0 copays for some of the most common prescription drugs. Many of UnitedHealthcare’s Medicare plans also include vision and dental coverage — 2 benefits excluded from Original Medicare.
2. Most Affordable in CT: CarePartners
If you’re looking for an affordable Medicare Advantage plan, be sure to get a quote from CarePartners. Most Medicare Advantage plans from CarePartners include $0 monthly premiums — you only need to pay your copays and prescription drug costs up to your deductible. Plans include $0 copays for preventive care and routine wellness visits as well as no waiting periods before you can start using your benefits. Many of CarePartners’ plans also include up to $1,500 worth of dental benefits.
- Medicare Advantage Plans
3. Best for Medicare Supplemental Plans: Humana
Your plan won’t cover 100% of your medical care costs even if you have Original Medicare. If you’d like an additional layer of protection without breaking the bank, consider a supplemental plan from Humana. Humana offers Medicare supplemental plans with deductibles as low as $198 a year — beyond this, your supplemental plan will cover 100% of your medical expenses not covered by Original Medicare. You can also easily add both vision and dental coverage to your Humana plan. They also offer independent Part D coverage as well.
- Member support
4. Best for PPO Coverage: Aetna
Most health insurance providers who offer Medicare Advantage plans in Connecticut only offer HMO coverage. You’ll pay more for your plan if you see a doctor outside of your plan’s network. Aetna is one of the only insurance companies in the state that offers PPO Medicare Advantage plans that allow you to see any doctor or specialist you need. Many plans include $0 premium costs as well as $0 deductibles for medical care costs. Aetna also offers affordable Medicare Part D and supplemental plans with PPO coverage.
- Submiting and tracking claims
5. Best for Assistance Choosing a Plan: Anthem
Choosing a Medicare Advantage plan can be difficult. Anthem makes it exceptionally easy to compare plan choices and look at all your options at a glance. Anthem has tools and calculators available to help you find a plan that fits both your medical care needs and budget, and it’s very easy to find a quote on its website. Just enter your ZIP code and you’ll see all of your plan options sorted by price, star rating and plan type. Copays start at just $5 for primary care provider visits and many plans also include $0 monthly premiums.
Find the Medicare Plan that’s Right for You
Still not sure where to start? The first step is to collect a few quotes. Getting a quote is easy — you can find a quote from most health insurance providers in as little as 60 seconds by entering your ZIP code and age. Be sure to get at least 5 quotes from competing Medicare Advantage plan providers to ensure that you aren’t overpaying.
Frequently Asked Questions
1) Q: What are the different parts of Medicare?
Medicare has 4 parts named Parts A, B, C, and D. Part A provides hospitalization coverage while Part B provides outpatient coverage, like doctor visits. Parts A and B make up Medicare’s core coverages. Part C is provides private-market Medicare plans, called Medicare Advantage Plans. Part C coverage often includes additional benefits. Medicare Part D provides coverage for prescription drugs. Get a Medicare Insurance Quote through the top providers here.
2) Q: Is Medicare free?
Because there are 4 parts to Medicare, there can be different cost structures. Most people won’t have to pay for Medicare Part A (hospitalization). Eligibility for premium-free Part A is based on your work history during which you paid Medicare taxes. Many people do pay a monthly premium for Medicare Part B, however, which covers outpatient medical services, like doctor visits. Deductibles also apply to services covered under Medicare Parts A and B, so you’ll pay a part of the annual cost.
Medicare Parts C and D are optional coverages and have premium costs of their own. Medicare Part C refers to Medicare Advantage Plans that offer additional coverage in exchange for a monthly premium. Part D, the prescription plan, reduces the cost of medications but also requires a monthly premium. Subsidies may be available for low income households to help reduce overall Medicare costs.
3) Q: Do I need to sign up for Medicare?
If you signed up for Social Security before age 65, you were enrolled in Medicare automatically but benefits will begin at age 65. In most cases, there are penalties for not enrolling at age 65, so it pays to sign up on time. Click here to get a medicare quote in minutes from the best providers.
If you have employer coverage, you may be able to delay Medicare coverage while your work plan is still in force. However, the size of the employer determines whether you’ll pay a penalty for not enrolling at age 65. Employees (and their spouses) of companies that offer group health insurance to 20 or more people are usually exempt from late sign-up penalties if they are covered by the employer’s plan.
About Sarah Horvath
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