Medicare Advantage Plans in Connecticut

Famous Connecticut residents include authors like Mark Twain and Harriet Beecher Stowe, whose stories have enthralled readers for more than 150 years. Everyone loves a good story, but when it comes to Medicare coverage, you want the facts. Here’s everything you need to know about Medicare Advantage plans in CT.

Medicare Advantage (Part C) plans are sold by private insurers who have a contract with Medicare. By law, these plans must provide coverage that matches Parts A and B of Original Medicare. Most also include Part D prescription drug coverage.

Many plans provide coverage for healthcare services Original Medicare doesn’t have like:

• Vision care
• Hearing aids
• Dental services
• Wellness programs such as SilverSneakers memberships at gyms

As of 2024, 99.7% of Connecticut residents with Medicare have access to a Medicare Advantage plan. The availability of plans depends on your ZIP code.

Some Medicare Advantage plans require you to choose your doctors and providers in-network. Others have more flexibility about the doctors and providers you may see. There are also differing costs per plan.

Original Medicare has federally mandated pricing based on your personal details, such as work history and income. But there isn’t a national standard for Medicare Advantage plan costs. Instead, each plan provider sets its own plan premiums. Some plans have monthly premiums starting as low as $0.

Original Medicare and Medicare Advantage plans have copayments and coinsurance. This is the portion you pay when accessing services. Original Medicare usually pays for 80% of services, and you pay the remaining 20%. This is known as coinsurance. Copayments are typically flat-rate charges.

Medicare Advantage plans often have lower copayments and must include a yearly cap on out-of-pocket spending. Medicare Advantage plans can also offer extra health and wellness benefits. A Medicare Advantage plan may help you lower your overall costs and save on healthcare bills.

In 2024, the average monthly premium for a Medicare Advantage plan in Connecticut was $20.37.

You’re eligible to enroll in a Medicare Advantage plan if:

• You’re enrolled in Medicare Part A and Part B
• You live in the coverage area of a Medicare Advantage plan

Before you can enroll in a Medicare Advantage Plan, you must be enrolled in Original Medicare. All U.S. citizens and permanent residents over 65 are eligible for Medicare.

Younger adults may also be eligible for Medicare. If you receive Social Security Disability benefits, and you’ve been receiving benefits for 24 months, you’re eligible for Medicare. Younger adults with a chronic condition such as end-stage renal disease (ESRD) can also qualify for Medicare coverage.

When Can I Enroll in Medicare?

You will be able to enroll in Original Medicare three months before the month you turn 65. In fact, you have seven months to enroll when you first become eligible for Medicare. This Initial Enrollment Period (IEP) starts three months before you turn 65, includes the month of your birthday, and extends until three months after your birthday month. If you enroll before your birthday, your coverage will begin as soon as you turn 65.

After you’re enrolled in Original Medicare, you can enroll in a Medicare Advantage plan. You can switch to a Medicare Advantage plan during your IEP and get coverage right away.

You can also switch to a Medicare Advantage plan during:

• The Medicare Advantage Open Enrollment Period  from January 1 to March 31.
• The Medicare Open Enrollment Period  from October 15 to December 7 (also called the Annual Enrollment Period)
• Special Enrollment Periods (SEP) are triggered by life events such as moving to a new home that’s outside of your coverage area or losing other coverage.

How Can I Enroll in a Medicare Advantage Plan?

After you’re enrolled in Original Medicare and have your Medicare card, switching to a Medicare Advantage Plan is very straightforward.

All you need to do is contact the plan provider and ask to enroll. A licensed insurance agent will walk you through the process and make sure you’re all set up in your new plan.

Many Medicare Advantage plans in CT offer comprehensive coverage. This includes prescription drug coverage. If you take medications, enrolling in a Medicare Advantage plan can help you get the coverage you need.

Each Medicare Advantage plan has a formulary. This is a list of all the medications covered by that plan. The formulary also divides meds into tiers, based on the copayments you’ll make for each medication.

Before you enroll in a Medicare Advantage plan, ask to see the plan formulary. Carefully review the formulary to make sure your meds are covered. It’s also a good idea to check the tiers and choose a plan that includes your medications in a lower tier.

Medicare Advantage plans are just as unique as plan members. Different people have different healthcare needs, so there isn’t one plan that’s best for everyone. Finding the right plan for you will take a bit of time and research. Start by carefully evaluating your healthcare needs. Think about the services you access and benefits you’d like to add. Then find a plan that covers the services you need.

One way to compare plans is to check the Centers for Medicare & Medicaid Services (CMS) star ratings. This rating is based on plan member reviews. You can find out how plan members rated the plan in categories like customer service and quality of care. Any plans with a four- or five-star rating are generally considered good plans.

For expert advice you can rely on, call GoHealth. Our licensed insurance agents will help you weigh the pros and cons of the Medicare Advantage plans available in your area. Together we’ll review the costs and coverage options for each plan so you have all the information you need to make the right decision.