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Medicare Plans in Connecticut – Coverage and Benefits

If you are going to turn 65 this year, are a legal resident of the state of Connecticut, and have a significant employment history in the United States, you qualify to enroll in any number of Medicare plans in Connecticut. With Medicare, the federal government will help you manage your health care expenses for hospital visits and outpatient care during a period in your life when you need it most. The basic form of this coverage comes in two parts: Medicare Part A, and Medicare Part B. Together, they are often referred to as “Original/Traditional Medicare”.

How much you pay for Original Medicare coverage will depend on several factors. Part B charges a monthly premium, and you may have to pay a similar fee for Part A. However, your employment history could leave you exempt from the Part A premium. If you have at least ten (10) years, or 40 quarters, of employment in your past, the premium for part A will be waived.

Medicare Part A (Hospital Coverage)

  • Inpatient care in hospitals
  • Skilled nursing facility care
  • Hospice care
  • Home health care
Medicare Part B (Medical Insurance)

  • Services from doctors and health providers
  • Outpatient care
  • Home health care
  • Durable medical equipment
  • Some preventive services
Medicare Part C (Medicare Advantage)

  • Includes all benefits and services covered under Part A and Part B
  • Usually includes Medicare prescription drug coverage (Part D) as part of the plan
  • Run by Medicare-approved private insurance companies
  • May include extra benefits and services for an extra cost
Medicare Part D (Drug Coverage)

  • Helps cover the cost of prescription drugs
  • Run by Medicare-approved private insurance companies
  • May help lower your prescription drug costs and help protect against higher costs in the future

Popular Medicare Insurance Programs in Connecticut

Currently, Medicare benefits are helping 586,545 Connecticut residents manage their health care needs. Of those, 24% (or 140,770) have opted into using a Medicare Advantage plan instead of Traditional Medicare. Medigap supplemental coverage, however, seems to be the more popular choice for 154,191 Connecticut residents. And the remaining 291,584 beneficiaries are either relying on Original Medicare by itself, or are a part of some employer-sponsored plan in order to cover the gaps in Traditional Medicare coverage.

Before you start shopping around for Connecticut Medicare supplement plans, make sure you are at least qualified for (if not already receiving) federal Medicare benefits.

A Cost-Benefit Analysis of Supplemental Coverage

It might be, depending on your unique circumstances. If you are younger, relatively healthy, and don’t anticipate needing much medical care, then Parts A and B might be enough to cover your needs. However, unexpected medical emergencies can happen to anyone. And if those emergencies require hospital time and outpatient rehab, the costs can add up before you know it.

Medicare Part A Costs Medicare Part B Costs
  • $1,184 (as of 2014) Part A Annual Deductible for access to Basic Hospital Services
  • $296/day for an Inpatient hospital Stay between 61-90 days long
  • $147 Annual Deductible (as of 2014) for basic Part B Medical Coverage
  • 80/20 Coinsurance costs for all Medicare coverage; Medicare pays 80%, you pay 20% Out-of-Pocket

Most people over the age of 65 are living on a fixed income. In such situations, paying for thousands of dollars in unexpected medical bills might become quite the strain on your budget. Most people don’t feel comfortable putting themselves in such a risky situation, which is why they buy supplemental coverage.

What is a Medigap Supplemental Policy?

Medigap was designed to offer you medical coverage in all of the areas – or gaps – where Medicare doesn’t cover you. The federal government has approved of ten (10) specific plans: A-D, F, G, and K-N. Plans E, H, I, and J also existed before 2010; however, the Medicare reform act which passed that year eliminated the need for them. Each plan offers the exact same type of coverage, regardless of your state or your insurance provider. The only thing that varies by location is the price.

Residents of Connecticut (and every other state) can expect the following benefits from these ten plans:

Top Medicare Supplement Plans in the Area

Type Starting From Part A Deductible Part B Deductible Excess Nursing Travel
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What is Medicare Advantage?

Medicare Advantage is technically more of a replacement than a supplement for Original Medicare. It is also sometimes referred to as Medicare Part C. What an Advantage plan does is that it replaces your Original Medicare from the government with identical (or sometimes better) coverage from a private insurance company. At the very least, you will receive the exact same benefits as you would with traditional Medicare, because this is required by law. Some companies offer extra benefits, such as vision, prescription drugs, or dental, in order to persuade customers. However, the more coverage and benefits you sign up for, the higher your overall costs will be.

Another potential drawback for Medicare Advantage is the restrictive networks. Whether it’s an attempt to cut costs or provide premium treatment, Medicare Advantage providers are sometimes picky about which doctors and health services they allow into their network. There may be a very real risk that you will have to change doctors, which is something to keep in mind before deciding on a plan.

More information on HMO/PPO plans: these acronyms are short for “Health Maintenance Organization” and “Preferred Provider Organization”, respectively. Whichever organization you join will determine where, when, and how you receive your medical care.

Top HMO Plans in the Area

Cost Plan Name Coverage Type Premium Deductible Rating
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Top PPO Plans in the Area

Cost Plan Name Coverage Type Premium Deductible Rating
There are no plans to show

The Major Differences between Medicare Advantage and Medigap

At the end of the day, your overall healthcare costs will probably be the strongest determining factor in which plan you decide to purchase. In the table below, we outline some of the costs you can expect to pay with each plan, including premiums and out-of-pocket expenses, as well as many other determining factors:

Questions Medicare Advantage Medicare Supplement
How are the plans funded? Medicare will pay your insurance company a fixed amount based on average healthcare costs for your region. You may also be required to pay a premium based on your location and insurance company. Your monthly premium takes care of the majority of your expenses.
Do I continue paying for Part B? Yes Yes
What does it cost me? Some plans offer a zero-dollar premium (because the government subsidy covers the full cost). Other plans may cost up to 0-0 monthly. While each plan does require a monthly premium, many of them are affordably priced.
What does the plan cover? Depending on your plan, it will cover at least the same benefits offered by Medicare parts A & B. Possibly other benefits; but the more benefits you sign up for, the higher your out-of-pocket expenses may be. All eligible expenses are split between Medicare, and your Medicare Supplement plan. If you have a comprehensive plan, such as Plan F, 100% of eligible expenses not covered by Medicare will be covered by your supplement insurance.
Can I budget my health care expenses? It’s challenging; the more often you require medical care, the more often you may be required to pay out-of-pocket. Budgeting is much easier with a Medicare supplement. You have fewer out-of-pocket expenses, and one simple monthly premium.
Can my plan be cancelled? Yes. Unfortunately, your health insurance company has the legal right to review their Medicare Advantage services annually and decide whether or not they wish to continue providing coverage. No – not unless you fail to pay your monthly premium, or your insurance company goes bankrupt. Only under such extenuating circumstances could your plan be cancelled.
Are pre-approvals or pre-certifications required? Unfortunately, yes. These Plans usually require pre-certification or other qualification for some specific types of care. No pre-approvals are required. If you qualify for Medicare, you will qualify for a Medicare supplement plan.
Can I use any doctor or hospital? Usually, you choose from a network of pre-approved providers. These networks can fluctuate over time. Yes. You are free to choose any doctor and/or hospital in the U.S. which accepts Medicare.
Can drug, vision, or dental coverage be included in the policy? Yes. No. These forms of coverage must be purchased separately.
Who is this plan type generally best suited for? If you are relatively young, healthy, live in an urban area, and have a limited income, a Medicare Advantage plan could work for you. If you live in a rural area without easy access to provider networks, if you like to budget your finances, or if you want comprehensive coverage, you might prefer a Medicare supplement plan.

Informative Medicare Resources

This article is a broad analysis of Medicare supplemental coverage, and contains just enough helpful information to get you started. From here, you can take it the rest of the way by doing some investigation on your own. Below are links and contact information of various offices which specialize in Medicare plans in Connecticut. Talking to any of these experts can definitely help you start going down the right path.

Useful Contacts


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Important Medicare-Related Healthcare Terms

  • HMO: Health Maintenance Organization, this refers to a network of doctors and hospitals with a plans’ network.
  • PPO: Preferred Provider Organization, this refers to a network of doctors and hospitals with a plans’ network.
  • Co-Pay: Amount of money charged per visit to doctor, specialist, etc.
  • Co-Insurance: A percentage required by the policyholder to pay out-of-pocket. For example, 80/20 coinsurance means the insurance company will cover 80% of the charges, and the policyholder pays the remaining 20% of the charges.
  • Deductible: This is the amount of money required out-of-pocket by the policyholder before the insurance will kick-in and pay for any remaining charges. For example, a policy with a $1,000 deductible means that you must pay full healthcare costs out-of-pocket up to $1,000 before the plan will start coverage.

 

 

 

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