What is Medicare Part A Coverage?
Medicare Part A coverage is hospital care coverage. This plan covers both lab tests and surgeries. Doctor care during the stay is also covered. There is also coverage for supplies like wheelchairs and walkers when they are medically necessary to treat either a disease or a condition. Part A covers in-patient hospital stays. These plans also cover care in a skilled nursing facility or nursing home care as well as Hospice care and some home health services. Note: Part A will cover nursing home care for medical purposes. Medicare will not cover the expense if custodial care is the only care necessary.
Part A includes benefits for hospital expenses.
Other expenses part A covers are, a semi-private room and meals as well as medications. There is also coverage provided for nursing services and other supplies from the hospital. Part A benefits will cover home health care services when deemed medically necessary. Your doctor must order home health services in order for this expense to gain approval. Skilled nursing facility (SNF) stays coverage will only receive approval by Part A after a qualifying hospital inpatient stay for a related illness or injury. To qualify for SNF care, the hospital stay must be a minimum of three days. A qualified stay begins on the day you are admitted. The day the hospital dischares you does not count toward the 3 day requirement. Patients can be kept for observation. Time spent under observation is considered outpatient. This time does not count towards your qualifying stay.
If your doctor has certified that you have a terminal illness, you may be eligible for hospice care coverage. Your doctor will need to determine a 6 month or less life expectancy. In hospice care, the focus is on palliative care. Hospice focus is not cure. The goal is to relieve pain and make the patient as comfortable as possible.
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Click here for more information regarding Medicare Part A benefit coverage.
Connecticut residents looking to compare plan options can click here for more details about plans available. If you still have questions or would like to set an appointment, please call the office at 203-796-5403. In fact, we are leading Medicare experts in CT and are here to help. We do not charge for our consultation services.
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Medicare Plans Connecticut
Medicare Plans Connecticut is a broad term that can refer to a number of companies or plan types in Connecticut. Insurance companies offer either Medicare Advantage plans (MAPD), Medicare Supplement plans (Also called Medigap) or Medicare Part D Rx plans. A summary of both plans and companies has been provided below. Choosing the right plan means matching up the needs of the insured (current health, doctors, as well as Medications and volume of care) with the strengths of the given plan type.
Medicare Advantage plans-
Managed Medicare plans offered with (MAPD) and without (MA) drug coverage. Medicare Advantage plans take the place of Original Medicare. They are the primary insurance and have a network as a result. There in network only (HMO) and out of network (PPO) plans available. In Connecticut, most plans are HMO style plans. Connecticare, United Healthcare, Aetna and Wellcare as well as Anthem BCBS offer plans in Connecticut.
There are two plans with a $0 monthly premium. Both require referrals to specialists. There are a number of plans in the $29 to $44 a month range. The higher end HMO and PPO plans have a premium from $99 to $128 a month. The positive points with MAPD plans are, they have a very low to no monthly premium. These plans include Medicare part D coverage and they offer some benefits that Original Medicare does not. Some of the negatives can be, the copay for medical services, provider networks as well as referrals for specialists. Click the links for plan designs of some of the more popular plans in CT.
Connecticut does not have medical underwriting which is important to consider. Medicare rules allow someone to change plans every January 1st during OEP. Without checking health, a member can change from a Medicare Supplement to a Medicare Advantage plan. If someone develops a health condition, they could change to a supplement without any issues.
Medicare Plans Connecticut
United Healthcare Medicare Complete Plan 1
United Healthcare Medicare Complete Plan 3
Aetna Medicare Plan HMO Connecticut
Medicare Plans Connecticut can also be Medicare Supplement Plans (Medigap)– Medicare Supplement plans are offered by a number of companies in CT. These plans are standardized. This means benefits are the same from company to company. Common plans offered in CT are Plans F, High F, N, K, L and G. AARP offered by United Healthcare tends to be the first choice in CT. A number of companies including Humana, AARP, Anthem BCBS, Combined Life, United American and Cigna all offer a number of plan choices.
Click here for standardized Medicare supplement rates in CT
Medicare Part D plans (stand alone Rx plans)- Medicare part D plans are offered by a number of companies in CT. Some of the more popular choices are UHC branded Saver, UHC branded Preferred RX, Humana Walmart Rx, Silver Scripts, Express Scripts Rx. There are too many plans to list them all. You cannot purchase a stand alone Rx plan with a Medicare Advantage plan. Clients can only purchase these plans along with a Medicare supplement. You can also combine these plans with Medicare A and B. If you buy a supplement plan, you do not have to use the same company for the Rx plan. Clients can choose any company they feel is offering the best plan for them. Note: The Humana Walmart Rx plan is the current lowest cost (lowest monthly premium) plan in CT.
States offer programs to individuals in need of assistance. In fact, you may qualify for assistance. Click here to learn about programs offered and determine if you are eligible.
If you have either additional questions or need a quote, Click here.
Medicare Supplement Rates Connecticut
Medicare Supplement Rates Connecticut are available at the bottom of this blog. These Medicare Supplement plans are also called Medigap plans. Connecticut is a standardized state for Medicare supplements. Plans have identical benefits from one company to the next. The only difference is in price and value added features. Value added are things such as Silver Sneakers being available with a plan. A Medicare supplement plan is secondary coverage. Original Medicare both A and B are the primary insurance with a supplement. Providers bill Original Medicare first. The portion not covered by Medicare is sent to the supplement. The supplement covers some or all of the remainder depending on the the plan chosen. Plan F covers 100%, plan N covers most charges, plan L covers 75% and so on. There are 9 supplement types in CT
How do you decide which one to take?
It depends on your situation. People in very poor health may be better with a Plan F. Someone in average health may look at plan N or plan L. Supplements have some advantages: No network and ability to choose coverage level are two big ones. Also, the ability to choose any Part D plan. There are also some negatives. The first is paying three premiums.
A part B premium of $121.80. The Supplement premium and the Rx premium. Some people will make the decision to go with a Medicare Advantage plan instead. Connecticut does not allow companies to underwrite plans. This simply means they can’t check your health. This allows members to move from one supplement to another during the year. Certain health conditions may cause an issue if you want to change plans. They could also move either to an advantage during OEP or from an Advantage to a supplement. Rates have been provided below. In fact, the grid holds the rates for every company with a supplement in CT.
Click this link for CT rates 2016
Are you looking for Medicare Advantage Plan information instead?
If you need to sign up for Medicare A and B, Click for online enrollment with Social Security
Medicare Donut Hole
‘Medicare Donut Hole’ is another term used to identify the coverage gap in prescription drug coverage. Most Medicare Prescription (Part D) plans have a donut hole. This means that after you and your Medicare drug plan have contributed a specific amount of money for your covered prescription drugs, you will have to pay 100% of the cost of your prescriptions up to a given limit. The limit amount will change each year.
In 2016, once you and your plan have spent $3,310 on covered medications, you will be considered to be ‘in the Medicare donut hole’. Not every Medicare participant will enter the donut hole. If the total spent on prescription medications is less than $3,310, there will be no coverage gap.
Once the you have reached the donut hole, Medicare will pay 42% of the price for generic drugs during the coverage gap. You will be responsible for paying the remaining 58% of the price. For covered name brand RX drugs, you will pay 45% of your Part D plan’s contracted cost. Visit the Medicare.gov site for coverage examples.
Medicare recipients meeting certain income and resource limitations may qualify for extra help. There is no applicable coverage gap or ‘Medicare donut hole’ for those recipients. Again, visit the Medicare.gov to learn more about extra help.
Also, people with Medicare who get Extra Help paying Part D costs won’t enter the coverage gap.
In 2016, you may qualify if you have up to $17,820 in yearly income ($24,030 for a married couple) and up to $13,640 in resources ($27,250 for a married couple).
If you don’t qualify for Extra Help, your state may have programs that can help pay your prescription drug costs. Contact your Medicaid office or your State Health Insurance Assistance Program (SHIP) for more information. Remember, you can reapply for Extra Help at any time if your income and resources change.
Click here for a free Medicare review and quote.
Anthem MediBlue Select HMO
Anthem MediBlue Select HMO is a Medicare Advantage plan with prescription drug coverage (MAPD). In fact, Anthem Blue Cross Blue Shield offers this plan only in Hartford county in the state of Connecticut. This, like all HMO plans, require that participants use in network providers. If you choose to use out of network providers, this plan will not cover your expenses. An exception to this would be urgent or emergency care which allows of of network services.
The plan has a monthly premium of $26. This would be in addition to the part B premium of $121.80. There are no referrals required for this plan. Co-pays for a primary doctor are $15 and $40 for a specialist. The plan has an annual out of pocket max of $6,100 per year. Annual maximum indicates the most the insured would need to pay in medical claims for the year. You can not apply either Monthly premiums or cost-sharing for part D prescription drugs to the maximum out of pocket amount.
You can add dental services to the plan for an additional premium. In Addition, Silver Sneakers is included in the $26 monthly premium and pays a local gym membership monthly fee. If you use approved diabetic supply vendors your diabetic supplies are covered at 100%.
This plan offers prescription drug coverage with $220 annual deductible. This deductible applies only to tiers 2-5. The plan excludes both Tiers 1 and 6 from this deductible. There is no limit to how much the plan will pay.
A Medicare Advantage plan should not be confused with a Medicare Supplement plan (also called Medigap).
MAPD plans offer both medical and drug benefits combined with the insurance company as the primary insurance. With a Medicare Supplement, original Medicare is primary. The insurance company would be the secondary insurance. As a result, a Medicare Supplement plan does not have a network. Because members may see any provider that participates with Original Medicare, it is different from an Advantage plan.
HMO summary of benefits Anthem MediBlue Select
Anthem MediBlue Selelct HMO application
Click here to request a personal Medicare review.
Aetna Medicare Plan HMO Connecticut
Aetna Medicare Plan HMO Connecticut is a Medicare Advantage Plan (MAPD). This plan is offered in Fairfield, New Haven, and New London counties. Aetna refers to this plan as the Shoreline plan. They also offer a similar version of it called “inland”. The inland plan includes Hartford, Litchfield and Tolland counties. The Aetna Medicare Plan HMO Connecticut is an HMO plan. Members must use in network providers (except for emergency and urgent care). If you choose to use an out of network provider in an non emergency or urgent care situation, there will be no coverage at all. Medicare A and B will not provide the standard 80% part B coverage when going out of network on a Medicare Advantage plan.
In addition to a $6,700 maximum out-of-pocket contribution (for medical expenses only), this Aetna plan is a $0 premium offering and requires referrals to see specialists. You only need to obtain a referral once per specialist each calendar year. The plan features very low co-pays for a $0 premium plan. With a $10 primary doctors copay and a $40 specialist copay. Most other co-pays are also low compared to other plans offered in the same market such as a $600 inpatient hospital co-pay and a $150 major radiology copay (basically means MRI’s, CAT and PET scans).
The prescription drug plan (included with benefits of plan)
is one of the few that does not have a deductible on tier 3, 4 and 5 drugs. Overall, this is a solid plan with a large national network of providers that can be accessed anywhere in the country. The one benefit that should be noted with this plan is the fact that it does have an annual deductible of $1,000 for some services such as Inpatient hospital, major radiology, Outpatient surgery, ambulance and some other services. A plan summary has been provided below for review.
CLICK HERE FOR AETNA MEDICARE PLAN HMO CONNECTICUT PLAN SUMMARY
Click here for a free Medicare review and quote.
Anthem MediBlue Plus HMO
Anthem MediBlue Plus HMO is a Medicare Advantage plan with prescription drug coverage (MAPD). This plan is offered by Anthem Blue Cross Blue Shield in 4 counties in the state of Connecticut. Clients can purchase in either Fairfield, Litchfield, New Haven as well as Windham counties. Given the plan is an HMO plan, participants must use in network providers. In fact, if you use out of network providers anthem will not cover your claims. An exception to this would be when getting urgent or emergency care which allows of of network services.
The plan has a monthly premium of $37 a month. This would be in addition to the part B premium of $121.80. This plan does not require a referral. Copays for a primary doctor are $15 and $40 for a specialist. The plan has an annual out of pocket max of $6,700 per year. Annual max indicates the most the insured would need to pay in medical claims for the year. It does not include prescription drug out of pocket costs. You can add dental coverage to this plan for an additional premium. They include Silver Sneakers in the $37 monthly premium and they pay a local gym membership monthly fee for members. Diabetic supplies are covered at 100% when using approved diabetic supply vendors.
A Medicare Advantage plan should not be confused with a Medicare Supplement plan (also called Medigap). MAPD plans offered medical and drug benefits combined with the insurance company as the primary insurance. With a Medicare Supplement, Original Medicare is primary. The insurance company would be the secondary insurance. As a result, a Medicare Supplement plan does not have a network. In fact, members may see any provider that participates with Original Medicare. This is not the case with an Advantage plan.
MediBlue Plus HMO Anthem summary of benefits
Anthem Mediblue Plus HMO application
Click here to request a personal Medicare review.
United Healthcare Medicare Complete Plan 1 Connecticut
United Healthcare Medicare Complete Plan 1 Connecticut is a Medicare Advantage plan with Prescription Drugs (MAPD). Medicare Complete Plan 1 is an HMO plan. This plan is available in all eight Connecticut counties. The plan has a $99 monthly premium. The annual out of pocket limit for medical expenses is $4,850. Primary doctor visit co-pays are $10. The specialist visit co-pay is $30. In fact, this plan does not require PCP referrals for specialist visits. Additional benefits are provided for podiatry care, hearing aids, SilverSneakers fitness program and also the NurseLine. This plan features contributions for vision exams. These plans include preventative dental coverage.
The drug plan has a co-pay plan with 5 tiers as well as a $130 deductible that applies to tiers 3,4 and 5 only. Like all other part D and MAPD drug plans in CT, a Coverage Gap (formerly called donut-hole) applies to this RX benefit. Although it is an HMO plan, the Medicare Complete Plan 1 does have the 2016 UHC Passport Program which provides access to doctors in other states on an in-network basis. Passport is not available in all states, but they do include it in the Connecticut plan. A dental benefit is also offered for an additional premium.
Please note:
A Medicare Advantage Plan with Prescription Drugs (MAPD) is NOT a Medicare Supplement plan (Medigap). With an MAPD plan, Medicare is not the primary or secondary insurance. The company offering the MAPD is your primary insurance and services must be obtained through participating providers in most cases. A Medicare Supplement plan is secondary to Original Medicare and does not include Part D prescription drug coverage. With a Medicare Supplement, there is not a network but instead, the insured would go to any provider that accepts or participates with Original Medicare.
A 2016 Summary of benefits as well as a 2016 application are available in the links below. You can send applications back to us either by email at Admin@croweandassociates.com or by fax at 203-567-6235.
Click here to download the UHC Complet Plan 1 Summary of Benefits – Connecticut
Click here to download the UHC Complete Plan 1 Application – Connecticut
Looking for a lower monthly premium? Click here to learn more about the United Healthcare Complete Plan 2.
Click here for a no-obligation Medicare quote.
United Healthcare Medicare Complete Plan 2 Connecticut
United Healthcare Medicare Complete Plan 2 Connecticut is a Medicare Advantage plan with Prescription Drugs (MAPD) offered by United Healthcare Medicare. Medicare offers the Complete Plan 2 in Fairfield, Hartford, Litchfield, Middlesex, New Haven, New London, Tolland as well as Windham counties. This plan is a HMO and has both a $29 monthly premium and an annual out of pocket max of $6,000 (Medical only). It features co-pays of $15 for primary doctor visits as well as $40 for specialist visits. Subscribers do not need specialist referrals.
United Healthcare pays %100 of preventative care as part of this plan. This includes; annual physicals, mammogram, cardiovascular screenings as well as certain vaccines. Plan 2 includes; home health care, podiatry services, hearing services, vision services and also basic dental services. The drug plan has a 5 tier copay plan with a $200 deductible for Tiers 3,4 and 5 only.
Like all other part D and MAPD drug plans in CT, there is a Coverage Gap ( donut-hole) that applies to this RX benefit. Although it is an HMO plan, the Medicare Complete Plan 2 does offer the 2016 UHC Passport Program at no additional cost. The Passport program provides access to doctors in other states on an in-network basis. Although the CT plan includes Passport, every state does not offer the Passport progam. For an additional premium, your coverage can include a dental benefit rider.
Please note:
A Medicare Advantage Plan with Prescription Drugs (MAPD) is NOT a Medicare Supplement plan (Also called Medigap). With an MAPD plan, Medicare is not the primary or secondary insurance. The company offering the MAPD is your primary insurance and services must be obtained through participating providers in most cases. A Medicare Supplement plan is secondary to Original Medicare and does not include Part D prescription drug coverage. With a Medicare Supplement there is not a network, instead, the insured would go to any provider that accepts or participates with Original Medicare.
A 2016 Summary of benefits and 2016 application are available in the links below. You can send applications back to us either by email at Admin@croweandassociates.com or by fax at 203-567-6235.
Click here for a UHC Plan 2 Summary of Benefits – Connecticut
To download a UHC Plan 2 application – Connecticut Click here
Click here for a no-obligation Medicare quote.
United Healthcare Medicare Complete Plan 3 Connecticut
United Healthcare Medicare Complete Plan 3 Connecticut is a Medicare Advantage plan with Prescription Drugs (MAPD) offered by United Healthcare Medicare. The Medicare Complete Plan 3 is an HMO plan. UHC offers Medicare Complete Plan 3 in Fairfield, Hartford, Litchfield, Middlesex, New Haven, New London, Tolland as well as Windham counties. The plan has both a $0 monthly premium and an annual out of pocket max of $6,700 (Medical only). It features co-pays of $20 for primary doc visits as well as $50 for specialist visits. If you would like coverage for a specialist visit, you will need a referral from you PCP. Referrals are valid for the full year. This plan provides additional benefits for vision, foot-care, hearing aids, SilverSneakers fitness program as well as NurseLine. This plan includes basic preventative dental services.
This Plan includes Preventative care at no cost.
In additional expenses the plan covers are, annual wellness visits, mammograms, colonoscopy and also annual gynecological exams. Plan members pay nothing for hospice care from a Medicare-certified hospice.
The drug plan has a 5 tier copay plan with a $140 deductible for Tiers 3,4 and 5 only. Like all other part D and MAPD drug plans in CT, there is a Coverage Gap ( donut-hole) applicable to this Rx benefit. Although it is an HMO plan, the Medicare Complete 3 does have the 2016 UHC Passport Program which provides access to doctors in other states on an in-network basis. Passport is not available in all states. A dental benefit is available with this program but there is a premium for adding it.
Please note:
A Medicare Advantage Plan with Prescription Drugs (MAPD) is NOT a Medicare Supplement plan (Also called Medigap). With an MAPD plan, Medicare is not the primary or secondary insurance. The company offering the MAPD is your primary insurance and services must be obtained through participating providers in most cases. A Medicare Supplement plan is secondary to Original Medicare and does not include Part D prescription drug coverage. With a Medicare Supplement, there is not a network but instead, the insured would go to any provider that accepts or participates with Original Medicare.
Both a 2016 Summary of benefits and 2016 application are available in the links below. You can send your application back to us either by email at Admin@croweandassociates.com or by fax at 203-567-6235
Click here for a UHC Plan 3 Application – Connecticut
Click here for a UHC Plan 3 Summary of Benefits – Connecticut
Interested in a lower maximum out of pocket plan? Click here to learn more about the United Healthcare Complete Plan 1.
Click here for a free personalized Medicare quote.
SilverScript Medicare Prescription RX Plans
Meidcare now offers clients new options for SilverScript Medicare Prescription RX plans in 2016.
SilverScript will provide two prescription plan options in 2016: SilverScript Choice as well as SilverScript Plus. The SilverScript Choice offers comprehensive coverage with low premiums and co-pays. SilverScript Plus provides additional coverage in the coverage gap (commonly referred to as the donut hole). The Plus plan is designed for people who need to take several medications on a regular basis. Because these people are more likely to reach the donut hole during the 2016 plan year.
Both SilverScript prescription medication plans offered in 2016 will feature a $0-deductible, low co-pays for many drugs and competitive premiums. In fact, SilverScript premiums in 30 states are lower than they were in 2015. In fact, premiums in eight of those states is below $20. Also, SilverScript Choice plans have the lowest prescription drug plan premium in four states. Members can access a convenient nationwide network consisting of a wide selection of pharmacies across the country. These include many large national and regional chains, many independent, community-based pharmacies, and the CVS/Caremark mail service pharmacy. Additionally, in 2016, SilverScript is introducing a new list of covered medications. This will help to keep co-pays low for some frequently prescribed drugs.
SilverScript recently received a 4-star performance rating from CMS for delivering value, clinical outcomes and customer service.
CLICK HERE TO REQUEST MEDICARE QUOTE INFORMATION.
Most Medicare Prescription Drug Plans have a coverage gap (also called the “donut hole”). This means there’s a temporary limit on what the drug plan will cover for drugs.
Click here to learn more about the Medicare donut hole.
Please contact us if you would like to learning more about the SilverScript or any other Medicare RX plan. You can either call the office at 203-796-5403 or email us at admin@croweandassociates.com for an appointment.
Original Medicare Enrollment
Original Medicare Enrollment in parts A and B is automatic for those drawing Social Security. Those people who are not that are not will need to enroll.
If you’re already collecting Railroad Retirement Board or Social Security retirement benefits when you turn 65, you will automatically be enrolled Medicare Part A . If you are under 65 and you receive Social Security or Railroad Retirement Board disability benefits, you will automatically be enrolled in Medicare Part A and Part B after 24 months of disability benefits.
You will need to sign up for Medicare part B, if you are not receiving retirement benefits before age 65 or if you qualify for Medicare through disability. Please note, you can sign up during your Initial Enrollment Period (IEP). This is the seven-month enrollment period that begins three months before you turn 65. This enrollment period includes the month you turn 65, and ends three months later.
Click here to visit the Medicare.gov site to learn details.
CLICK HERE TO REQUEST MEDICARE QUOTE INFORMATION.
Still have questions? We are Medicare specialists. Please call if you have questions or need help navigating the Medicare enrollment process. You can either call the office at 203-796-5403 or email us at admin@croweandassociates.com.
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