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Medicare Advantage Plans

Medicare Advantage Plans are managed health programs that serve as a substitute for both “Original Medicare” Part A and B benefits. There are a number of types of Advantage plans.  The majority are either HMO or PPO plans. Medicare Part A provides payments for in-patient hospital services and stays. Part B provides coveage for outpatient services.  Doctors visits, lab work, scans and x-rays all fall under part B.  Original Medicare claims are processed through the Centers for Medicare and Medicaid Services (CMS). Medicare Advantage plans are offered by commercial insurance companies. They receive compensation from the federal government, to provide all Part A and B benefits to enrollees, but do not pay claims through the CMS.

Most Medicare Advantage plans (sometimes referred to as “Part C”) include the Part D prescription drug benefits, and are known as a Medicare Advantage Prescription Drug plan (MAPD). The government makes seperate payments to the plans offering drug benefits with the advantage plan. Medicare pays the insurance company a set amount every month for members enrolled in the plans.

Medicare Advantage plans

must offer a benefit that is at least equal to Medicare’s and covers what Original Medicare covers. They do not have to cover every benefit in the same way. Plans that require higher out-of-pocket costs than Medicare for some benefits,  can balance it out by offering lower copayments for doctor visits or other benefits.  CMS limits how much the Medicare Advantage plans can vary from benefits under Original Medicare. Many plans offer benefits which are not covered by Original Medicare.  They do this as a value added benefit to entice more people to enroll in the plan.

All Medicare Advantage plans must have out of pockets maximums for medical services.

The limit for 2016 is $6,700 medical out of pocket.  This applies to in-network services only. Once the out of pocket maximum is obtained, the plan will pay all additional costs. This assumes the services received are in network.  Medicare advantage plan have networks. This means the enrollee must use in network doctors to be covered.  There are exceptions to this such as with a PPO plan.

Other ways to get care out of network would be for an emergency or urgent care situation. Enrolling in a PPO plan provides the ability to go out of network. PPO plans permit a subscriber to use any physician or hospital, but at a somewhat higher expense. Certain PPO plans can lead to much higher costs for going out of network.  The combined out of pocket max goes up to $10,000 on a PPO.  The total is for in and out of network usage.

People can enroll in a Medicare Advantage plan

when first eligilble for Medicare A and B.  They must enroll in A and B prior to enrolling in an advantage plan.  Under most situations, the member can change plans every January during AEP. There are exceptions to this rule however. Many states have multiple Advantage plans offered by various companies.  Some states have over 20 different plans to choose from.  Companies will also offer plans by county.  They may offer a plan in one county but not another within the same state. 

People with low medical utilization tend to migrate towards advantage plans.  If someone is going to the doctor a few times a year on average, they tend to look at the low Advantage premiums as a way to save money. Those with higher medical utilization will have a tendency to go with a Medicare supplement plan of some type.  Supplements tend to have higher premiums and less out of pocket costs which appeals to someone utilizing care more often.  Supplements are also attractive to those that do not want to abide by a network of doctors.  Others tend to go with a supplement to avoid the need for prior authorization which is required on advantage plans.

Trial Right–

Medicare Advantage trial rights are rules that allow someone to switch out of their advantage plan. There are two cases in which a trial right is created.

• Taking an advantage plan when first eligible for Medicare.  A trial right is created allowing the member to change back to Original Medicare any time in the first 12 months.  They can go to Original Medicare with a supplement and/or Rx plan the first of any month
• Taking an advantage plan for the first time. If someone is taking an Advantage plan for the first time. (Even if they have been on a supplement previously). They will have a trial right for the first year they are in the advantage plan. This would allow them to change to a supplement and/or drug plan

AEP- At this time you can change your plan (Advantage to supplement or supplement to advantage) every January 1st during AEP.  At this time someone can make any change they would like. Some states will underwrite a move to a supplement however.

MADP- During this period, a person may leave an advantage plan and go back to Original Medicare.   MADP runs from  January 1 through February 14th every year.  They can also enroll in a supplement and/or Rx plan if they would like.

SEP- A Special Election Period allows someone to make a change outside of AEP.  Certain circumstances will create a SEP.  Moving outside the plan service area, qualifying for extra help, lose of employer coverage.  These are all examples that would create a special election.

Additional Resources:

 Medicare Basics Video – Click here

 For Medicare Advantage Basics Video Click

Click for Medicare Supplement Basics Video

Medicare Information for state of Connecticut

Medicare Part B Coverage

Medicare Part B coverage is medical insurance.  Part B covers doctor visits.  It also covers well visits.  Coverage for medically necessary services and supplies is provided. This coverage includes any service or supply that you require for either diagnosis and or treatment of a medical condition. Part B also covers outpatient services.  Covered services include those provided by either a hospital, doctor’s office, clinic or other health care facility.

Medicare Part B also covers many preventive services to prevent illness or detect them at an early stage.  Together,  Parts A and Part B are known as Original Medicare.

Medicare Part B benefits

Medical services and supplies covered by Medicare Part B include (but may not be limited to):

• Doctor’s visits,
• Urgent care visits,
• Laboratory tests,
• X-rays,
• Emergency ambulance services,
• Mental health services, and
• Durable medical equipment.
• Preventive services, such as pap tests, flu shots, and screenings.
• Rehabilitative services, including physical therapy, occupational therapy, as well as speech-language pathology services.

Part B has a monthly premium associated with it.  The monthly premium is $104.90 in 2016.  If you get either Social Security, Railroad Retirement Board, or Office of Personnel Management benefits, your Part B premium will be automatically deducted from your benefit payment. If you don’t get these benefit payments, you’ll get a bill.   Note:   If you did no take Part B when you were first eligible, the cost of Part B will go up 10% for each full 12-month period that you  could have had Part B but didn’t sign up for it, except in special cases. You will have to pay this penalty as long as you have Part B.

Click here to learn how and when to enroll in Medicare.

Are you ready to sign up for Medicare?  You can sign up online.  Click here to enroll.

We are one of  the Northeast’s leading Medicare expert brokerages.  We do not charge consultation fees.  Feel free to contact the office at 203-796-5403 if you have questions.

Click here for a free personalized Medicare quote.

Interested in getting a home or auto quote?  We can help with that as well.  Email us at Admin@CroweAndAssociates.com.  We will send you a personal online link to enter your info and request a no obligation quote.

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

Click here for a no obligation Medicare quote.

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.

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.

We are a full-service brokerage and offer clients not only guidance with Medicare, but all health plan needs.  We offer dental insurance, both long and short term care policies.  Crowe and Asscoiates can help with estate planning by offering several types of life insurance as well as investment opportunities.