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Each year, Medicare eligible indivduals wonder which type Mediare plan will cover their helath care needs best. Many beneficiareis wonder if they should enroll in a Medicare Supplement or a Medicare Advantage plan. Although both options provide comprehensive coverage, it is important for individuals to consider their needs and budget to make the best choice. In this post, we will go over some ways to decide the best candidates for MAPD Plans.

People Who Want All-in-One Coverage

MAPD plans are good for; anyone who prefers having all their healthcare benefits managed under a single plan. Plan enrollees only need to carry one ID card and pay for Part B and 1 plan premium. Although, some plans do not even charge a premium.

Private insurers offer Medicare Advantage plans (Part C) and bundle together:

• Part A (hospital coverage)
• Part B (medical insurance)
• Often Part D (prescription drug coverage)
• Plus extra perks like vision, dental, hearing, and wellness benefits

Budget-Conscious Individuals

Many MA plans offer low or even $0 monthly premiums. This is in contrast to Medigap plans (used with Original Medicare), which usually have higher premiums.

While enrollees are still responsible for copays and out-of-pocket costs, Medicare Advantage plans have annual out-of-pocket maximums. The maximums provide financial protection Original Medicare alone doesn’t offer. In other words, these plans are a great choice for those on a fixed income trying to cap their annual healthcare costs.

People Who Don’t Travel Often

Because Medicare Advantage plans generally have local provider networks, enrollees must see doctors and hospitals within the plan’s service area for non-emergency care.

These plans are a good choice for individuals who don’t travel often and usually receive care in their local area. MAPDs might not be a good fit for those who live in multiple states throughout the year.

Those Who Value Extra Benefits

Because Medicare Advantage plans usually offer additional benefits beyond what Original Medicare provides, some people prefer them over other options.

Some of the additional benefits (not included in Original Medicare) plans may offer are:

• Dental exams
• Vision exams and an eye wear allowance
• Hearing exams and hearing aid coverage
• Gym memberships
• Transportation to medical appointments
• OTC items
• Healthy food cards

Please note; this list varies by carrier plan type and area. Not all benefits are included in every plan.

Comfortable with Managed Care

Many Medicare Advantage plans involve managed care structures, like HMOs or PPOs, that coordinate your services and may require referrals or prior authorizations.

People who are comfortable navigating provider networks, or calling their plan for care coordination support may find these plans are a good option.

Those in Good Health

Because MA plans often come with copays for services, they may be more cost-effective for individuals who don’t expect to need frequent medical treatment. In other words, Medicare Advantage plans may be a good fit for healthy retirees who normally see a doctor a few times a year for annual checkups or minor services.

Best Candidates for MAPD Plans

Choosing the right Medicare plan depends on personal health needs, budget, and lifestyle. A Medicare Advantage plan can offer convenience, cost savings, and extra benefits,, only if it aligns with how much and where helathcare is needed.

Before enrolling, consider:

• Current doctors (are they in the plan’s network?)
• Medications (are they covered?)
• How often you travel
• Comfort level with managed care.

Medicare Advantage plans are not one-size-fits-all, but for the right person, they can be a useful, value-packed healthcare solution.

Agents click here to learn how Connecture and Sunfire can make quoting and enrollment easier

Before switching or enrolling for the first time, be sure to review options carefully. It is important to check each year during Medicare’s Annual Enrollment Period (AEP) for the plan that best suits current health care needs and budget. A licensed Medicare agent can provide options and help find the most suitable coverage option.

Unfortunately, as people age, the risk for chronic conditions like heart disease, diabetes, and cancer increases. Although with the right preventive measures in place, many of these conditions can be delayed, managed effectively, or even avoided. That is why we will go over the importance of preventative services for Medicare beneficiaries.

Preventive Healthcare

The objective of Preventive healthcare is to maintain wellness and discover health issues before they become serious. It includes regular checkups, screenings, immunizations, counseling, and lifestyle intervention. These services are all designed to detect potential health problems early or prevent them from happening.

Why Preventative Service for Medicare Beneficiaries Matters

Early Detection

Some serious conditions, such as colorectal cancer or high blood pressure, may not show symptoms until they’ve progressed. That is why routine screenings are important. They can catch these conidtions early, when they’re easier to treat. This helps the beneficiary have a better qualityof life and save money on treatments.

Managing Chronic Conditions

Due to the fact that, over two-thirds of Medicare beneficiaries suffer from multiple chronic conditions, preventative care is essential. Preventive care helps manage these illnesses more effectively, avoiding emergency visits, hospitalizations, and complications. Annual wellness visits give beneficiaries an opportunity to review medications, coordinate care, and update personalized prevention plans.

Immunizations

Keep in mind; Flu shots, shingles vaccines, and COVID-19 boosters can be life-saving for older adults whose immune systems may not be as strong as younger individuals. Medicare Part B covers many of these vaccines. Staying up-to-date with immunizations can help prevent avoidable illness and hospital stays.

Mental and Cognitive Health

Preventive care also includes screenings for depression and cognitive impairment that are critical as people age. These services allow early interventions that can improve quality of life and help individuals maintain independence.

Health Education and Lifestyle Support

Through programs like smoking cessation counseling and diabetes self-management training, Medicare supports healthier living. Lifestyle changes such as, eating healthier foods, excercising or quitting smoking can dramatically reduce the risk of future health problems.

Overcoming Barriers to Access

Despite the clear benefits, many beneficiaries don’t fully utilize preventive services. Reasons include lack of awareness, confusion about coverage, transportation challenges, or simply not knowing what’s available to them. That’s why education and outreach; especially from healthcare providers, caregivers, and community organization are so crucial.

In the event a client wants to have better coverage for an illness, agents should understand the benefitof ancillary products to avoid gaps in coverage.

Agents: Watch a quick YouTube video on why and how to sell ancillary products

Preventive healthcare isn’t just about avoiding illness. It’s about living better, longer, and keeping your independence. For Medicare beneficiaries, taking advantage of all the preventive services Mediare covers is one of the smartest health decisions they can make.

Medicare Advantage (MA) plans are growing in popluarity as an alternative to Original Medicare, often attracting enrollees with low premiums, extra benefits, and all-in-one coverage. However, understanding the true Medicare Advantage Plan cost breakdown is crucial to avoid unexpected financial burdens. Here’s a detailed look at the key expenses associated with Medicare Advantage plans.

Premiums

Many MA plans advertise low or even zero-dollar premiums. However, enrollees must still pay the standard Medicare Part B premium ($185 per month in 2025) unless they qualify for financial assistance. Some plans may also charge an additional monthly amount for extra benefits, like dental comprehensive coverage.

Deductibles and Copays

Unlike Original Medicare, which has standardized costs, Medicare Advantage plans vary widely in deductibles and copay amounts. Enrollees of some MA plans must to meet an annual deductible before coverage kicks in, and they charge copays for doctor visits, hospital stays, and prescription drugs.

Out-of-Pocket Maximums

One advantage of MA plans is that they have an annual out-of-pocket maximum, unlike Original Medicare. In 2025, the maximum amount a MA plan CMS allows MA plans to charge for in-network services is $9,350. Please keep in mind, not all plans charge this amount for an out-of-pocket maximum; most plans have lower MOOPs. This is the most they are allowed to charge, the amount varies greatly by plan. Once this limit is reached, the plan covers all additional costs for the remainder of the year.

Out-of-Network Care

Most MA plans operate within a provider network. HMO plans require enrollees to use only in-network providers, while PPO plans allow some out-of-network visits at a higher rate. Please note; unless you are in a emergency situation, seeking care outside the network can lead to significant additional expenses.

Prescription Drug Costs

Many Medicare Advantage plans include Part D prescription drug coverage. The cost for prescrptions vary based on the plan’s formulary. Factors such as tiered formulary pricing and preferred pharmacy networks can influence out-of-pocket expenses for medications. Most plans also have a prescription deductible to meet for medications over a specific tier level.

Hospitalization and Specialist Care

While MA plans cover hospital and specialist care, costs can add up quickly. Some plans charge daily copays for hospital stays. Additionally, specialist visits usually have higher copays than PCP visits or require referrals, adding another charge.

Extra Benefits and Hidden Costs

Medicare Advantage plans often include extra benefits like dental, vision, and hearing coverage. However, these benefits may have limitations, such as caps on coverage or a restricted provider network, which can lead to unexpected out-of-pocket expenses.

Travel and Emergency Care Costs

Unlike Original Medicare, which offers nationwide coverage, most MA plans have geographic restrictions. If you travel frequently, you may face higher costs for out-of-network emergency care or require a plan with national coverage options.

Agents see how easy it is to compare MA plans with Sunfire and Connecture

Medicare Advantage plans can be a cost-effective option for some enrollees, but it’s essential to understand the full financial picture. By carefully reviewing plan details, including premiums, out-of-pocket limits, network restrictions, and prescription drug costs, enrollees can make informed decisions about healthcare coverage and avoid expensive surprises.

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As a Medicare insurance agent, maintaining a strong reputation and ensuring client satisfaction is essential for success. While providing the best possible service, agents must also be proactive in preventing client complaints that could damage their credibility, lead to compliance issues, or impact their business. We will explain how to avoid client complaints and build better client relationships.

Explain plan details and costs clearly

Many complaints arise from misunderstandings about plan coverage, costs, or network restrictions. To avoid this, agents should take the time to explain plan details, including premiums, deductible and co-pays. Do not forget to include out-of-pocket plan limits.

Remember to emphasize any network restrictions as well as provider availablity. This is extremely important for Medicare Advantage plans. It is helpful to provide a summary of benfits so clients can review them before enrolling in a plan.

Ensure clients enroll in the correct plan

Sometimes complaints occur if the client feels they were enrolled in a plan that does not fit their needs. The best ways to avoid this are; conduct a thourough needs assessment. Be sure you consider all medications, docotors and expected healthcare useage. Comparing mulitple plans and explaining the pros and cons of each helps the client make an informed decision.

Learn about rapid disenrollments

Be transparent coverage changes

Because Medicare plans can change every year, clients may be unhappy if they experience unexpected costs or coverage changes. To prevent this; be sure you procactively inform them of any modifications to their current plan, Remind them to take a look at their annual notice of change (ANOC). Offer an annual review during AEP to ensure thye are still in the best plan for their coverage needs.

Follow CMS compliance guidelines

The CMS has strict marketing and sales guidelines. Agents must avoid misleading or high-pressure sales tactics, use only approved marketing materials and be sure to obtain consent before discussing any pans. It is also important to never make unverified claims about coverage, benefits or plan costs.

Provide ongoing support

Clients appreciate agents who are accessible and responsive. To maintain trust; return calls and emails promptly. Offer assistance after enrollment, such as claims questions and benefit explanations. It is always a good idea to follow up to make sure clietns are happy and understand hw to use their plan benefits.

Handle issues and complaints professionally

Even with the best practices, complaints may still come up. When they do; be sure you listen attentively to the client’s concerns without interruption. It is important to acknowledge their frustration and provide a solution oriented repsonse. If it is necessary, escalate issues to the appropriate carrier rep or Medicare support services.

Document interactions

Keeping records of client communications, plan discussions, and enrollments helps protect agents and clients in case of disputes. Maintain notes from meetings, make note of any special concerns. Keep written enrollment confiramtions and copies of signed documents, authorizations especially the SOA.

Stay updated on Medicare rules and plans

Medicare regulations, plan offerings, and compliance rules change regularly. Stay informed by attending carrier training and webinars. Complete all annual certifications including AHIP. Join industry groups and network with other agents to stay updated on all industry and CMS rules.

If you are ready to join the team at Crowe; click here for online contract

Medicare agents play an important role helping clients navigate complex healthcare decisions. By being transparent, compliant, and client-focused, agents can minimize complaints, enhance client satisfaction, and build a strong reputation in the industry. Providing top-notch service not only leads to long-term client relationships but also increases referrals and business growth.

The Medicare Advantage market has experienced substantial growth in recent years, with Medicare C-SNP market growth one of the fastest-growing segments. C-SNPs cater to individuals with specific chronic illnesses, offering tailored benefits and care coordination. As healthcare costs rise and the over 65 population grows, C-SNPs are becoming the plan of choice for both beneficiaries and insurers.

What Are C-SNPs

Medicare Advantage Special Needs Plans (MA SNPs) provide targeted care and services to specific beneficiaries. Within this category, C-SNPs focus on beneficiaries with qualifying chronic conditions such as diabetes, cardiovascular disease, or chronic lung disorders. C-SNPs offer enhanced care management, specialized provider networks, and condition-specific benefits. These plans go beyond what traditional Medicare or standard MA plans provide.

Growth of the C-SNP market

Several factors are fueling the growth of the C-SNP market:

Chronic disease prevalence – Due to the aging U.S. population, the number of individuals with chronic conditions is rising. According to the CDC, six in ten adults have at least one chronic disease. This has increased the demand for tailored healthcare solutions.

Regulatory support – CMS continues to promote C-SNP expansion, offering increased flexibility in plan design and benefits to better meet the needs of chronically ill beneficiaries.

Increased insurer participation – As health plans recognize the financial and clinical benefits of offering C-SNPs, more insurers are entering the market. This leads to greater competition and plan innovation.

Improved care coordination – C-SNPs focus on the management or chronic conditions and care coordination, which aligns with the healthcare industry’s push towards value-based care.

Enhanced supplemental benefits – Many C-SNPs offer non-medical benefits, such as meal delivery, transportation, and in-home support services. This makes them attractive to eligible beneficiaries.

Challenges of C-SNPs

Regulatory issues – C-SNPs must meet stringent CMS requirements, including annual Model of Care (MOC) approvals and strict care coordination standards.

Enrollment requirements – Because C-SNPs require beneficiaries to have a qualifying chronic condition, plan enrollment may be more complicated than traditional MA plans.

Provider networks – Ensuring access to specialists and chronic disease management programs may be difficult in rural or underserved areas.

Watch a quick YouTube video on changes to DSNP & LIS members

The Future of C-SNPs

The future of the C-SNP market seems promising, with continued growth in personalized healthcare solutions and care coordination. As CMS allows flexibility in benefit design and insurers look for growth strategies, C-SNPs have an opportunity to become an even bigger part of the Medicare Advantage market.

Even with some challenges ahead, the potential for improved patient outcomes and cost efficiency make C-SNPs an important part of Medicare’s future.

In a memo dated March 20, 2025, CMS withdrawals DST SEP change. CMS announced the withdrawal of the changes to the enrollment process that were set to take place on April 1,2025. In other words, there will be no changes to the DST SEP policy that is currently in place.

Why this is good news

The reversal of this decision is great news for both agents and their clients. Because it takes the burden off of already stressed clients who have had to deal with a weather related or other FEMA declared area emergency.  This means, the current SEP will not change. Beneficiaries do not have to self-enroll using 1-800-Medicare to use this SEP.

As per the CMS memo of March 20, 2025, insurance carriers will accept enrollment applications submitted by licensed agents. This helps Medicare beneficiaries avoid both stress and confusion. It also allows agents to ensure the process is completed correctly and in a timely manor.

Medicare DST SEP

The DST SEP is an enrollment election period for qualified Medicare beneficiaries . CMS provides this SEP to those who miss a valid election period due to weather-related emergencies or FEMA declared disasters.

Only areas where state or local government officials declare an emergency or disaster can use this SEP. This SEP starts the date the incident occurs and continues for two months after it starts or the extension period begins. It can be in place for up to a year after the incident.   

Please note: Beneficiaries can either enroll in or disenroll from a Medicare plan using the DST SEP. New coverage goes into effect the first day of the month following the submission of the application.

Eligibility for the DST SEP

To qualify for this SEP, the beneficiary must live in the area the disaster occurred in. In addition, they must have missed a valid election period (AEP, IEP or OEP, or an SEP) because of the emergency.

In some cases, individuals use the SEP if they require help from a family member or caregiver who is impacted by a disaster. This can prevent them receiving the assistance they need during an enrollment period.

Watch a quick YouTube video on the changes to DSNP SEPs

A couple more reasons to use the DST SEP: When a disaster causes the inability to access Medicare plan information or submit an application. Another example is; when a disaster impacts a healthcare facility or provider. This can hinder the beneficiary’s access to information necessary to make an informed enrollment decision.  

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Due to the recent changes in DSNP SEPs, many agents are asking questions about the different levels of Medicare DSNPs. Medicare Dual-Eligible Special Needs Plans (D-SNPs) are a type of Medicare Advantage plan designed specifically for individuals who qualify. These plans offer specialized benefits tailored to meet the unique healthcare needs of dual-eligible individuals. However, not all D-SNPs are the same, and understanding the different types can help beneficiaries make informed decisions about their coverage.

We provide an overview of the DSNP models below:

CO-D-SNPs (Coordination Only D-SNPs)

CO D-SNPs meet the minimum CMS requirements for D-SNPs. All plans meet state requirements and hold a contract with state Medicaid agencies in the states they operate in. These plans also coordinate the delivery of Medicare and Medicaid services to their members. Because these plans do not qualify as HIDE or FIDE, beneficiaries cannot use the DSNP SEP to enroll in one of these plans. However, they can enroll in these plans during another valid election period.

Learn more about the DSNP SEP

AIP D-SNPs (Applicable Intergrated Plans) – Coordination Only EAE

AIP D-SNP is a fully integrated DSNP with exclusively aligned enrollment or a highly integrated DSNP plan with exclusively aligned enrollment and cover certain Medicaid benefits. To qualify as a AIP DSNP, plans must be either FIDE or HIDE SNP with EAE or a CO D-SNP with EAC that covers primary and acute care. It must also cover Medicare cost sharing and at least one of these home health services; medical supplies, equipment appliances or nursing facility services.

AIP D-SNPs must implement unified plan level appeals as well as grievance procedures.

Click here for full definition of DSNPs

HIDE SNPs (Highly Intergrated D-SNPs)

The HIDE SNPs provide Medicaid benefits to members either through the plan or an affiliated Medicaid managed care plan. Coverage includes LTSS (long term services and support), behavioral health care or both. Plans have a contract for Medicaid coverage with the state Medicaid agency. This may be accessed through the DSNP, the DSNP’s parent organization or another organization owned by the DSPs parent company. This contract must cover the entire service area.

FIDE SNPs (Fully Integrated D-SNPs)

These plans provide Medicare and Medicaid benefits under one entity that holds a Medicare advantage contract and a contract with the state Medicaid agency. FIDE SNPs must cover both Medicaid primary and acute care as well as LTSS, This includes at least 180 days each year of nursing facility coverage.

What is EAE

EAE is exclusively aligned enrollment which happens when states require DSNP enrollment be limited to only those who are fully dual eligible. Individuals must also receive coverage of Medicaid benefits through the DSNP or a Medicaid managed care plan owned by the same parent company as the DSNP. When a plan is exclusively aligned, it facilitates coverage integration ensuring better care for enrollees.

Why we need alignment

Alignment provides assurance that Medicare and Medicaid work together to provide comprehensive, coordinated coverage for dual eligible individuals. This provides members with a well organized system of care that improves health outcomes.

Watch a quick YouTube video on the new DSNP enrollment

How it works with D-SNPs

Aligned FIDE SNPs – these plans align Medicare and Medicaid under 1 carrier as 1 entity. Members access benefits with only 1 ID card. This helps members avoid confusion and ensures members easily get all the benefits they need.

Aligned HIDE SNPs – HIDE plans align Medicare and Medicaid under 1 carrier using 2 separate entities, possibly requiring members to use 2 different ID cards. In some cases, this may be confusing for members.

Unaligned HIDE SNPs – Unaligned plans operate as 2 separate managed care plans. The Medicare plan is managed by the Insurance Carrier while the Medicaid coverage is managed by the state Medicaid organization. This can result in at least 2 ID cards and in some cases, more.

Find out about other SEPs for Medicare enrollment

Choosing the Right D-SNP Plan

When selecting a D-SNP, it is crucial to consider the level of Medicaid eligibility, the extent of additional benefits, and the coordination of services. Since plan availability varies by state, beneficiaries should use licensed Medicare agents to review their options carefully to find a plan that best meets their needs.

For more information on Medicare D-SNP options in your state, consult Medicare.gov or your local Medicaid office.

Because some agents are unsure of the PAP ACC and MCD SEPs, we will go over them and try and clear up any confusion.  It is important to know; both CMS and the carriers monitor the use of these SEPs. They are reporting any inappropriate use of these SEPs. We hope this post provides information that makes is easier to use these SEPs properly. This will help prevent delays with your client’s application processing.

What is a PAP SEP

A PAP (Pharmaceutical Assistance Program) SEP is an enrollment period for individuals who qualify to enroll in the state’s pharmaceutical assistance program (SPAP). To qualify for the SPAP program, beneficiaries must meet specific income and asset requirements.

Click here to see a list of states where the SPAP is available

Who can use a PAP SEP

The PAP SEP begins when the individual enrolls in the SPAP. If an individual enrolls in the SPAP program, they receive one oppportunity annually to use this SEP. They can use it to enroll in or change their Medicare Advantage or PDP plan. Anyone automatically enrolled in a PDP plan by their SPAP cannot use this SEP.

If an individual receives notice that they no longer qualify for SPAP benefits, they can use the PAP SEP. The SEP begins the month they lose the SPAP and continues for two months after they are notified of the loss (whichever comes later).

What is an ACC SEP

The ACC SEP is a Medicare Advantage Special Enrollment Period for those who request plan information in an accessible format.  Beneficiaries cannot use the ACC SEP as an election period on it’s own. The beneficiary must have been eligible for another valid election period before they can use this SEP.  The ACC SEP ensures beneficiaries who requested information in an accessible format receive additional time to submit an application for a vailid election period. This helps them get enrollment requests processed by extending the deadlines for application submissions.

Accessible format is a way of receiving health coverage information in a way that can be understood by individuals with disabilities. This format includes large print, Braille, audio recordings, or digital text that can be read by screen readers. This allows beneficiaries to access and understand important medical inforamtion and make appropriate plan choices.

Find out about the CT MSP income limits 2025

Who can use an ACC SEP

The ACC SEP is available to any Medicare beneficiary who did not recieve the materials they needed to make an informed enrollment decision in an accessible format at the same time standard material is provided.

Important: This is not a “stand-alone” election period. Indviduals must have been eligible of another valid election period but didn’t have the information they needed in an accessible format to make an informed decision in time. This SEP starts at the end of an election period in which the beneficiary submits a request for accessible formatted materials. The SEP is ineffect for at least as long it takes for the beneficiary to recieve the materials.

Watch a YouTube video on new rules for Dual and Drug help in 2025

What is an MCD SEP

The code MCD is for Medicaid and can only be used by individuals who have a change in Medicaid status of some type. Individuals who are newly eligible for Medicaid, lose eligibility Medicaid, or who’s Medicaid status changes can use the MCD SEP. Qualified individuals can use this SEP once within 3 months of the qualifying event or notification of change (whichever is later).

Who can use the MCD SEP

The MCD SEP applies to Medicare beneficiaires who:

Become eligible for any type of assistance through the Title XIX program. This includes partial duals who receive cost sharing assistance under Medicaid.

Those who lose eligibility for assistance or have a change in the level of assistance they qualify for. This applies even if they stop receiving Medicaid benefits or still qualify for LIS (Low Income Subsidy).

This SEP gives individuals one chance to make a change within 3 months of a qualifying event or when they receive a notice of the changes, whichever is later.  The effective date for enrollments is the first day of the month after the carrier recieves the enrollment request.

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Please remember: Agents must use the correct SEP code to ensure carriers can process enrollments in a timely manner. Using an incorrect code could cause a delay or denial by the carrier. In some instances, it can result in the agent receiving corrective action from carriers and/or CMS. 

If you are a Medicare agent, you know that 2025 has been a challenge finding plans that offer the benefits our clients are looking for. That is why we want you to take a look at the Connecticare Medicare Advantage Plans 2025. The plans offer some great coerage with many great supplemental benefits.

Connecticare Medicare Advantage Plans 2025

Connecticare is offering 5 Advantage plans in 2025 this includes 1 D-SNP. Each plan is available statewide in all counties of CT.

It is important to note: these plans also provide coverage in NY with Emblem providers.

Here are some of the plan highlights:

All the plans include SilverSneakers to help members stay active. Plans also include a $0 Teledoc copay amount and over $150 in member rewards ad a comprehensive formulary.

If you are an agent who is ready to join our team; click here for contract

Choice Plan 3 (HMO-POS)

This plans has a $0 monthly premium. It also has a $0 co-pay for PCP visits and a $35 specialist co-pay. The cost for anual physicals, screenings and immunizations is $0.

Although hearing services are not covered on this plan, it provides a $0 preventative dental benefit that covers cleanings, exams, flouride treatments and standard x-rays every 6 months. It also proides up to $2,000 of comprehensive dental coverage. A free eye exam is included each year and up to $400 for eyewear and $50 per month for mail order OTC items.

Passage Plan 1 (HMO-POS)

The Passage Plan 1 also offers members a $0 premium plan with several great benefits. PCP visits are $0 and the specialist co-pay is only $35.

This plan offers some very generous benefits that include; a hearing benefit for hearing servies and hearing aids of $3,000 annually. The dental benefit covers 1 exam, cleaning, flouride & standard x-rays at no cost every 6 months. The dental coverage includes a comprehensive dental benefit of $2,000. Additioanlly, they also provide a $0 eye exam each year and $550 of eye wear coverage. There is a $75 monthly OTC allowance for plan members. As you can see, this plan includes a fantastic benefit package.

Click here to download a copy of the full 2025 Connecticare First Look

Flex Plan 3 (HMO-POS)

The Flex Plan 3 has a low monthly premium. In the counties of Hartford, Litchfield ,& Tolland, the premium is $29 per month. In the counties of Fairfield, New Haven, New London & Windham; the preium is $36 per month.

This plan has a low PCP co-pay of $5 per visit and a $50 specilaist co-pay amount. Although this plan doe snot include a hearing benefit, it does provide1 dental exam with cleaning, flouride and standard x-rays every 6 months. The plan also offers dental riders for $27 a month for $2,000 or $35 a month for $3,000 of comprehensive coverage. Vision coverage includes a $0 eye exam and a $300 eye wear allowance annually. The OTC benefit for this plan is $50 per quarter.

Watch a YouTube video of the plan benefits

Choice Plan 2 (HMO-POS)

The Choice Plan 2 is another great plan option offering members a $0premium, a $0 co-pay for PCPs and a very low $10 specialist co-pay.

Addtional plan benefits include a $3,000 annual hearing benefit that covers hearign exams and hearing aids. A dental beenfit that covers 1 exam, cleaning, flouride & standard x-rays every 6 monthsas well as $3,000 in coverage for comprehensive services. Additioanlly, the plan provides a $50 monthly OTC benefit.

Important: prescrption drugs are not covered on this plan.

Choice Dual (HMO-POS D-SNP)

In order to enroll in this plan, members must be QMB+, SLMB+, and FBDE eligible. The premium for this plan is $0; as are all doctors visits including; specialists, lab services, in-patient hospital and more.

Learn about the CT MSP income limits 2025

Hearing benefits for each year are $2,500. The plan provides a $0 eye exam as well as a $500 annual eye wear allowance. The dental benefit is $0 for preventative services (cleanings, exam, fouride & stnadard x-rays) every 6 months and includes $3,000 for comprehensive benfits.

Are you a Crowe agent who wants to add Connecticare products; click here for contract

As you can see while other plans have scaled back their benefits, Connecticare has increased benefits. This carrier provides some great plan options and is worth taking a look at for your clients coverage.

Make sure you are aware of the Medicare SEP changes for 2025

Medicare offers several options for health coverage, including Original Medicare and Medicare Advantage (Part C). Choosing the right plan can be challenging, especially if you’re trying a Medicare Advantage plan for the first time. Fortunately, Medicare provides trial rights that allow beneficiaries to switch back to Original Medicare under specific conditions. Understanding Medicare trial rights helps beneficiaries make informed decisions and avoid being locked into a plan that may not meet your needs.

What are Trial Rights

Medicare trial rights are special protections. They allow beneficiaries to return to Original Medicare if they are dissatisfied with their Medicare Advantage plan. These rights apply in two primary situations:

Those who enroll in a Medicare Advantage plan when first eligible for Medicare and decide within the first 12 months that it’s not the right fit, can return to Original Medicare. You can also enroll in a Medicare Supplement (Medigap) plan without facing medical underwriting restrictions.

Beneficiaries who had a Medigap plan and dropped it to join a Medicare Advantage plan for the first time, can switch back to Original Medicare anytime within the first 12 months. Additionally, they have the right to re-enroll in the same plan they had previously if it is still available. If it is not, they can purchase a different Medigap plan.

Why are Trial Rights important

Medicare Advantage plans may not always work out as expected. They typically have provider networks, may require referrals for specialists, and can come with different costs than Original Medicare. If the beneficiary’s preferred healthcare providers are not in-network, or the coverage does not suit their healthcare needs, trial rights provide a way to switch back without penalty.

Click here to watch a video on what you need to know before a Medicare sale

Understanding how to use a Medicare Trial Right

Those who decide to use the trial right should:

• Contact a Medicare agent, if possible to get the best plan options to fit coverage needs. Those who don’t have an agent; call Medicare at 1-800-MEDICARE or visit Medicare.gov to change their plan back.
• Be sure to apply for a Medigap policy within the 12-month window, if they want supplemental coverage. This helps ensure coverage without going through underwriting.
• Because Original Medicare does not include prescrption drug coverage, it is also important to enroll in a standalone PDP plan.

Things to remember

• Medicare trial rights allow beneficiaries to return to Original Medicare within 12 months of enrolling in a Medicare Advantage plan for the first time.
• Those who switched from a Medigap policy to a Medicare Advantage plan for the first time may be able to reinstate their Medigap policy. If it is not available anymore, they can or get a new one.
• These rights help protect beneficiaries from being stuck in a plan that does not meet their healthcare needs.

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Ready to join the team at Crowe; click here for online contracting

It is important to understand the rights of your clients to ensure they have the flexibility to choose the best coverage for their healthcare needs. If a client enrolls in a Medicare Advantage plan for the first time, explain the time available should they want to go back to Original Medicare. To take advantage of these protections, act within the trial period.