Connecticut Medicare Advantage: The Best & Worst Plans

If you’re looking for more coverage than Medicare Parts A and B provide, you might want to consider a Medicare Advantage plan, also known as Part C. But make sure the plan’s provider network is ok for you, and remember that a $0 monthly premium isn’t always worth it in the long run.

Medicare Advantage plans are one way to get Original Medicare health insurance (Parts A and B), usually bundled with additional benefits like prescription drug coverage or dental care. Around 45 percent of Medicare beneficiaries in Connecticut have an Advantage plan. Many people like Advantage plans because, in addition to extra benefits, they include a maximum out-of-pocket limit on what you’re required to pay for covered services each year.

A drawback to Medicare Advantage (MA) plans, though, is that you are limited to your plan’s network of providers and facilities, which means fewer choices and potential difficulty finding covered care if you move, live in two places, or are traveling. You’ll also likely need a referral to see a specialist.

Advantage plans are sold by private insurance companies, so availability and price will vary by location. This is why it’s critical that you do some research and compare prices.  With about 39 Medicare Advantage plans available across Connecticut, you’re likely to have several plan options in your area. There is no objectively “best” Medicare  plan—the best plan for you is the one that gets you the coverage you need for the least amount of money.

Before you make Medicare decisions, take time to consider your current health care needs, what you might need in the future, and your budget. Then shop around for plan options.

You can get started with Insurify ’s free Medicare comparison tool to find the right Medicare plan for you. Shop Medicare Advantage plans as low as $0/month—all you need is your ZIP to get started.

We know your health plan choices can be overwhelming— that’s why we have licensed insurance agents available to provide objective assistance, free of charge. Give us a call at 1-844-965-1378 (TTY 711) Monday-Friday 8am – 8pm ET.

What Are the Top-Rated Advantage Plans in Connecticut?

Medicare uses a star rating system to measure how well Medicare Advantage (and Part D) plans perform, with five stars being the best.  Each plan is scored in several categories: staying healthy, managing chronic conditions, plan responsiveness, member complaints, and customer service. Plans also receive an overall star rating which reflects overall performance. The star ratings can help you compare different plans. You can learn more by looking at a plan’s rating in each category.

Remember that the best Medicare plan is the one that will get you the care you needed for the least amount of money. There is no objectively “best” plan.

Below are the top-rated HMO and PPO Advantage plans in the state, including their monthly premiums, deductibles, and out-of-pocket maximum limits.  The Affordable Care Act (also called Obamacare) requires that all plans include preventive health care services for a $0 copay, at least at in-network providers.

Disclaimer: The plan the benefit information provided is a brief summary, not a complete description of benefits. For complete information, contact the plan.

Aetna Medicare Elite Plan H5521-157 (PPO)

• - **Premium: $0.00 / month
  **

• **Health Plan Annual Deductible: $0
  **

• Annual Out of Pocket Max: $6,700 (not including prescription drugs)

Available in New Haven, Fairfield, Middlesex, Tolland, Hartford, Litchfield, Windham, New London, this four-star plan includes prescription drug coverage with no deductible and $0 copays for 30-day supplies of tier 1 and 2 drugs at preferred retailers. Beneficiaries also enjoy $0 copays for in-network eye exams, glasses, and contacts. Preventive and comprehensive dental are included at 50% coinsurance. Hearing exams are $45 at in-network providers.

Aetna Medicare Explorer Premier Plan H5521-013 (PPO)

• Premium: $99/month

• Annual Prescription Drug Plan Deductible: $250

• Annual Out of Pocket Max: $7,550

This four-star plan is available in Fairfield, Hartford, Litchfield, Middlesex, New London, Tolland, Windham, and New Haven counties. In-network primary care visits are $10, and in-network specialists are $45. What makes this plan a little more expensive is that preventive and comprehensive dental services are provided with $0 copay regardless of provider. The plan offers $0 copays for tier one drugs at preferred retailers. Routine eye exams, glasses, and contacts, are included with no copay. In-network hearing exams require a $45 copay.

Aetna Medicare Prime PCP Elite Plan H5793-012 (HMO)

• - **Premium: $0/month
  **

• **Annual Deductible: $0
  **

• Annual Out of Pocket Max: $6,700 (does not include prescription drugs)

**
** Residents of Fairfield, Hartford, Litchfield, Middlesex, New Haven, New London, Tolland, and Windham counties have access to this four-star plan. Remember that with HMOs you often have to pick a primary care provider, but your copays for those visits will be $0. Specialist visits will likely require a referral and a $40 copay.  Hearing exams are $40, and preventive and comprehensive dental visits are offered at 50% coinsurance. Routine eye exams, glasses and contacts are included with no copay.

Aetna Medicare Value Plan H5793-001 (HMO)

• Premium: $99/month

• Annual Deductible: $0

• Annual Out of Pocket Max: $7,550 (does not include prescription drugs)

Fairfield, Middlesex, New Haven, New London, Hartford, Windham, Litchfield, and Tolland county insurers offer this four-star plan. As with Aetna’s Explorer plan (#2 above), this plan costs a bit more because preventive and comprehensive dental services are covered with zero cost sharing. The plan requires no deductible for the prescription drugs, and cost sharing for tier one prescription drugs is $2 for 30 day and $5 for 90 day. Medical visits are slightly more expensive than with some other plans, at $15 for primary care and $50 for specialists. Hearing exams are $50, and routine eye exams, glasses, and contacts are included at no cost to you.

Anthem MediBlue Extra H5854-011 (HMO)

• Premium: $35.20/month

• Annual Prescription Drug Deductible: $445

• Annual Out of Pocket Max: $6,700 (does not include prescription drugs)

This HMO plan has four stars and is available in Fairfield, Hartford, Litchfield, Middlesex, New Haven, New London, Tolland, and Windham counties. While this plan has a deductible for prescription drugs, note that all tier one medications and tier six select care drugs are covered with $0 copay. Primary care visits are only $5, and specialists and hearing exams are $40. Outpatient mental health visits, at $25, are cheaper with this plan than some others. Routine vision exams, glasses and contacts are covered with no cost to you.  Preventive dental exams, cleaning, and x-rays are covered with $0 copays, but fluoride treatments and comprehensive dental services are not covered with the standard package. Enrollees can choose to buy optional plan supplements to increase comprehensive dental coverage.

Anthem MediBlue Plus H5854-007 (HMO)

• Premium: $26/month

• Annual Prescription Drug Deductible: $445

• Annual Out of Pocket Max: $6,700 (does not include prescription drugs)

This four-star plan is only available in Hartford county. Its high prescription drug deductible comes with the benefit of all tier six select care drugs available at a $0 copay. Primary care visits are $20 and specialists (including hearing tests) $50. Apart from routine eye exams, no vision care is included with the standard plan, nor are dental services. Optional supplemental benefits for eyewear, preventive, and comprehensive dental are available for an extra monthly cost.

Anthem MediBlue Select H5854-010 (HMO)

• Premium: $0/month

• Annual Prescription Drug Deductible: $275

• Annual Out of Pocket Max: $6,950 (does not include prescription drugs)

Residents of F airfield, Hartford, Litchfield, Middlesex, Windham, and New Haven counties have access to this four-star plan. Though it comes with a prescription drug plan deductible, tier six select care drugs always have a $0 copay, as do tier one drugs at preferred retailers. Primary care visits are low cost at $5, and specialist visits are $40. Hearing exams are $45. Oral exams and cleanings for preventive dental care are included in the basic package, with additional dental coverage available through optional supplemental benefits (an additional monthly fee). Routine eye exams, glasses, and contacts are included with no copay.

ConnectiCare Choice Part B Saver H3528-017 (HMO)

• Premium: $0/month

• Annual Prescription Drug Deductible: $445

• Annual Out of Pocket Max: $7,550 (does not include prescription drugs)

Another four-star plan, this is available to residents of Hartford, Fairfield, New Haven, Middlesex, Tolland, Windham, New London, and Litchfield counties. Note that tier six select care drugs are not covered by this plan. Primary care visits are $25, specialist visits are $50, and hearing exams are $40. Routine eye exams are only $10, while glasses and contacts are covered at a $0 copay. No preventive or comprehensive dental coverage is included in the basic plan, but optional supplemental benefits can be purchased for an extra monthly fee.

What Do Medicare Advantage Plans Cover?

All Advantage plans include Medicare Parts A and B. The benefits of these two parts are standardized by the Centers for Medicare and Medicaid Services (CMS), so all A and B plans will cover the same benefits.

Most Connecticut Medicare Advantage plans also include a prescription drug plan, aka Medicare Part D. And some Advantage plans include extra benefits like preventive dental, hearing, vision, or wellness programs.  Be sure to check the details of the plans you’re considering.

However, many MA plans limit you to a certain network of health care providers, especially if you want the lowest cost. Before enrolling, you should check to see if your preferred providers and facilities participate in the plan’s network.

Similarly, if the MA plan you’re considering offers prescription drug coverage, check to see if your medications are included in the list of covered drugs (called a formulary) and how much they will cost.

How Much Will My Medicare Advantage Plan Cost?

There’s no simple answer to this question. While the Part A and B benefits of all Advantage plans are set by the federal government, these plans are sold by private insurance companies who set different prices. (This is why you need to shop around!) Your total costs will depend on which plan you buy, what health care services you use, and what providers you see.

With MA, you are responsible for monthly premiums (including your Medicare Part B premium, which was based at $148.50 in 2021) as well as your deductible, copayments and/or coinsurance.

Take note that a low monthly premium—some Advantage plans even have $0 premiums—isn’t always worth it in the long run because your deductible and/or out-of-pocket max could be very high.

When predicting your total out-of-pocket costs with an Advantage plan, be sure to consider not only your monthly premium and your deductible but also the frequency of health services you need (and their copays), whether your providers are in the plan’s network, and whether your medications are included in the plan’s formulary. Also think about whether the annual deductible is feasible for you.

Remember that one upside of MA plans is that they have maximum limits on your out-of-pocket costs. The caps, though, can range from $5,000 – $8,000 dollars, which is a lot of money for most people.  (Some people with a lot of health care needs find that Medigap, or Medicare supplement plans, can ultimately provide a lower out-of-pocket expenditure even though the premiums are higher.)

Since prices of MA plans will vary even within a single state, be sure to shop around and compare prices before making a decision!

Ready for Medicare to work for you? Use the Insurify Medicare comparison tool to explore Connecticut Medicare plans. Start with your ZIP code, and you’ll be comparing plans in less than two minutes. Try it today!

What Types of MA Plans are Available in Connecticut?

There are several different types of Medicare Advantage options in the state:

• Health Maintenance Organizations (HMO plans): These plans require you to choose a primary care provider, and you must get all your non-emergency care (like doctor visits) from providers within the plan’s network for the services to be covered. Most HMOs include Medicare Part D prescription drug coverage. Sometimes HMOs are the only plan type available in an area.

• Preferred Provider Organizations (PPO plans): You’ll probably have a wider choice of doctors, but you’ll pay less when you use in-network providers. Most PPO plans include coverage for prescription drugs.

• Private Fee-for-Service Plans (PFFs): With these plans, you can see any provider who accepts the terms of your plan, but it can be difficult to find someone who accepts, and a provider can decide at every visit whether to accept the plan and agree to treat you.

• Special Needs Plans (SNPs): Special Needs Plans are tailored to the health care needs of certain populations, such as people who have certain serious/chronic health conditions, who qualify for both Medicare and Medicaid, or who live in a nursing home or other facility.

Am I Eligible for Medicare Advantage?

The primary eligibility requirement is that you’re enrolled in Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). Other than that, you need to be a U.S. citizen or lawfully present and reside in the service area of the Advantage plan you’re considering.

You also can’t have end-stage renal disease (ESRD). There are special plans for people with this health condition.

When Can I Join, Drop, or Change MA Plans?

There are several key time frames when you can add or make changes to your plan:

• Initial Enrollment Period: This is the seven-month period that begins three months before you turn 65 and ends three months after.

• Annual Open Enrollment Period. From October 15 – December 7, you can join, change, or drop a plan. Your coverage will begin on January 1 (as long as the plan gets your request by December 7).

• Annual Medicare Advantage Open Enrollment Period. From January 1 – March 31, Medicare Advantage enrollees can switch to a different Advantage Plan or switch to Original Medicare (and join a separate Medicare drug plan).

There are also “special enrollment periods” for when certain things happen, like if you move or lose other health coverage.

FAQ: Connecticut Medicare Advantage

Compare Medicare Advantage Plans Before Buying

Advantage plans appeal to many Medicare beneficiaries who want a bundled option for getting their health insurance. But since the private insurance companies who sell these plans can set their own prices, you need to shop around before making a decision.

Insurify’s price comparison tool can help you quickly and easily find Medicare plan options in your area, and our licensed insurance agents are here to offer objective assistance, free of charge, Monday-Friday 8am – 8pm ET. Compare prices now using just your zip code, or give us a call at 1-844-965-1378 (TTY 711)