- ConnectiCare is a managed care company that provides Medicare Advantage (Part C) plans to Connecticut residents.
- These plans work with in-network providers throughout Connecticut and even in some neighboring states.
- Every ConnectiCare Part C plan covers as least as much as original Medicare, plus some extras like prescription drug, dental, and vision coverage.
ConnectiCare is a managed care company and subsidiary of New York–based healthcare insurer, EmblemHealth. It offers Medicare Advantage (Part C) plans to people who live in Connecticut.
The ConnectiCare network of providers, including general practitioners and specialists, can be found throughout the entire state of Connecticut and in western Massachusetts. ConnectiCare providers also practice in four New York counties, including Westchester, Orange, Putnam, and Rockland.
Read on to learn what the Medicare Advantage plans from ConnectiCare offer and to get a look at how much they might cost.
ConnectiCare Medicare Advantage plans are available only to residents of Connecticut. You must also be eligible to enroll in Medicare.
These plans are available in all eight Connecticut counties.
ConnectiCare offers four types of Medicare Advantage plans. Next, we’ll go over the basics of what each type offers.
ConnectiCare Choice plans (HMO)
Like all Health Maintenance Organization (HMO) plans, ConnectiCare Choice plans pay for only the medical care you receive from in-network providers, pharmacies, and hospitals.
There are three Choice plan levels, indicated by numbers 1, 2, and 3. Each level has different costs and provides varying degrees of coverage. All three plans are available in all eight counties.
Plan 1 and Plan 3 include Medicare Part D prescription drug coverage. Plan 2 does not.
ConnectiCare Passage plan (HMO)
There’s only one ConnectiCare Passage plan. What sets this plan apart is its $500 hearing aid allowance.
The ConnectiCare Passage plan is available in all eight Connecticut counties and includes prescription drug coverage.
ConnectiCare Flex plans (HMO-POS)
Like all HMOs that include a Point-of-Service (POS) option, ConnectiCare Flex plans give you the ability to use out-of-network providers throughout the United States.
There are three Flex plan levels, indicated by numbers 1, 2, and 3. All three plans are available in all eight Connecticut counties.
Flex Plan 3 has a varying monthly premium based on the county where you live.
ConnectiCare Choice Dual plan (HMO D-SNP)
It’s available in all eight Connecticut counties and includes prescription drug coverage.
As discussed above, certain ConnectiCare Advantage plans include Medicare Part D prescription drug coverage. ConnectiCare doesn’t sell any stand-alone Part D plans.
You must use ConnectiCare in-network pharmacies to get the most coverage for your prescription medications.
Like all Medicare plans that provide prescription drug coverage, ConnectiCare HMO and HMO-POS plans have a formulary.
A formulary is a list of covered prescription drugs that’s divided into tiers. These tiers include different types or categories of medications. Each tier has different out-of-pocket costs, deductibles, and copays.
ConnectiCare’s formulary includes five tiers. Copays for medications on each tier vary based on whether or not you use a standard or preferred pharmacy, with preferred pharmacies being less expensive.
Tiers 1 and 2 are not subject to an annual deductible. For medications on tiers 3, 4, and 5, you’ll pay aa deductible that varies by plan.
Generally, the higher tier your drug is in, the more expensive your copay will be. Here’s an overview of the types of drugs included within each tier:
- Tier 1: preferred generic drugs
- Tier 2: generic drugs
- Tier 3: preferred brand drugs
- Tier 4: nonpreferred brand drugs
- Tier 5: specialty drugs
Some of these services include:
- in-patient hospital care
- hospice care
- limited skilled nursing facility care
- limited home health care
- emergency ambulance services
- durable medical equipment
- outpatient preventive and medically necessary services
- screenings for conditions like diabetes, cardiovascular disease, certain types of cancer, depression, and substance use disorder
- flu and pneumonia shots
Some ConnectiCare plans provide additional coverage for:
- preventive or comprehensive dental care
- prescription drugs
- vision care and an eyewear allowance
- fitness programs
- Teledoc services
- emergency services required outside of the United States
- SilverSneakers program
- an allowance for over-the-counter medical items
The copays, deductibles, and premiums for ConnectiCare plans may vary from county to county. The table below provides some samples costs for a few different ConnectiCare Medicare Advantage plans in a few areas across the state.
|Location, plan||Monthly premium||Health deductible, drug deductible||Primary care copay||Specialist copay||Out-of-pocket max|
|Bristol, CT: ConnectiCare Choice Plan 3 (HMO)||$0||$395, $445||$10||$45||$7,550|
|Stamford, CT: ConnectiCare Passage Plan 1 (HMO)||$0||$0, $275||$25||$50||$7,550|
|West Haven, CT: ConnectiCare Choice Dual (HMO D-SNP)||$0||$0, $445||$0||$0||$7,550|
|Norwich, CT: ConnectiCare Flex Plan 2 (HMO-POS)||$134||$0, $300||$15||$35||$6,000 in network, $10,000 out of network|
Medicare Advantage (Part C) plans are optional insurance plans you may choose to purchase from a private insurance company. To buy a Part C plan, you must first enroll in original Medicare.
By law, Part C plans are required to cover at least as much as original Medicare. Many Part C plans, including some ConnectiCare plans, also cover extras that original Medicare doesn’t. These extras may include:
- prescription drug coverage
- vision coverage
- dental coverage
Not all Part C plans are available in every location. Your state, county, and ZIP code determine what plans you are eligible to buy. You can search and review the Part C plans available in your ZIP code using Medicare’s plan finder tool.
Part C plans typically require that you see providers within their network. If you wish to keep your current doctors who accept Medicare assignment, check to see if they’re listed under the plan you’re considering before you sign up.
- ConnectiCare offers Medicare Advantage plans to residents of Connecticut.
- ConnectiCare plans are available in all eight counties in Connecticut.
- ConnectiCare’s plans vary in terms of copays, deductibles, and covered services.
- Some, but not all, ConnectiCare Part C plans include prescription drug coverage.
This article was updated on November 20, 2020, to reflect 2021 Medicare information.
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