Medicare Advantage Plans in Southeastern CT
What are they!
Managed by private companies, Medicare Advantage (MA) plans replace the original MediCare "system" by managing their members' medical treatments/services & prescriptions plus paying providers.
Note: (MA) plans are MediCare's Part C. Each company has a yearly contract with CMS.
MA plans were developed to provide Medicare beneficiaries with:
● All medical procedures & services covered by Part A & Part B.
● All treatment/services through the plan's network of providers.
● A complete annual physical and Additional coverage not available in original Medicare.
● Most plans include what is called Supplemental benefits such as vision and dental; in others, they can be added at an extra cost.
● Prescription coverage is included in most MA plans. The plan is then called a MAPD.
MA companies focus on improving members' treatment outcomes by monitoring and coordinating all their medical services and prescriptions.
Recent studies have shown that "enrollees are much healthier than enrollees who stick with 'Original Medicare,' with or without Medicare supplement insurance."
To improve the outcome of medical treatment many MAPDs are focusing on Social Determinates of Health. (SDoH) This involves monitoring all the events and happenings in a person's life and surroundings.
For example, health can decline if patients do not attend follow-up appointments after hospitalization. To correct this, some MA plans provide transportation to needed medical visits as a no-cost benefit. Paying for a vehicle is cheaper than paying for additional expensive treatment. Thus, considering SDoH factors results in better health.
What you gain by enrolling in one of New London County MAPDs!
● an individual's outcome after receiving treatment is often better — plus the quality of the care received is usually higher!
Why? All the treatment an individual receives is coordinated and monitored, which means better results. Monitoring medications adds to this!
● A Better Medicare Alliance study found — "individuals in private MA plans had:
- > one-third fewer ER visits
- > 23% fewer stays in a hospital than those in traditional fee-for-service MediCare."
● People enrolled in MAPDs report they like their plan because:
-> They can receive a complete annual physical (not in basic Medicare) and other supplemental benefits.
-> "75% of regular Medicare Advantage members used at least one supplemental benefit a year, and 48% used at least two supplemental benefits."
-> The monthly cost is usually significantly lower than that of a MediGap plan with a stand-alone Part D plan. Lower cost is a Big Plus for many.
What do you "have to do" when enrolled in a MAPD? — You:
● Continue to pay your monthly Part B cost.
● Pay the MA companies plan's monthly cost, if any.
● Use the MDs and other providers in the company's network when treatment or service is needed.
● Show any providers you use the ID card for your MA plan' not your MediCare card. They bill your MA company for your treatment, not the MediCare system.
What are the costs — when using the MAPD plan's providers?
When going to an MD for medical treatment:
● Visits for a preventive exam or test have no cost.
● Visits to an MD about a condition/situation will have a co-pay.
● The co-pays to see a Specialist will be higher than your primary care MD.
When receiving more complex medical treatment such as:
● A diagnostic test. There will usually be cost-sharing, such as 20% or a specific fee.
● Being admitted to a hospital for a complex situation. Plans have a per-day fee, usually for the first four or five days.
If a complex condition develops with ongoing treatments/services, the plan's Maximum out-of-pocket (MOP) provision will limit your ongoing medical-related costs during the year.
Note: MediCare limits the medical MOP each year. (up to $8,300 in 2023) Plans with no monthly cost often have an MOP close to the maximum.
When going to the Pharmacy for medication:
● Costs for medications are not included in the MAPD plan's medical cost MOP. The prescription part of the plan has a separate MOP.
When the Prescription Drug Plan (PDP) program was created in 2004, all companies were to develop plans with four coverage stages :
● First — the Deductible. Many plans only apply it to medications in higher Tiers.
● The second stage — Initial Coverage, where you pay co-pays or cost sharing.
● The third stage — Coverage Gap [was initially called the donut hole] Over recent years, it has been improved, and now you pay 25% cost sharing for Brands and Generics
● Fourth — the Catastrophic stage. In 2023, an individual usually pays 5%, and there is no MOP for medication-related costs. Beginning in 2024, improvements will be made to eliminate this 5% cost-sharing.
Note: The co-pays and cost-sharing the PDP company uses will vary based on the Tier level in which they placed the medication.
Learn about the eight MAPD companies in New London County in 2025 and their 29 options by calling:
John C Parker's Google Voice # — (860) 451-9793 today if you:
+ Will soon be 65
+ Are you planning to leave an employer plan and want to sign up?.
When meeting, we can:
● Review your situation and interests:
● Take time to help you better understand MediCare and simplify how the Medicare Advantage Plans in New London County, Connecticut work.
● Select, when an enrollment period is available, a MAPD that fits your situation and will provide peace of mind.
In thinking about and considering a MAPD, be alert for deceptive TV ads:
- > Some say, which is not so, that anyone on Medicare can get certain benefits.
Note: Only individuals whose income qualified them for MedicAid, in addition to MediCare, and thus are dual eligible:
- > can sign up anytime during the year.
- > can qualify for many of the benefits mentioned
In addition, one retirement-focused ad mentions their MediGap plan (a Medicare Supplement); however, it is not approved in CT!
Working with a professional Medicare Health Plan Professional
MediCare's federal marketing regulations require any phone discussion about enrolling in or the benefits of a Medicare Advantage or Prescription Drug Plan to be recorded.
However, when meeting face-to-face, which is more effective, a recording is not required:
- > we can talk on the phone about your situation
- > then meet to review plan benefits and options
- > if you are interested in a plan, we can meet again to sign up.
BTW - Most enrollment forms can be completed online, but understanding - what a question on the application means is more straightforward when meeting in person.
Individuals gain a lot from meeting with a Medicare Insurance professional to enroll.
How are MAPDs developed?
● Companies developing a MAPD plan submit the proposed benefits to the MediCare system for approval. The request also indicates the Counties where the company wants to offer this plan.
● When approved, the company signs a one-year contract.
● Marketing the plan to individuals can begin Oct. 1st for a Jan 1st effective date.
● Individuals can enroll from Oct 15th to Dec 7th in a plan approved for the County where they reside.
MediCare pays the MA company a fixed monthly payment to manage treatment, pay providers, etc., for each person who signs up for their MAPD.
Times to sign up for a MAPD — generally called election periods — are set by federal regulations.
Each period's name and how it can be used, is described below. They are listed in priority order:
Priority One — Initial Coverage Election Period (ICEP)
● The ICEP is a one-time, seven-month period at age 65 to apply for a Medicare Advantage plan! — People usually select a MAPD, an MA plan with prescriptions.
Note: The ICEP is at the same time as the Initial Enrollment Period (IEP) for signing up for Medicare's Parts A and B for the first time.
The ICEP allows a person to apply for coverage in either month 3, 2, or 1 before eligible, during their eligible month, and in month 1, 2, or 3 after 65.
Priority Two — Medicare Advantage Open Enrollment Period (MA OEP)
● The MA OEP is a special once-a-year time from Jan 1st to March 31st. It was developed so an individual in an MA or MAPD who is dissatisfied with some part of their plan can make a change.
How the MA OEP works. An individual can:
-> Select a new MA or MAPD with their current or another company.
-> Return to original Medicare, select a stand-alone Prescription Drug Plan (PDP), and a Medicare Supplement plan.
● A person who signed up for MediCare when first eligible and enrolled in a MA or MAPD can also make a change during the first three months they are enrolled using the MA OEP.
Priority Three — Special Election Period (SEP)
● The SEP is a time for individuals who have certain life events to change their MAPD, such as:
-> moving to a different state.
-> learning they qualify for Extra Help with prescription costs.
In addition, there are various situational SEPs. One example is a person enrolled in a Medicare Supplement who changed to an MA/MAPD and became dissatisfied during the first 12 months. They can then:
-> Return to Medicare, apply for a Medicare Supp and a PDP.
Priority Four — Annual Coordinated Election Period (AEP)
● The AEP is the most common time when individuals can change their MA or PDP.
● It happens each fall, currently from October 15th to December 7th.
● New coverage selected during the AEP is effective January 1st.
Individuals can make changes during the AEP, such as selecting a:
● Different plan from their current Medicare Advantage company.
● plan with a different Medicare Advantage company;
Priority Five — Open Enrollment Period for Institutionalized Individuals (OEPI)
● The OEPI is for individuals in a long-term care facility
● Gives them the flexibility to meet their medical situation! They can make changes:
-> when entering,
-> while in,
-> within the first two months after leaving.
Why do election periods have <—> priorities?
If a person's life situation results in being eligible for two election periods, the rules say the plan they selected will be effective based on the highest priority election period.
For example, A person who is moving would qualify for a SEP, but if the move happens during their seven-month ICEP, the effective date for the coverage they select will be based on the ICEP enrollment rules, which is Priority One.
John is required by CMS marketing regulations to inform Medicare beneficiaries that:
● He is appointed and certified by all eight Medicare Advantage (MA) companies offering plans during 2025 in New London County, the only area where he helps individuals. These companies have 29 regular MA plans. John is pleased to review and offer beneficiaries:
● He is also appointed and certified by six Prescription Drug Plan (PDP) companies offering 14 plans in New London County and CT.
● Beneficiaries can also find help with plan choices in New London County by contacting:
+ Medicare.gov and
+ CT's State Health Insurance Program (SHIP).
< - - > However, this help will not be from a licensed or certified professional.
Note: CMS regulations state that any information created about Medicare Plans, such as the content on this website, that does not mention a company name, plan benefit details, or plan costs, is considered Communication material, not marketing material.
[Thus, the information on this site does not have to be approved by CMS.]