Medicare Advantage Plans in Southeastern CT
What are they!
Medicare Advantage (MA) plans replace Medicare's original "system". Private companies develop plans to manage members' medical treatments/services & prescriptions. They replace the Medicare claims contractors and are responsible for paying providers.
Note: Each company has a yearly contract with CMS.
CMS considers MA plans to be a part of Medcare Part C. Each company's plan is responsible for providing Medicare beneficiaries with:
● Coverage for all medical procedures & services included under Part A & Part B.
● All treatment/services through a network of providers.
● A complete annual physical.
● Additional coverage not available in original Medicare is called Supplemental benefits. These usually include vision,, dental,, and others. Some may be added at an extra cost.
● Prescription coverage is combined with medical in most MA plans. The plan is then called a MAPD.
The focus on monitoring and coordinating all of their members' medical services and prescriptions results in improved treatment outcomes.
Recent studies have shown that "members are much healthier than individuals who stick with 'Original Medicare,' with or without Medicare supplement insurance."
In a step to hopefully gain better outcomes following medical treatment, many MAPDs are monitoring what is called an individual's Social Determinants of Health (SDoH). These are all the events and happenings in a person's life.
Note: The Cleveland Clinic defines SDoH as "the nonmedical factors that impact your health and longevity. Examples include your income, job, education level, and zip code. Many SDOH are out of your control. But with support from healthcare providers and community groups, you can gain access to resources your family needs to be as healthy as possible".
Focusing on SDoH is important following hospitalization because an individual's health can decline if they do not attend follow-up appointments. 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 an expensive treatment. Thus, considering SDoH factors results in better health.
How are MAPDs developed?
● Companies developing a MAPD plan submit the proposed benefits to the MediCare system for approval. The request also indicates the States and 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 October 1st for a Jan 1st effective date.
● Individuals can enroll from October 15th to December 7th for coverage to be effective on January 1st 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.
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? Coordinating and monitoring all the treatment an individual receives results in better outcomes. 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 plan's network of MDs and other providers and pay an office co-pay when any treatment or service is needed.
● When going for an appointment show the provider your plan's ID card not your MediCare card. They bill your MA company for your treatment, not the MediCare system.
What are your costs — when going to MAPD plan 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 for 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 has a Maximum out-of-pocket (MOP) provision to limit your ongoing medical-related costs during the year.
Note: MediCare sets the maximum medical MOP plans can use each year. (up to $9,350 in 2025) Many plans have a lower MOP maximum.
When going to the Pharmacy for medication:
● The cost of co-pays and cost sharing for medications are not included in the MAPD plan's medical cost MOP. The prescription part of the plan has a separate MOP.
When legislation created the Prescription Drug Plan (PDP) program in 2004, all companies were to develop plans with coverage at least as good as the Part D Standard plan, which provides medications in these four coverage stages:
● First — the Deductible. Plans have the option only to apply it to medications in higher Tiers.
● The second stage — Initial Coverage, which is based on the plan covering 75%. However, most plans set co-pays or cost sharing.
● The third stage — Coverage Gap [was initially called the donut hole]. Over recent years, it was improved from no coverage to 25% cost sharing for Brands and Generics
● Fourth — the Catastrophic stage where an individual pays 5%,.
Recent legislation made improvements in the Part D coverage. The coverage Gap was eliminated, so the Standard plan now has three phases. In addition, the individual maximum cost fortheir share of the cost of medications is now limited. It is $2,000 in 2025 and will be $2,100 in 2026.
Note: The co-pays and cost-sharing the PDP company uses will vary based on the Tier level at which they place individual medications.
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, which John is pleased to review and offer to beneficiaries:
● He is also appointed and certified by six Prescription Drug Plan (PDP) companies offering 14 plans in New London County and CT.
● Beneficiaries in New London County can also find help with plan choices 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 to describe 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.]
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 qualify for many of the benefits mentioned
In addition to ads for Medicare Advantage plans, an advertisement for retirement-focused plans mentions their Medicare Supplement (MediGap); however, it is not approved in Connecticut.
Working with a professional Medicare Health Plan Professional
MediCare's federal marketing regulations require any discussion over the phone 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.
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 effective date for the plan they selected will be based on the election period with the highest priority.
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.