So, we all know the rules, right? You cannot say anything is the BEST that would be using a superlative! Not many changes this year so limited plan disruption with all the carriers staying pretty strong. It is a tit-for-tat in comparing and adding benefits to determine what is a good fit. Also, keep in mind network differences with some clients needing a PPO and others just fine with an HMO.
However, let’s break down the Medicare Advantage Plans in CT to help you guide clients.
HMOs: Requires you to stay in a network and only covered when out of network in an emergency situation.
PPOs: You can receive care from any provider in or out of the network BUT you will pay less when staying in the network. Out-of-network providers have to agree to treat you and must be opted into Medicare.
DSNP: You can have BOTH Medicare and Medicaid
MAPD Plans in CT
(These are popular plans not ALL available plans/carriers)
| Carrier | Lead Plan | Premium | Deductible | Network | PCP | Specialist | Inpatient | Outpatient | Lab | Rx |
| Aetna | Essential Elite | $0 | $1,000 | PPO | $0 | $40 | *$175 days 1-5 | *$65-$295 | $0 | $0 Ded |
| Anthem | Access Select | $0 | $0 INN $750 OON only |
PPO | $5 | $45 | $325 days 1-6 | $325 copay | $15 | *95 T3-5 |
| Carepartners | Access PPO | $0 | $1,000 | PPO Limited in network providers |
$0 | $45 | *$795 per stay | *$200-$300 | $0 | $0 Ded |
| Connecticare | Choice 3 | $0 | $195 | HMO | $0 | $45 | *$490 days 1-3 | *$300-$395 | $0-$15 | $0 Ded |
| UHC | Choice Flex | $0 | $0 | PPO | $0 | $45 | $395days 1-5 | $295-$395 | $0 | $0 Ded |
Note all benefits run on a calendar year
*Deductible Applies
INN=In network
OON=Out of network
Ancillary Benefits
| Carrier | Lead Plan | Hearing Aids | Dental | Vision | Fitness | OTC |
|---|---|---|---|---|---|---|
| Aetna | Essential Elite | $0-$1799 copay Nations Hearing | $1000 (100% anywhere) | $250 Reimbursement | Silver Sneakers | $75 per Quarter |
| Anthem | Access Select | $1000 max | $750 allowance | $125 allowance | Silver Sneakers | $35 per Quarter |
| Carepartners | Access PPO | Copays $250-$1150 | $1,000 allowance | $150 allowance | Silver Sneakers | $65 per Quarter |
| Connecticare | Choice 3 | N/A | Preventive included comprehensive must be purchased | $500 allowance | Silver Sneakers | $75 per Quarter |
| UHC | Choice Flex | $175-$1225 copay | $500 allowance (DVH Flex Card) | $100 allowance | Renew Active | $40 per Quarter |
This is not including the DSNP options for your clients as well as not representing EVERY MAPD plan in CT. Goes to show there is a lot out there to choose from and conducting a needs analysis with your clients is really the best first step. When the benefits are close in cost share it may boil down to the ancillary benefits.
This is quite a bit to review and understand so why not reach out to us to help you!
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1 (800) 772-6881 x7731 | sales@pfsinsurance.com
Serena Bugryn
Regional Vice President
Contact a Pinnacle Representative if you have any questions.
1 (800) 772-6881
support@pfsinsurance.com
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