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FAQ

Enrollment

You are eligible to enroll in a ConnectiCare Medicare Advantage Plan if:

  • You qualify for Medicare Part A;

  • You are enrolled in and continue to pay Medicare Part B; and

  • You reside in ConnectiCare's service area.

Except under certain limited circumstances, the Centers for Medicare & Medicaid Services (CMS) does not allow Medicare Advantage plans to enroll Medicare beneficiaries that have End-Stage Renal Disease.

ConnectiCare offers a variety of Medicare Advantage plans to meet the different needs of many individuals. So there's sure to be a ConnectiCare Plan that’s right for you. See our plans.

Initial Coverage Election Period

You can enroll when you first become eligible for Medicare (three months before the month you turn age 65 until three months after the month you turn age 65). If you did not elect Medicare Part B when you were first eligible, you can still enroll in a Medicare Advantage plan. You will have a three-month period to enroll, which begins three months before your Medicare Part B effective date. You will not be able to enroll after your Medicare Part B effective date.

If you receive Medicare benefits due to a disability, you can join from three months before to three months after your 25th month of disability.

Please Note: You must qualify for Medicare Part A and be enrolled in and continue to pay for Medicare Part B to be eligible.

Annual Election Period for 2019 Coverage: October 15, 2018 – December 7, 2018

If you are eligible for Medicare, you can enroll in or switch plans during the Annual Election Period. For example, you can switch from Original Medicare to a Medicare Advantage plan (like a ConnectiCare Medicare Advantage Plan). Your coverage will be effective on January 1.

Special Enrollment Period

In certain situations, you may be able to join, switch or drop a Medicare Advantage plan at other times during the year. Some of these situations include:

  • If you move out of your plan's service area

  • If you have both Medicare and Medicaid

  • If you qualify for Extra Help paying for your Part D Prescription Drugs

  • If you live in an institution (such as a nursing home)

  • If you lose your employer coverage

For more information on enrollment periods, please contact us.

How to enroll in a ConnectiCare Medicare Advantage plan will depend on which one you’re choosing.

Please refer to our “How to enroll” section of our website for details.

You can use our convenient Find a Doctor search tool, located right on this website. This online directory is updated daily so you’ll get the most up-to-date information. To find your doctor, click here.

Yes. It's important to know that your health plan will be there for you if you have a medical emergency or urgent care situation, especially when you travel. All our plans (except the Passage Dual Special Needs Plan) include coverage for worldwide emergency and urgent care.1

1 Subject to limitations. Please note, Passage Dual Special Needs Plan do not include coverage of emergency and urgent care out of the United States.

General Information

Medicare Advantage plans (Medicare Part C) are health plans approved by Medicare and run by private insurance companies, like ConnectiCare. They include your Part A (hospital insurance), your Part B (medical insurance) and in many cases, your Part D Prescription Drug Coverage. They can also include extra benefits and services like routine care and wellness programs. Medicare Advantage plans ─ an option for your Medicare coverage ─ may save you money, offer added benefits and services, and keep all of your coverage in a single health plan.

Compared to Original Medicare alone or with a Medicare Supplement plan, Medicare Advantage plans can be a simpler option:

  • Convenience: All of your coverage from a single health plan.

  • Prescriptions: Part D Prescription Drug Coverage included in most plans.

  • Benefits: Access to additional benefits, such as routine care and wellness programs. You can also get optional benefits like dental.

  • Financial protection: Included in all plans with the annual maximum out-of-pocket limit for covered medical expenses.

Please Note: Monthly plan premiums, prescription drug and dental costs do not count towards the plan’s annual maximum out-of-pocket limit.

Medicare plan options at work are outlined in the chart on the New to Medicare page.

If you don't sign up for Medicare Part B (Medical Insurance) during your Initial Enrollment Period*, a 10% penalty may be added to the Part B premium for each 12-month period you could have had Part B but didn’t take it, unless you qualify for the Part B Special Enrollment Period. The late enrollment penalty continues for as long as you have Part B.

*Your Initial Enrollment Period is the seven-month "window" around your 65th birthday. It includes the three months before your birth month, your birth month, and the three months after your birth month.

Still working?

If you’re covered under a group health plan based on current employment (yours or your spouse’s), you qualify for a Special Enrollment Period. You can sign up for Part A and/or Part B:

  • Any time you have current employer insurance (COBRA and retiree insurance don’t count as current employer insurance); or

  • During the 8-month period that begins the month after employment or your group coverage ends, whichever comes first.

For more information on the Medicare Part B late enrollment penalty and/or Medicare Enrollment Periods, you can contact Medicare directly by calling 1-800-MEDICARE (1-800-633-4227), TTY: 1-877-486-2048 (24 hours a day/7 days a week) or visit the official website at www.medicare.gov.

Or, you can also speak with a ConnectiCare representative. Find numbers and hours of service.

Passage Plan 1 (HMO)

Yes, except for Connecticut Children’s Medical Center. Connecticut Children’s Medical Center doesn’t accept ConnectiCare Medicare Advantage Passage plans.

No, you don’t need your primary care provider (PCP) to give you a referral if you’re just seeing a physical therapist.

You’ll want to tell the specialist’s office when you make an appointment that you are in a plan that requires a PCP referral. The specialist can call us or check our website to confirm that your referral is valid.

You contact your PCP, who will decide if you should come into the office for a visit or consult by phone. Your PCP will tell you what specialist(s) to see and send referral(s) to ConnectiCare. Your PCP should also tell you the date your referral(s) expire.

PCPs who accept Passage members have the authority to make referrals. They notify us so we can process claims. ConnectiCare doesn’t need to review or approve your PCP’s referrals unless you or your provider ask us to review as part of an organization determination request..

Your PCP will decide how long your referral will last and tell you.

Check with your PCP, who set the time period for the referral, or your specialist to see if the referral is still valid. Or, you can contact us.

Click here to find PCPs who accept Passage plans. Then, contact the PCP you choose to register as a new patient and make sure to tell us the name of your PCP by logging into our website or contacting us.

You can see another PCP and pay the same $0 copay as long as the PCP accepts Passage plan members. Click here to confirm the PCP accepts Passage plan members.

The specialist will bill you the fee based on the rates established by the Centers for Medicare & Medicaid Services. If you have questions about the claim, call us.

You choose your PCP. You can change the PCP assigned to you as long as the provider is in your plan's network.  You just need to let us know.  Under your Passage Plan 1 (HMO), you can change your PCP in three ways: 

Then, contact the PCP you select to register as a new patient.

Your PCP will notify us about the referral. But before you go to the specialist, make sure the referral has been sent to us. If the specialist has a question, his or her office can contact your PCP’s office.

Contact your PCP and tell him or her about what your ob/gyn recommended. Your PCP will decide what specialist you should see and submit a referral to ConnectiCare.

You have three ways to do it under your Passage Plan 1 (HMO): 

Passage plans don’t require you to have a referral to go to a facility, such as an urgent-care center, an emergency room, a radiology facility or a hospital. If you’re ever in doubt about the status of a referral, give us a call.

It depends. If your PCP orders lab work, for example, you may have to pay for it. Your Evidence of Coverage has all the details. Prescription medicines aren’t covered by the PCP copay, either. You can find a link to your Evidence of Coverage in the "My coverage" section of your Care Dashboard.

If you have chosen a Passage plan, you need a PCP who accepts patients with your plan. Click here to find a Passage PCP. There are hundreds of PCPs who accept ConnectiCare Passage members. We do want to caution you: your plan will not cover visits to PCPs who don’t accept Passage plans.

No, you don’t need a referral for lab work. Check your Evidence of Coverage that we mailed to you to see what you may need to spend on lab work. You can find a link to your Evidence of Coverage in the "My coverage" section of your Care Dashboard.

Not all PCPs have urgent-care facilities. If yours does, then you will pay your urgent-care copay for your visit.

You don’t need referrals to emergency rooms and urgent-care centers.

Yes, specialist visits will each have a copay as long as you have a valid PCP referral. If the specialist performs other services – diagnostic tests or procedures – those may be subject to other copayments or coinsurance. Your Evidence of Coverage has all the details. You can find a link to your Evidence of Coverage in the “My coverage” section of your Care Dashboard.

No. Your PCP will send the referral to ConnectiCare. That way, we have a record of the referral when we receive a claim from the specialist you visit.

Prescription drugs

You can find out if your prescription drugs are covered by clicking here to view the ConnectiCare Medicare Advantage Formulary.

A formulary is the list of prescription drugs covered by ConnectiCare under your plan. Except in limited circumstances, your prescription drugs must be included in our formulary to be covered.

As a ConnectiCare member, you’ll have the flexibility to purchase your covered prescriptions from our extensive network of pharmacies. You can also get the medications you take regularly mailed to you by Express Scripts Pharmacy, the company that manages this service for us.



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Last Update 09/30/2018

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