Frequently Asked Questions for Members
If you have a question, be sure to check here first. We may have already answered it for you.
QUESTIONS ABOUT MEDICARE
What is Medicare and what are the different parts?
- The Original Medicare Plan has two parts: Part A (hospital Insurance) and Part B (medical Insurance). It is a fee-for-service health plan. You pay a deductible, and after meeting your deductible, Medicare pays its share of the Medicare-approved amount, and you pay your share (coinsurance).
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Medicare Part A - Hospital Insurance
Most people do not pay a premium for Part A because they or a spouse already paid for it through their payroll taxes while working. Medicare Part A (hospital insurance) helps cover inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. Beneficiaries must meet certain conditions to get these benefits. -
Medicare Part B - Medical Insurance
Most people pay a monthly premium for Part B. Medicare Part B (medical insurance) helps cover doctors' services and outpatient care. It also covers some other medical services that Part A does not cover, such as some of the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary. -
Medicare Part C – Medicare Advantage Plans
Medicare Part C includes all Medicare Advantage plans such as Managed Care Organizations, which are provided by private insurers, like ConnectiCare, who are approved by Medicare.
Medicare Advantage plans provide all of your Part A and Part B benefits and must cover at least all of the medically-necessary services that the Original Medicare Plan provides. In addition, Medicare Advantage plans generally offer extra benefits like routine care and wellness programs. Many Medicare Advantage plans also include Part D Prescription Drug Coverage (see Part D below).
With a Medicare Advantage plan, you can have all of your coverage from a single health plan, which will make things easier and more convenient for you. -
Medicare Part D – Prescription Drug Coverage
Medicare Part D is the voluntary prescription drug insurance coverage that went into effect January 1, 2006. Everyone with Medicare can get this coverage that may help lower prescription drug costs and help protect against higher costs in the future. Medicare Prescription Drug Coverage is insurance. Private companies provide the coverage. Beneficiaries choose the drug plan and pay a monthly premium. Like other insurance, if a beneficiary decides not to enroll in a drug plan when they are first eligible, they may pay a penalty if they choose to join later.
Who is eligible for Medicare Parts A and B?
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You are eligible for Medicare Parts A and B if you are 65 or older and:
- You are either a citizen or a permanent resident of the United States,
- You or your spouse worked at least 10 years in Medicare-covered employment.
- You have been determined to have ESRD (End Stage Renal Disease).
- You are disabled and have been receiving either Social Security or Railroad Retirement Board (RRB) benefits for two years.
And
You are eligible if you are under 65 and:
Or
How and when do I apply for Medicare Part A?
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To apply for Medicare Part A, contact your local Social Security Administration office or, if either you or your spouse worked for the railroad, contact the Railroad
Retirement Board (RRB).
- Initial Enrollment Period - When you first become eligible for Medicare (three months before you turn age 65 to three months after the month you turn age 65).
- General Enrollment Period - Between January 1 – March 31 each year.
- Special Enrollment Period - If you or your spouse (or family member if you are disabled) is working and has group health plan coverage through the employer or union.
- Special Enrollment Period for International Volunteers - If you are serving as a volunteer in a foreign country.
Many People Automatically Get Part A
If you get benefits from Social Security or the Railroad Retirement Board (RRB), you automatically get Part A starting the first day of the month you turn age 65. If you are under age 65 and disabled, you automatically get Part A after you get disability benefits from Social Security or certain disability benefits from the RRB for 24 months. You will get your Medicare card in the mail three months before your 65th birthday or your 25th month of disability.
Most people don’t pay a Part A premium because they paid Medicare taxes while working.
Some People Need to Sign up for Part A
If you aren’t getting Social Security or Railroad Retirement Board (RRB) benefits (for instance, because you are still working), you will need to sign up for Part A. You will need to sign up even if you are eligible for premium-free Part A. You should contact Social Security three months before you turn age 65. If you worked for a railroad, contact the Railroad Retirement Board (RRB) to sign up.
If you aren’t eligible for premium-free Part A, you can buy it during the following times:
For more information on Part A, call Social Security, or visit www.medicare.gov. If you get benefits from the Railroad Retirement Board (RRB), call your local RRB office or 1-877-772-5772 (TTY users should call 312-751-4701).
How and when do I apply for Medicare Part B?
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To apply for Medicare Part B, contact your local Social Security Administration office or, if either you or your spouse worked for the railroad, contact the Railroad Retirement Board (RRB).
- General Enrollment Period - Between January 1 – March 31 each year. Your coverage will begin on July 1. The cost of your Part B will go up 10% for each full 12-month period you could have had Part B but didn’t sign up for it, unless you qualify for a Special Enrollment Period (see below). You may have to pay this late enrollment penalty as long as you have Part B.
- Special Enrollment Period - If you wait to sign up for Part B because you or your spouse is working and has group health plan coverage based on that work, or if you are disabled and you or a family member is working and has group health plan coverage based on that work, you can sign up for Part B any time while you have group health plan coverage based on current employment or during the 8-month period that begins the month the employment ends, or the group health plan coverage ends, whichever happens first.
- Special Enrollment Period for International Volunteers - If you waited to enroll in Part B because you had health insurance while volunteering in a foreign country, you can sign up during the 6-month period that begins the month you are no longer volunteering outside the United States, or the sponsoring organization is no longer tax exempt, or you no longer have health coverage outside the U.S., whichever comes first.
You have a seven-month enrollment period that begins three months before you turn 65. Try to apply early so your Part B coverage start date won’t be delayed. Part B is optional and you must pay a monthly premium to stay enrolled in the program.
If you don’t enroll during this initial seven-month period, you’ll have to wait until the next general enrollment period (January 1 - March 31 of each year). Your Part B coverage will then begin in the following July. You may be required to pay a penalty if you do not enroll in Part B when you are first eligible.
If you didn’t sign up for Part B when you first became eligible, you may be able to sign up during one of these times:
Usually, you don’t pay a late enrollment penalty if you sign up for Part B during a Special Enrollment Period.
Call Social Security at 1-800-772-1213 for more information about your Medicare eligibility and to enroll in Part B (TTY users should call 1-800-325-0778). If you get Railroad Retirement Board (RRB) benefits, call your local RRB office or 1-877-772-5772 (TTY users should call 312-751-4701). For general information about enrolling, visit www.medicare.gov and select, "Find Out if You’re Eligible."
What are Medicare Advantage Plans?
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Medicare Advantage plans are health plan options that are approved by Medicare and run by private companies, like ConnectiCare. They are part of the Medicare Program and are sometimes called "Part C" or "MA plans." Medicare pays an amount for your care every month to these private health plans. Medicare Advantage plans must follow rules set by Medicare.
Medicare Advantage plans provide all of your Part A (hospital insurance) and Part B (medical insurance) benefits and must cover at least all of the medically-necessary services that the Original Medicare Plan provides.
Medicare Advantage plans generally offer extra benefits such as preventive care and wellness programs. Many Medicare Advantage plans include Part D Prescription Drug Coverage.
You’ll get this comprehensive coverage from a single health plan, which will make things easier and more convenient for you. Overall, Medicare Advantage plans give you choices, letting you select the coverage that really suits your needs.
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The Advantages of a Medicare Advantage Plan:
- Medicare Advantage plans are available with affordable monthly premiums. Many plans offer $0 monthly premiums in addition to your Medicare Part B premium.
- A Medicare Advantage member will continue to receive regular Medicare-covered services. In addition, a Medicare Advantage plan member will also have access to additional benefits and services, such as routine care and wellness programs, that neither Medicare Supplement plans nor the Original Medicare Plan provides.
- Prescription Drug Coverage is often included in a Medicare Advantage plan while a Medicare Supplement plan member must enroll in a separate Part D Prescription Drug plan (PDP) and pay an additional premium.
- Medicare Advantage plans offer the convenience of getting comprehensive coverage from a single source.
- Medicare Advantage plans have Annual Maximum Out-of-Pocket Limits. These annual limits, or caps are on the amount you may have to pay out of your own pocket for medical expenses. If you were to reach your plan’s annual limit, the plan will pay 100% of your covered medical expenses for the remainder of the calendar year. You can feel secure knowing that you are protected against unforeseen catastrophic medical costs.
QUESTIONS ABOUT CONNECTICARE VIP MEDICARE PLANS
What Medicare Advantage Plans does ConnectiCare offer?
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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.
ConnectiCare VIP Prime (HMO) Plans
Are you looking for a medical plan that offers more benefits than Original Medicare alone and is more affordable than most Medicare Supplement plans?
Consider one of the ConnectiCare VIP Prime Plans. ConnectiCare offers a variety of VIP Prime Plans, each providing you with cost effective, comprehensive medical coverage. Two of our plans include Prescription Drug Coverage. There is a range of premium and copayment options to choose from, allowing you to select the plan that really suits your individual needs.
VIP Prime Plans are Coordinated Care Plans where you receive care through the participating doctors and hospitals in our statewide network.
ConnectiCare VIP Option (HMO-POS) Plans
Do you reside in Connecticut, but spend extended periods of time away from Connecticut and would like coverage for out-of-network medical services?
Consider one of the ConnectiCare VIP Option Plans. These are Point-of-Service Plans that not only offer you affordable cost-shares for in-network services, but also give you the flexibility to seek coverage outside ConnectiCare’s network. Both of these plans include Prescription Drug Coverage.
Out-of-Network coverage is available for certain services including, but not limited to Preventive Screenings and Immunizations, Doctor Office Visits, Lab Services, X-rays, Ambulatory Surgical Center Services, Ambulance Services, Inpatient and Outpatient Hospital Care, and Physical Therapy.
Please Note: Out-of-Network services that are NOT covered include: Inpatient and Outpatient Mental Health Care, Skilled Nursing Facility Care, Home Health Care, Outpatient Substance Abuse Care, Diabetic Self Management Training, Diabetes Supplies and Services, Kidney Disease Education Services, Medicare-Covered, Eyewear, and Vision Discounts.
Click here to See Our Plans.
Does ConnectiCare offer Dental Coverage?
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Yes, you can enhance your ConnectiCare VIP Medicare Plan with our new Supplemental Dental Plan option for an additional low monthly premium of $28, you'll get up to $1,000 in dental services in 2012.
- 100% Coverage for Preventive Services including oral exams and cleanings
- 100% Coverage for Diagnostic Services including X-rays
- 100% Coverage for Basic Services including fillings
- 50% Coverage for Major Dental Services including, but not limited to, Endodontics, Periodontics, dentures and bridgework, denture adjustments, oral surgery and bony impactions
This Plan includes:
No Annual Deductible for Preventive and Diagnostic Services. You’ll enjoy:
Why should I choose ConnectiCare?
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At ConnectiCare each Plan starts with the individual. Since value means different things to different people, we offer it in many different ways.
- Affordable monthly premiums starting at $0*.
- Cost-effective, comprehensive medical benefits, and no referrals required for specialist visits
- Affordable copayments including a $0 copayment for Annual Physicals, Preventive Screenings and Immunizations
- Savings on Prescription Drugs with our Preferred Pharmacy Benefit
- The option to add our Supplemental Dental Plan
- Statewide network of doctors and hospitals
- Flexibility to seek out-of-network coverage with our Point of Service Plans
- Savings on eyewear with our Vision Discount Program
- Health and Wellness Support, including our Disease and Care Management Programs designed specifically for our Medicare members
- Financial protection through annual limits, or caps, on what you may have to pay out of your own pocket for medical expenses
Our Medicare Advantage Plans are offered only in Connecticut, which means we focus 100% of our attention on the Medicare members in our state. With us, you’re a neighbor, not a number. We work hard each day to know our customers, understand their needs and provide them with responsive service that is dedicated and personal.
ConnectiCare started out in 1981 right here in Connecticut. We were founded with the mission of creating a health plan that truly cares about the health of its members. Our members understand that “You know us by heart” is more than just our marketing motto. It’s about the trust and confidence you feel working with a friendly, local company. It’s about helping you make the right choice about your Medicare coverage before you’re a member and following through with responsive service once you become a member.
* In addition to your Medicare Part B monthly premium.
Click here to See Our Plans.
How can I find out if my prescription drugs are covered?
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You can find out if your prescription drugs are covered by clicking here
to view the ConnectiCare Formulary. The ConnectiCare Formulary is a list of approved covered drugs, both brand name and generic. A formulary is a list of drugs covered by your plan to meet patient needs. This list is selected by ConnectiCare in consultation with a team of health care providers, which represents the prescription therapies believed to be a necessary part of a quality treatment program. A printed formulary is provided to all members.
How can I purchase my prescription drugs?
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If you are a member of ConnectiCare VIP Medicare, you must use network pharmacies to access the prescription drug benefit, except under certain non-routine circumstances where you cannot reasonably use network pharmacies. Listed below are your network pharmacy options.
Retail Pharmacies
To use our retail pharmacy service, you would need to present your ConnectiCare VIP Medicare ID card at any participating pharmacy. For your convenience, there are over 60,000 pharmacies in the ConnectiCare network, including many national chain pharmacies like CVS, Rite Aid and more. Many of our participating pharmacies are Preferred Pharmacies with whom we have negotiated rates that will save you money.
With all of our Preferred Pharmacies, you can purchase a 90-day supply of most prescription drugs for the same prices as a 60-day supply of the same prescription drug.
Our Preferred Pharmacies include, but are not limited to:
Arrow, Big Y, CVS, Price Chopper, Rite Aid, Sam’s Club, Shop Rite, Stop & Shop, Target, Walgreens,
Wal-Mart, Xpect Discount
Mail Order / Home Delivery
If you are a ConnectiCare VIP member, you have access to Express Scripts Home Delivery pharmacy, which dispenses long-term prescriptions (usually a 90-day supply) through the mail. It’s easy to get your medication delivered to your home. For more information on Home Delivery, click here.
Can I get assistance with paying my prescription drug costs?
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People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If you qualify, Medicare could pay for up to seventy-five (75) percent or more of your drug costs including monthly prescription drug premiums, annual deductibles, and co-insurance. Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty. Many people are eligible for these savings and don’t even know it.
- 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7 days a week;
- The Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or
- Your Medicaid Office.
For more information about this Extra Help, contact:
How can I find out if my doctors are in ConnectiCare’s network?
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ConnectiCare has a statewide network of contracted physicians, hospitals, pharmacies and medical professionals. ConnectiCare’s VIP Medicare Provider Directory is available to you online and in printed form. Our online Provider Directory is updated daily with the latest additions and changes.
Click here to search for a doctor.
Or
Click here
to view the ConnectiCare VIP Medicare Provider Directory.
Will I have coverage for emergency care when traveling outside the United States?
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Yes, as a member of ConnectiCare VIP Medicare, you will have emergency care coverage outside the United States. You will be responsible for a copayment for each emergency room visit. If you are admitted to the hospital within 24 hours for the same condition, you will pay $0 for the emergency room visit.
In addition, there is a $50,000 plan coverage limit for emergency room services outside the United States every year.
Who is eligible to enroll in a ConnectiCare VIP Medicare Plan?
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You are eligible to enroll in a ConnectiCare VIP Medicare Advantage Plan if:
- You qualify for Medicare Part A; and
- You are enrolled in and continue to pay Medicare Part B; and
- You reside in Connecticut.
Please Note: You will not qualify if you have End-Stage Renal Disease (permanent kidney disease requiring dialysis or a kidney transplant), except under certain limited circumstances.
When can I enroll in a ConnectiCare VIP Medicare Plan?
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You can only enroll in a ConnectiCare VIP Medicare Plan during specific times of the year.
- 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 get Medicare due to a disability, you can join from three months before to three months after your 25th month of disability. -
Annual Election Period for 2012 Coverage: October 15, 2011 – December 7, 2011
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 VIP Medicare Plan). Your coverage will be effective on January 1, 2012. - Special Enrollment Period
- 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
Here are some important enrollment dates:
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 the following:
For more information on Enrollment Periods, contact us toll-free at 1-877-224-8221 between the hours of 8:00 a.m. – 8:00 p.m., Monday through Friday (TTY/TDD users dial 1-800-842-9710). Extended hours 10/15 – 2/14, 8:00 a.m. – 8:00 p.m., seven days a week.
How do I enroll in a ConnectiCare VIP Medicare Plan?
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You can enroll in a ConnectiCare VIP Medicare Plan online, over the phone, by mail or by scheduling a personal consultation. Click here to view details on all of these enrollment options.
How do I request more information about ConnectiCare VIP Medicare Plans?
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To request an Informational Kit, call us toll-free at:
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1-877-224-8221 (TTY/TDD users: 1-800-842-9710)
Monday through Friday, 8:00 a.m. – 8:00 p.m.
Extended hours 10/15 – 2/14, 8:00 a.m. – 8:00 p.m., seven days a week.
Can I make my Plan’s monthly premium payments directly from my personal bank account?
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Yes, ConnectiCare offers a Direct Debit Program making it easier to make your monthly premium payment. It saves you time and paperwork – no more monthly premium invoices and no more monthly premium checks to write. Each month ConnectiCare deducts your premium directly from your bank account and credits your ConnectiCare account. All pre-approved deductions will appear on your monthly bank statement.
If you would like to sign up for the Direct Debit Program, click here
to download and print the Direct Debit Program Instructions and Application Form. You can complete the form and mail it in with your enrollment application.
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If you are already enrolled in a ConnectiCare VIP Medicare Plan and are looking to switch to a different VIP Medicare Plan, please contact your ConnectiCare Representative or call Member Services, toll-free at 1-800-CCI-CARE (1-800-224-2273) 8:00 a.m. – 8:00 p.m., seven days a week (TTY/TDD users: 1-800-842-9710).
Please Note: You can only switch to a different VIP Medicare Plan during this year's Annual Enrollment Period from 10/15 - 12/7/11.
As an existing ConnectiCare VIP Medicare Plan member, how do I add Dental Coverage?
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If you are already enrolled in a ConnectiCare VIP Medicare Plan and would like to add our Optional Supplemental Dental Plan, please contact your ConnectiCare Representative or call Member Services, toll-free at 1-800-CCI-CARE (1-800-224-2273) 8:00 a.m. – 8:00 p.m., seven days a week (TTY/TDD users: 1-800-842-9710).
Please Note: You can only switch to a different VIP Medicare Plan during this year's Annual Enrollment Period from 10/15 - 12/7/11.
H3528_CCI_12_4006_01r3 CMS Approved 1/30/2012
Last Update 1/1/2012
