- Health Maintenance Organization (HMOs). All of the HMO plans available in Connecticut have an in-network provider requirement. That means that you generally must receive all covered care from the doctors, hospitals, and other health care providers who are affiliated with the plan. Exceptions include emergency care and urgent care.
- If you are out of state, you are out of network, except for urgent or emergency care.
- Preferred Provider Organization (PPOs). A PPO is similar to an HMO. There is a preferred network of service providers and medical facilities. However, unlike an HMO, PPO’s allow members to utilize out-of-network providers and facilities, usually at a higher cost than in-network.
- Private Fee for Service Plans (PFFS plans). Unlike HMOs or PPOs, PFFS plans set their own fees for service. PFFS plans decide how much they will pay for any covered Medicare service. Beneficiaries in a PFFS may use any Medicare-approved physician who accepts the rates set by the plan. A physician may decide to stop accepting those rates at any time, so you must check whether this is so each time you visit a medical provider before you receive services to avoid having to pay the bill out of your own pocket. Physicians who accept the terms of a PFFS plan may not charge more than 115 percent of the contracted rate. Similar to HMOs and PPOs, PFFS plans may offer benefits in addition to Original Medicare coverage such as extra days in a hospital.
- Medicare Savings Plans. These plans combine a tax-advantaged bank savings account with a high-deductible for or catastrophic health insurance policy. These Savings Plans generally make the most sense for high-net-worth individuals in good health. Before choosing this plan, contact a state certified tax or estate-planning advisor for more detailed advice.
Special Needs Plans (SNPs). Special Needs Plans are designed to serve those:
- Who live in a nursing home
- Are eligible for both Medicare and Medicaid (dual eligible)
- Are living with a chronic illness
- Cardiovascular disorders
- Chronic heart failure
- Diabetes mellitus
Please note that in the list below there may be some inaccuracies or omissions. There is also variance of plans depending on your city, county and region of Connecticut. The information was provided by the CMS, Centers for Medicare & Medicaid Services.