Applying for a Medicare Health Plan

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MediCare pays MDs and other outpatient providers just 80% of MediCare's approved amount for office visits, Labs, and other services. 


What this means! Today more and more medical treatment is performed outpatient thus, in a complex situation, having to pay 20% means - you face a Big Risk!


What to do? Buy what I like to call a Medicare Health Plan to pay providers most of what MediCare didn't. 


There are two types of this special medical insurance, shown below,:

First - a Medicare Supplement Plan

 Owning gives you the flexibility to receive treatment from any provider in any state who agreed to participate with MediCare.
Plans are available from private companies after they are approved by the CT Insurance Dept. for sale throughout the state.

 
Providers submit invoices to the MediCare claim administration who pays them MediCare's part then sends it to the Supplement company who pays them most or all of the 20% Medicare did not pay.

How to buy a Medicare Supplement?
Individuals in CT can (normally) apply for a plan or change plans at any time for coverage the 1st of the next month.
    Note: When applying for a plan in CT a review of health history is not required as in some states.

More details on Medicare Supplements are on this page.


Second - a Medicare Advantage Plan (MA)

Private companies develop the benefits and services and then submit the plan to the federal government for approval. 


●  Individuals enrolling in a MA receive coverage, as a minimum, for everything original MediCare does plus annual physicals, and usually additional benefits.  


More details are on this page.


How to buy a MA plan! 

●  The times  to apply - "election periods" - for a MA are limited by federal regulations. 


●  The eligible "times" are described in the sections below: 

   [Listed in order of priority]


Initial Coverage Election Period (ICEP).

   It's a 7 month period when turning 65 - MediCare calls a person eligible the month when 65.  

   In a person's ICEP they can apply during any of the 3 months before 65, the month when 65, and in each of the 3 months after 65 for a Medicare Advantage (MA) plan or a MA with prescription coverage (MAPD).  


    Note: There is also a time  - the Initial Enrollment Period (IEP) - for the person staying on original Medicare to buy a Prescription Drug Plan for medication coverage.  

Medicare Advantage Open Enrollment Period (MA OEP)

   The MA OEP is a special period each year, from January 1st to March 31st, for a person who is dissatisfied with their current Medicare Advantage (MA) or (MAPD) plan.   

They can select a new MA/MAPD or return to original Medicare and select a Prescription Drug Plan. 

This period is also available to a person who enrolled in a MA during the first 3 months on MediCare.   

Three additional Election Periods! [in priority order]

Special Election Period (SEP) This is for a variety of life events happen such as: 

   + an individual with a MA or a PDP moves to a different state. 

   + a person learns, based on income level, they qualify for Extra Help with prescription costs.


SEPs are also for special situations such as a  person who changed to a MA/MAPD from a Med Supp, is dissatisfied, can return to Medicare, and apply for a Med Supp and PDP if do so within 12 months.


Annual Election Period (AEP): 

    + a time in the fall of each year to change MA or PDP coverage for January 1st. 

    + the AEP is currently from October 15th to December 7th. 


Institutionalized Individuals have a Open Enrollment Period (OEPI):

    + a special time to make a change when entering a long term care facility, while in, and when leaving.


BTW - you can send a note with questions about Election Periods to - Learn@JohnCParker.ag