Applying for a Medicare Health Plan

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So much medical treatment such as office visits, Labs, and other services is provided today on an outpatient basis. However, MDs and other participating providers are just paid 80% of the amount MediCare set for each. This means   - having to pay 20% can be a Big Risk!


What to do? Buy a special insurance plan which can pay most of the part MediCare doesn't. I like to call them Medicare Health Plans and they are two types - shown below:

First - a Medicare Supplement

They give you flexibility to receive treatment from any provider in any state who agreed to participate with MediCare. 

  Plans are approved by the CT Insurance Dept. and then purchased from private companies. 

MediCare providers invoice the Supplement company which pays them most 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: A review of health history is not required when applying for a plan in CT as in some states. 


More details on Medicare Supplements are on this page.

Second - a Medicare Advantage Plan (MA)

Private companies develop the benefits for their plans and then get them approved by the federal government. 

 ●  Individuals enrolling in a MA receive coverage, as a minimum, for everything original MediCare does and usually additional benefits.  More details are on this page.

●  The times  to apply for a MA are limited. Federal regulations have set "election periods" for when an individual can apply.


The federal MA election periods are described below and listed in order of priority:

Initial Coverage Election Period (ICEP).

   It's a 7 month period when turning 65 - MediCare calls it being eligible. 

   A person can apply starting 3 months before 65, during the month when 65, and in each of the 3 months after turning 65.  

   In this period an individual can enroll in a Medicare Advantage (MA) plan or a MA plan with prescription coverage (MAPD). 


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

Medicare Advantage Open Enrollment Period (MA OEP)

   This 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.   

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

The option to make a change is also available to a person during the first 3 months on MediCare who enrolled in a MA.   

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 if do so within 12 months.


Annual Election Period (AEP): 

    +  a time each year in the fall 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