I like to call this special insurance — "Medicare Health Plans"!
Lets look a why you need a Plan! — If you just use Part A & Part B — called original Medicare — you would be responsible to pay:
-> outpatient providers — 20% of the treatment expense MediCare did not pay!
-> hospitals — a $1,420 deductible
● Bottom line — In a complex medical situation, and using just original MediCare, there is no limit on the amount you face — a very Big Risk!
● When you join a MA everything in original MediCare is covered plus other benefits. * All of your medical treatment is received through MDs and other providers in the companies network.
( * The full annual physical and other benefits are of considerable interest.)
Note: Most MA plans also cover prescriptions and are called a MAPD.
● More details on the private company MAPD plans are on this page.
● The ICEP is a seven month period to apply for a MA plan — usually a MAPD so prescriptions are included.
A person can apply during any of the three months before 65, the month when eligible, and in any of the three months after 65.
● The MA OEP is a special time each year for anyone, dissatisfied with their current Medicare Advantage (MA) or (MAPD), to make a change.
It works this way: Any time from January 1st to March 31st you can:
-> Select a new MA or MAPD with the same company or to another.
-> Return to original Medicare and select a Prescription Drug Plan.
● A person who signed up for MediCare when first eligible and also enrolled in a MA or MAPD can also use a MA OEP to change during the first three months on the plan.
● The SEP is a time for individuals, who have certain life events, to change their MAPD. Situations such as when:
-> moving to a different state.
-> learning, based on income level, they qualify for Extra Help with prescription costs.
A SEP is also available to the person who changed to a MA/MAPD from a Med Supp and then, during the first 12 months, was dissatisfied. They can:
-> Return to Medicare, apply for a Med Supp, and a PDP.
● The AEP is the most common time for a person to change their MA or a PDP. It happens each fall for new coverage on January 1st. Change can be made to a plan with their current company or to another.
● The AEP currently runs from October 15th to December 7th.
● The OEPI gives individuals in a long term care facility flexibility to meet their medical situation! They can make changes:
-> when entering,
-> while in,
-> when leaving.
If a persons situation resulted in them being eligible for two election periods at the same time the enrollment rules for the period with the highest priority would be followed.
An example of how this works: A person who moves during the seven months of their ICEP to select a plan, is also eligible for a SEP but has to follow ICEP's enrollment rules since it is Priority One.
This second type of Medicare Health Plan, but certainly not less important, is also available from private companies. They were the first private plan to work with MediCare. Named Supplements because the company sends money to the provider to "add to" the partial payment of the approved amount * the MediCare sent them.
[ * The approved amount MediCare sets is often deeply discounted from retail.]
When you own and use a Supplement — often called a MediGap — you have fexibility to receive treatment from any MD or provider in any state who accepts MediCare.
Details on how Medicare Supplements work, are regulated, and on eligibility here in CT are on this page.
OK — what can I do? Individuals who plan to be covered by original MediCare and back it up with a Supplement have the option to get part of the cost of their outpatient medications paid by — Buying a Prescription Drug Plan (PDP)
How does signing up work? When first entitled to MediCare a person has a time to sign up for a PDP — called the Initial Enrollment Period (IEP).
Note: When a person does not sign up for a PDP during IEP they can not sign up when ever they want. Sign up times are limited to the federal enrollment periods like for a MAPD!
Note: The most common is the Oct 5 to Dec 7 Annual Enrollment Periond.
BTW - you can ask questions or about a time to talk to learn more by sending a note - Learn@JohnCParker.agency