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:
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.
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:
● 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.
● 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.
● 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
The Medicare-Health-Plans-Southeastern-CT content is copyrighted © 2018 to 2019 by John C Parker, RHU, LTCP - All Rights Reserved.