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