What are Medicare Health Plans & when can you apply!

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What are they?  There are two types  - a Medicare Advantage Plan & a Medicare Supplement. Both offer benefits in different ways to pay treatment expenses MediCare does not. 


MDs and other providers who agreed to participate with MediCare are just paid 80% of the amount approved for each outpatient treatment or service. office visit, Lab test, etc. This means, since more and more medical treatment is performed outpatient today, having to pay 20% in a complex situation becomes -  a Big Risk! 


What to do? Buy the special medical insurance I like to call Medicare Health Plans. An overview of the two types is shown below:


First - a Medicare Supplement Plan

Works great for the person who wants flexibility to receive treatment from any MD or provider in any state who agreed to accept MediCare's level of payment.

 
Plans are submitted by private companies to the CT Insurance Dept. and when approved will be available for sale throughout the state.

 
How they work! Providers, following treating a person, submit invoices to the MediCare claim administrator who pays them MediCare's part (80% ). The invoice is then sent to the Supplement company who will pay the provider most or all of the 20% Medicare did not pay.

 
How to buy!  
Individuals in CT can (normally) apply for a plan or change plans at any time. Coverage is then effective the 1st of the next month.
    Note: When applying for a plan in CT there is no review of health history as in some states.

More details on Medicare Supplements and how they work are on this page.


Second - a Medicare Advantage Plan (MA)

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


●  Individuals enrolling in a MA receive coverage, as a minimum, for everything original MediCare does and usually prescriptions from the company. MA plans also offer annual physicals and additional benefits.  


More details on MA plans are on this page.


When can you buy a MA plan! 

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


These "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.

  

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


    Note: Individuals using basic MediCare! There is also a time  - the Initial Enrollment Period (IEP) - 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 to:

   + Select a new MA or MAPD

   + Return to original Medicare and select a Prescription Drug Plan.

 

A person just eligible for MediCare who enrolled in a MA can also take advantage of the MA OEP during their first 3 months on MediCare.   

Three additional Election Periods! [in priority order]

Special Election Period (SEP) When a person has certain life events they qualify for a SEP. Situations 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