When can you apply for a Medicare Health Plan?

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What is a Medicare Health Plan?

 Special insurance plans to pay the 20% of outpatient expenses MediCare doesn't. There are two types  - a Medicare Advantage Plan & a Medicare Supplement.


Why is it needed? -  Having to pay 20% of all outpatient treament in a complex situation means you would face  -  a Big Risk!  

To protect your income & savings from what could be Big Costs -- it's important to buy either a:

First Option - a Medicare Supplement Plan

Buying gives you flexibility to receive treatment from any MD or provider in any state who accepts MediCare.

 
How it works! The provider submits an invoice to the MediCare claim administrator who pays them 80% of the allowed * amount. The administrator sends the invoice to the Supplement company who pays the provider most or all of the 20% Medicare did not pay.  [ * deeply discounted from retail.]

 
How to buy!  
Individuals in CT can (normally) apply for a Supplement or make a change at any time, Coverage is effective the 1st of the next month.
    Note: There is no review of health history when applying in CT after initial eligibility as in many states.

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

Second Option - a Medicare Advantage Plan (MA)

●  Buying means individuals will receive treatment for everything original MediCare covers from a network of providers. Plans usually include other benefits plus prescriptions. (MA with prescription coverage is an MAPD)    

   [The annual physical and other benefits are of considerable interest.]  


●  Private companies develop the MA with the benefits they want to offer and MediCare approves. 


●  More details on MA plans are on this page.

The times to apply for a MAPD - "election periods" are described below in order of priority.

Initial Coverage Election Period (ICEP) - for Medicare Advantage (MA) (MAPD) plans.

   It's a 7 month period around the month a person is eligible for MediCare.

  

   A person can apply for an MAPD (MA with prescription coverage) in the 3 months before 65, the month when eligible, and in the 3 months after 65. 


What about buying just a prescription plan?  Individuals using basic MediCare also have a time  - called the Initial Enrollment Period (IEP) - to buy a Prescription Drug Plan (PDP) to pay part of their outpatient medications.  

Medicare Advantage Open Enrollment Period (MA OEP)

   The MA OEP is a special time to make a change for anyone dissatisfied with their current Medicare Advantage (MA) or (MAPD) plan. 


A change using this period can be made from January 1st to March 31st to:

    ->  Select a new MA or MAPD

    -> Return to original Medicare and select a Prescription Drug Plan.

 

A person who enrolls in a MA / MAPD when eligible for MediCare can also use the MA OEP the first 3 months on MediCare.   

A Special Election Period (SEP)

Individuals who have certain life events qualify for a SEP to change their plan. The SEP is available when a person: 

       ->  with an MA or a PDP moves to a different state. 

       ->  over 65 leaves an employer plan. 

       ->  learns, based on income level, they qualify for Extra Help with prescription costs.


A person who changed to a MA/MAPD from a Med Supp, is dissatisfied, can also has a SEP to return to Medicare, apply for a Med Supp. and a PDP if do so within 12 months.

The Annual Election Period (AEP):

  A time each fall to change MA or PDP coverage, with their company or to another for, January 1st. 

 

The AEP is currently October 15th to December 7th. 

Open Enrollment Period for Institutionalized (OEPI)

  A special period to give individuals in a long term care facility flexibility. They can make a change using - the OEPI :

          ->  when entering, 

          ->  while in, 

          ->  when leaving. 

Election periods have an order of priority!

 If a person is eligible for two election periods at the same time there is a priority on which period is used. 

     For example A person who has a SEP during their ICEP follows the ICEP enrollment rules.

Send a note if questions about Election Periods!

BTW - to learn more or ask questions send to - Learn@JohnCParker.agency