A "Medicare Health Plan" is a special kind of medical insurance which works with the MediCare system.
Why needed? - If a person was just covered by original MediCare - they 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 you were just covered by original MediCare you would face — a Big Risk!
● When you join a MA all medical treatment is received through MDs and other providers in the companies network. Everything in original MediCare and usually prescriptions is covered plus other benefits. *
( * The full annual physical and other benefits are of considerable interest.)
Note: A MA plan with prescription coverage, as most do, is an 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 enrolled in a MA or MAPD when they first became entitled by MediCare 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 person who changed to a MA/MAPD from a Med Supp and becomes dissatisfied can use a SEP to change during the first 12 months,
-> They can return to Medicare, apply for a Med Supp, and a PDP.
● The AEP is the most common time to make changes. I happens each fall so a person can change their MA or PDP for new coverage on January 1st. Change can be made 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! They can make changes:
-> when entering,
-> while in,
-> when leaving.
If a person was eligible for two election periods at the same time the priority order sets the enrollment rules. The period with the highest priority would be followed.
It works this way: A person who moves, and thus is eligible for a SEP, during the seven months of their ICEP, has to follow ICEP's enrollment rules since it is Priority One.
The second type, but certainly not less important, also comes from a private company. These plans were the first type to work with MediCare and named a Supplement since they "add to" MediCare's partial payment. *
[ * The approved amount is often deeply discounted from retail.]
When you own a Supplement — also called a MediGap — you gain flexibility to receive treatment from any MD or provider in any state who accepts MediCare.
Details on how Medicare Supplements work, are regulated, and about eligibility to buy are on this page.
OK - When I buy a Supplement how do I get coverage for prescriptions?
Individuals with original MediCare and a Supplement have coverage for medical situations but not for outpatient medications!
What to do? Buy a Prescription Drug Plan (PDP) so part of your outpatient medication cost can be paid. When a person becomes entitled to MediCare there is a time - called the Initial Enrollment Period (IEP) - to buy a PDP.
Note: You can not sign up for a PDP when every you want. Sign up times are limited like for a MAPD!
BTW - you can ask questions or about a time to talk to learn more by sending a note - Learn@JohnCParker.agency
Content on Medicare-Health-Plans-Southeastern-CT is © 2018 to 2020 by John C Parker, RHU, LTCP - All Rights Reserved.
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