This insurance is best described as — Medicare Health Plans!
Buying one means when you have an accident or health change you are protected and avoid what could be — a Very Big Risk — to your income & savings!
This page has — highlights of the two types of plans & times to sign up:
● When you join a MA the plan covers everything original MediCare does plus other benefits. *
( * A full annual physical, which is of considerable interest and other benefits.)
Any needed medical treatment is received through MDs and other providers in the companies network.
Note: Most MA plans as part of their focus on coordinating overall health also include your prescriptions and are then called a MAPD.
● Details to help you understand how private company MAPD plans work on this page.
● The ICEP is a seven month one time period to apply for a MA plan — usually a MAPD so prescriptions are included. It covers the same time as signing up for MediCare.
A person can apply in month 3, 2, or 1 before eligible for MediCare [the month when 65], during their eligible month, and in month 1, 2, or 3 after 65.
● The MA OEP is a special once a year time Jan 1st to March 31st when anyone, dissatisfied with their current Medicare Advantage (MA) or (MAPD), can make a change.
It works this way:
-> Select a new MA or MAPD either with the same or another company.
-> Return to original Medicare, select a Medicare Supplement, and a stand alone Prescription Drug Plan.
● A person who signed up for MediCare when first eligible and enrolled in a MA or MAPD during their ICEP can also make a changing using a MA OEP during the first three months on the plan.
● The SEP is a time, when an individual who has certain life events, can 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 SEP is also available to a person in a Medicare Supplement who changed to a MA/MAPD but then became dissatified during the first 12 months. They can then:
-> Return to Medicare, apply for a Medicare Supp, and a PDP.
● The AEP is the most common time anyone with a MA or PDP can make a change. It happens each fall and the new coverage is effective January 1st.
● The change can be to a plan with their current or to another company.
● The AEP currently runs from October 15th to December 7th.
● The OEPI is for individuals in a long term care facility and gives them flexibility to meet their medical situation! They can make changes:
-> when entering,
-> while in,
-> when leaving.
If a persons situation resulted in being eligible for two election periods at the same time the enrollment rules for the period with the highest priority would be followed.
An example: A person who moves and thus could have a SEP but it is during their initial seven month [ICEP] has to follow ICEP's enrollment rules, which is Priority One.
Supplements were the first private company plans to work with MediCare. They are:
-> Named Supplements because the company sends the outpatient provider money to "add to" the partial payment * MediCare sent them.
[ * MediCare's approved amount is often deeply discounted from retail.]
When you own a Supplement — often called a MediGap — you have fexibility to receive treatment from any MD or provider in any state who accepts MediCare.
Why needed! — If you receive medical related treatment and just had Part A & Part B — called original Medicare — you would be responsible to pay:
-> all your outpatient providers — 20% of MediCare's approved amount for each treatment!
-> the hospital — a $1,420 deductible
● Bottom line — In a complex medical situation, and just using original MediCare, there is no limit on the amount you are responsible for — a very Big Risk!
Details to help you understand how Medicare Supplement plans work, are regulated, and CT's eligibility and enrollment rules are on this page.
OK — what can you do? Individuals using original MediCare & a Supplement can:
-> get part of their outpatient medications cost paid by — Buying a Prescription Drug Plan (PDP)
How to sign up! — The PDP sign up rules say a person:
-> can select a PDP when first eligible for MediCare in what is called the PDP — Initial Enrollment Period (IEP).
-> does not have to sign up for a PDP during their IEP. But if they do not they can not sign up when ever they want.
Note: PDP sign up times are limited to the federal enrollment periods like for a MAPD! The most common is the Oct 5 to Dec 7 Annual Election Period.
Do I have to buy a PDP? I don't talk any medications! No but if you do not have "credible" prescription coverage, such as from an employer a monthly penalty will be added when you do sign up.
BTW - you can ask questions or about a time to talk to learn more by sending a note - Learn@JohnCParker.agency