They are best described with the name — Medicare Health Plans!
Buying one means: If an accident or change in health happens you will not face expensive & extensive outpatient treatment & services — a Very Big Risk — to your income & savings!
This page describes — some plan highlights & when you can sign up:
● When you join a MA the plan covers everything in original MediCare plus other benefits. *
( * Having a full annual physical and other benefits is of considerable interest.)
All the medical treatment you may need is received through MDs and other providers in the companies network.
Note: Most MA plans include and manage 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 is the same time as signing up for MediCare.
A person can apply in month 3, 2, or 1 before eligible [the month when 65] for Medicare, during their eligible month, and in month 1, 2, or 3 after 65.
● The MA OEP is a special once a year time for anyone, dissatisfied with their current Medicare Advantage (MA) or (MAPD), to make a change.
It works this way: Any time during January 1st to March 31st you can:
-> 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 for an individual, who has 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 SEP is also available to the person who was enroll in a Medicare Supplement, then changed to a MA/MAPD but became dissatisfied, during the first 12 months. They can:
-> Return to Medicare, apply for a Medicare Supp, and a PDP.
● The AEP is the most common time for anyone with a MA or PDP to make changes. 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 has a SEP during the seven month [ICEP] to select a plan has to follow ICEP's enrollment rules since it is Priority One.
These plans were the first private plan to work with MediCare and are:
-> Available from private insurance companies:
-> Named Supplements because the company sends the outpatient provider money to "add to" the partial payment * MediCare sent them.
[ * The amount MediCare approved 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 you need! — If you receive medical related treatment just using Part A & Part B — called original Medicare — you would be responsible to pay:
-> all your outpatient providers — 20% of the treatment expense MediCare did not pay!
-> the hospital — a $1,420 deductible
● Bottom line — In a complex medical situation, if just original MediCare is used, there is no limit on the amount you face — a very Big Risk!
Details to help you understand how a Medicare Supplement works, are regulated, and the eligibility and enrollment rules here in CT are on this page.
OK — what to do? Individuals who plan to be covered by original MediCare can:
-> back up any medical treatment with a Supplement!
-> get part of their outpatient medications cost paid by — Buying a Prescription Drug Plan (PDP)
The sign up rules — When:
-> first become eligible for MediCare a person has a time — called the Initial Enrollment Period (IEP) — to sign up for a PDP.
-> a person does not sign up for a PDP during IEP they can not sign up when ever they want.
Note: 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.
I don't talk medications why do I have to buy a PDP? if you do not have "credible" prescription coverage, such as from an employer a monthly penalty is 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