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!
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.
● 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.
● 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.
● 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.
● 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.
● 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.
● 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.
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.
Content on Medicare-Health-Plans-Southeastern-CT is © 2018 to 2020 by John C Parker, RHU, LTCP - All Rights Reserved.
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