Buying either plan from a private company means you are then protected from what could be — a Very Big Risk — to your income & savings since MediCare only pays 80% of your outpatient treatment expenses!
This page was developed to — highlight the two kinds of Medicare Health Plans & times to sign up:
● MA plans cover everything original MediCare does plus other benefits. *
( * A full annual physical and other benefits such as dental & vision)
Individuals in a MA plan receive needed medical treatment through MDs and other providers who participate in the companies network.
Note: The focus of most MA plans is to coordinate and individuals overall health plus prescriptions. They are then called a MAPD.
● Details to help you understand how private company MAPD plans work are on this page.
● The ICEP is a one time period of seven months to apply for a MA plan when turning 65! — people usually select a MAPD which includes prescriptions. The ICEP 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. They 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.
● In addition, a person who signed up for MediCare when first eligible and enrolled in a MA or MAPD during their ICEP can usie a MA OEP to make a change during the first three months on the plan.
● The SEP is a time 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 for anyone with a MA or PDP to make a change. It happens each fall and the new coverage is effective January 1st.
● The can change to a plan with their current or to another company.
● Sign up during 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 effective date rules for the period with the highest priority would be followed.
An example: A person who moves could have a SEP but if the move happens during their seven month [ICEP] their effective date will be based on the ICEP' enrollment rules, which is Priority One.
Supplements were the first private company plans to work with MediCare.
-> Named Supplements because the company sends your MD or outpatient provider money to add to or "supplement" the payment * MediCare sent them.
[ * MediCare's approved amount for treatments & services 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 just used original MediCare, in a complex medicate situation, you would be responsible to pay your provider(s) — 20% of the approved amount MediCare set for each outpatient treatment! Plus there is no limit on the amount you are responsible for. So you face — 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 during their PDP Initial Enrollment Period (IEP) when first eligible for MediCare.
-> 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! After when first eligible the Oct 5 to Dec 7 Annual Election Period is the most common time to make a change.
I don't take any medications! If a person does not sign up and 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