Medicare Advantage (MA) plans are developed by private insurance companies to provide you with:
● All the treatment and procedures covered by Medicare Part A & Part B
● A full annual physical and additional benefits such as dental, vision, and fitness.
● All the treatment and services you might need through the plan's network of providers.
Note: MA plans are what is called Medicare Part C.
You gain from the focus of MA plans on improving treatment outcomes through the plan's coordination of all medical services. Coordination is improved by including coverage for prescriptions. Plans with medications & medical are called a MAPD.
MAPD companies are expanding the additional benefits they offer. Some include benefits such as dental, vision, hearing, and fitness coverage and others offer additional benefits as options.
● Continue to pay your monthly Part B cost. Plus MA companies (usually) have a monthly cost based on the level of benefits in the plan you selected, Plans with lower co-pays, cost sharing, and Maximum Out of Pocket will have a higher monthly cost.
● Select, when you need treatment, providers in the companies network. They bill the company not MediCare's system for your treatment.
● The quality of care is usually higher and treatment outcomes are often better!
Why is that? When all your medical treatment and medications are coordinated the results are better! Then too:
● A recent study by the Better Medicare Alliance showed — "individuals in private MA plans had:
- > one-third fewer ER visits
- > 23% fewer stays in a hospital than those in traditional fee for service MediCare."
● People like MAPSs because:
-> they receive a real annual physical and the extra benefits.
-> the monthly cost is usually lower than with a MediGap plan plus a stand alone Part D plan. This is a Big Plus for many.
First: When a person turns 65 they have a seven month time called the Initial Coverage Election Period (ICEP) to sign up for a MA plan. It is three months before eligible, the month when eligible, and three months after.
Second: Each year Medicare has an Annual Election Period. (AEP) It takes place in the Fall and is currently from October 15 to Dec 7 and any change they make will be effective January 1st. In the AEP a person can change to a:
● different plan with their current Medicare Advantage company..
● plan with a different Medicare Advantage company;.
John C Parker's Google Voice # — (860) 451-9793 today:
● Discussion during a call, whether you'll soon be 65 or have a qualified enrollment period such as leaving an employer, will be on:
-> your situation & interest
-> simplifying how Medicare Advantage Plans in New London County Connecticut work.
● When an enrollment period is available the focus will be on selecting a MAPD best for your situation, which will provide peace of mind.
Note: A couple companies are running MAPD TV ads for plans not approved in New London County!
● Face to face meetings are not safe these days — we can however talk on the phone about your situation and review options. Then if you want to sign up most enrollment forms can now be completed on line.
● Companies develop the benefits for a specific MA plan they want to offer.
● The plan is then submitted to MediCare and indicates the State and specific Counties where the company wants to offer the plan.
● When approved the company signs a one year contract.
● Marketing to individual for a Jan 1st effective date can begin on Oct 1st.
● Individuals living in an approved County can enroll from Oct 15th to Dec, 7th.
MediCare pays the MA company a fixed monthly payment for each person who signs up for their MAPD.
When going for medical treatment:
● You pay an office visit co-pay when you go to a network MD.
● Your co-pays to see a Specialist will be higher than a primary care MD. Preventive visits have no cost.
● You may having other ways of cost sharing for some services.
● You pay a per day fee when hospitalized for the first four or five days.
● All your co-pays and other medical treatment costs are limited each calendar year by the plan's Maximum Out of Pocket (MOP) provision.
Note: MediCare limits the medical MOP. ($6,700 in 2020 & will be $7,550 in 2021) Many of the no monthly cost plans use this. Some offer a lower MOP on a plan with a higher monthly cost.
When buy medications:
● Medication cost are not covered by the medical MOP. When using the prescription part of the plan your:
# benefits vary based on coverage stage of the prescription planyou are in:
-> First is the Deductible. Many plans only apply it on higher Tiers.
-> The next stages called — Initial Coverage — Coverage gap [donut hole] — Catastrophic . use co-pay and cost sharing based on the Tier they placed a medication in.
# medication costs are also limited by a MOP
Yes — at certain times!
The primary time is called the Annual Election Period. (AEP) A person using MediCare's AEP can:
● Select another plan from their company or change to another company.
● Make changes from 10/15 to 12/7 with the new coverage effective Jan 1st.
MediCare also has other special times for life change situations, such as moving, where a change can be made.
Federal regulations limit the times to enroll in or change a MAPD plan.