Medicare Advantage (MA) plans are developed by private insurance companies and provide you:
● All the treatment and procedures covered by Medicare Part A & Part B
● Additional benefits such as a full annual physical and often dental, vision, and fitness.
● All needed treatment and services by going to the plan's network of providers.
Note: MA plans are what is called Medicare Part C.
MA plans focus on improving a person's treatment outcomes by coordinating all medical services. Coordination is improved by including coverage for medications. Plans are then called a MAPD.
The MAPD companies are expanding the additional benefits they offer. Some include dental, vision, hearing, and fitness coverage and others offer them as options.
● Continue to pay your monthly Part B cost and MA companies (usually )and based on the plan you selected you have a monthly cost, Plans with lower co-pays, cost sharing, and Maximum Out of Pocket will have a higher monthly cost.
● Select providers in the companies network, when treatment is needed, and 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? Better results come from the coordination of all of your medical treatment and medications.
● 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 them because of the complete annual physical and the extra benefits. A big plus is the monthly cost is usually lower than with a MediGap plan plus a stand alone Part D plan.
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;.
In New London County for calendar year 2021 you can select:
● One of 30 different plans from the six Medicare Advantage companies.
Call or Text 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.
● Having a face to face meeting is not safe these days but we can talk on the phone to review options. Then if you want to sign up most enrollment forms can now be completed on line.
● Companies decide on the benefits for a specific MA plan they want to offer.
● The plan is then submitted to MediCare. When approved they sign 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.
The State and specific Counties where the company wants to offer the plan are part of the proposal sent to MediCare. Individuals living in an approved County can then buy the new plan.
MediCare pays the MA company a fixed monthly payment for each person who signs up for their MAPD.
● You pay an office visit co-pay when you go to a network MD.
● Co-pays to see a Specialist are higher than a primary care MD. Preventive visits have no cost.
● You may be charged cost sharing for some services.
● A per day fee is charged for the first four or five days if hospitalized.
● All your co-pays, cost sharing, and other costs for medical treatment during a calendar year are limited by the plan's Maximum Out of Pocket (MOP) provision.
Note: MediCare sets a limit for the medical MOP. ($6,700 in 2020) Many plans use this. Some may offer a lower MOP but with a higher monthly cost.
● The medical MOP does not include your medication costs. The prescription part of the plan also has a MOP for the various co-pays and cost sharing based on the Tier a medication is in.
● Prescription plan benefits vary based on coverage stages.
-> First is the Deductible. Many plans only use it on higher Tiers.
-> The next stages are the — Initial Coverage — Coverage gap [donut hole] — Catastrophic .
Yes — at certain times!
The primary time to make a change is called the Annual Election Period. (AEP) A person using the 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 such as a life change situation, such as moving, where a change can be made.
Federal regulations limit the times to enroll in or change a MAPD plan.