Connecticut's Medicare Supplement Plans
Background on <—> This "special" medical insurance!
Today many medical treatments and services are provided outpatient!
● MediCare however, does not pay MDs or other outpatient providers 100% of what they consider the cost of their services!
Why? The way MediCare's system works — it:
● Reviews medical treatments and services and "assigns" the amount to pay for each.
● Asks MDs and others, as part of agreeing to participate, to accept just 80% of this amount *. It is called accept "assignment".
* Discounted, often deeply, from retail!
This means if you are only using MediCare and receive:
● Any outpatient treatment or services you are responsible for 20% of each!
Note: You also have to pay Part B's $198 annual deductible.
Bottom line — paying this could quickly be a Big Risk to income & savings!
● Any in hospital treatment — the assigned amount is paid for all medically necessary services — you have to pay Part A's $1,408 deductible!
MediCare not paying 100% of treatment costs quickly becomes a BIG expense! What to do?
Buy a Medicare Supplement, its one of the Medicare Health Plans, and works with the MediCare system.
When you own the Supplement company:
● Pays providers of outpatient treatment or services most or part of the medical treatment / service invoices MediCare did not pay.
● Pays the hospital Part A's deductible. ($1,408 in 2020) MediCare would have paid the assigned amount for all authorized treatment and services.
What are the advantages to you of a — Medicare Supplement?
● Allows individuals, who want to or may need to see a provider in another state, to get their treatment paid.
● Generally pays providers all or part of a person's treatment MediCare did not - the so called Gap.
[Supplements are often called MediGap Plans.]
● Protects your income & savings — from a lot of treatment bills coming in the mail following an unexpected medical situations!
Note: 9 out of 10 people who have a Medicare Supplement say they are happy!
Are there any limits on the treatment a person with a Medicare Supplement can receive?
No!
When you own a Supplement:
● You can receive any treatment MediCare has determined to be medically necessary from any provider, in any state, who elected to participate.
BTW — When making an appointment just tell the provider you have MediCare. Providers do not have to know what Supplement company you have.
Going for treatment! How is your Medicare Supplement used?
● The provider's office will ask to see your Medicare and Supplement plan ID cards. They do not ask for any office charge!.
● The treatment charge for your visit will be submitted by the provider to a MediCare claims administrator.
● Your Supplement company:
-> gets any expenses being charged to you from the MediCare claim administrator
Note: The approval to access your expenses was in the details of the plan application.
-> then pays your provider all or part of the treatment expense they did not receive.
● The MediCare system sends you a coverage summary quarterly when you have treatment.
Note: There is a - Maximum You May Be Billed - column on the summary with a code by the amount. This indicates it was sent to the Supplement company.
● The Supplement company also sends an explanation of their payments.
Note: Do not pay any of the many provider invoices they send you. Wait to see the actual amount you are responsible for, if any, on the supplement statement.
Are Medicare Supplements regulated? Yes — in two ways!
First — coverage in plans is indirectly controlled from the federal level:
● Federal regulations authorized the National Association of Insurance Commissioners (NAIC) to develop the coverage to included in the different plans which can be offered.
● Plans were given "lettered' names". A has the least coverage, B, C. etc. have more.
[Confusing since the parts of MediCare also have letter names. ]
● There have been coverage updates over time.
● The federal regulations instruct each state legislative body to approve the NAIC's recommended coverage and implement the plans in state regulations.
.
● A supplement here in CT with a specific letter will be the same as that letter in most states.
● A new federal regulation was effective Jan 2020. It restricts the availability of certain plans with full coverage to people of a certain age:
-> Thus, anyone who became 65 in January 2020 or after, called newly eligible, can not buy a supplement, which pays Part B's deductible such as Plan F.
Note: Individuals who enrolled in a now restricted Plan prior to Jan. 2020 can keep it.
Second — Eligibility and marketing regulations are developed at the state level.
Connecticut state legislation and regulations authorize the CT Insurance Dept. (CID) to ensure:
● All companies offering supplement plans in CT follow these state and CID requirements when any lettered plan is offered.
-> the same monthly cost will be charged to a person enrolling whether they are male or female or 65 or 95.
-> the selected plan will be available to individuals living in any CT County.
-> questions on a person's health history can not be asked.
-> any proposed monthly increases are to be submitted to the CID. When approved, increases are often effective January 1st.
Note: CID often refers to Supplements as MediGap plans.
● Individuals enrolling in a Medicare Supplement:
-> receive their new coverage the 1st of the next month after applying.
-> can normally change their current plan to another at any time, whether with their company or to another.
Note - All companies offering a specific lettered plan provide the same coverage - but:
-> the monthly cost charged by different companies can vary considerably.
A couple — less costly — Supplements to think about:
● First — Plan N - One company offers N for over $100 a month less than their full coverage F.
Why is N less? You & the company share in paying providers what MediCare did not such as:
-> Part B's annual deductible [$198 for 2020];
-> a $20 co-pay for each MD office visit;
-> a $50 co-pay if any emergency room visits.
● Second — High Deductible Plans. They are only available from a few companies but are the lowest cost Supplements in CT.
-> Why? Coverage is the same as Plan F or G but, a person pays, at the beginning of each calendar year or after they enroll, their providers the first $2,350 (for 2020) of any treatment received.
-> Any medical related expenses above the deductible are fully paid by the company.
-> High deductible plans are a good option for someone who was using a high deductible plan when under 65.
● Note: High F is not available to newly eligible individuals [65 in Jan 2020 or later] but they can buy the new High G with the same deductible.
Med Supplements cover medical treatment —What about coverage for medications?
MediCare Part B nor the Medicare Supplement which backs it up do not cover prescription medications purchased at a local pharmacy!
What to do? Buy what Medicare calls a Prescription Drug Plan.(PDP) It's Medicare's Part D and:
● Covers part of the cost of a outpatient prescription by charging co-pays and cost sharing based on the Tier level of the medication.
● Buying a PDP is voluntary but if a person did not have "credible" prescription coverage, such as from an employer, a penalty is added when they sign up.
● PDPs are developed by and individuals purchase them from a private company. Availability is based on the County you live in.
Note: There are about 25 options in New London County.
When can you purchase a PDP?
● When turning 65 you can apply during what is called the PDP's Initial Eligibility Period.
● Once enrolled a person can only change during the Oct 15 to Dec 7 Annual Election Period (AEP) unless a person qualifies for a Special Enrollment Period, such as when moving.