Pay most or all of the 20% MediCare did not pay the provider following an office visit or other outpatient treatment. Plan's also pay the Part A deductible when in a hospital.
A couple points:
● Supplements are also called MediGap Plans since they generally pay the part - the Gap - of treatment cost MediCare does not.
● A good way to think about this special kind of insurance — it's a life ring over your money!
● You can go to any provider in any state who participates in MediCare and agreed to receive the level of payment.
Note: When making an appointment just tell the provider you have MediCare. They do not have to know what Supplement company you have.
● 9 out of 10 people are happy with their Medicare Supplements.
● When you receive treatment:
+ Providers submit their charge for your treatment to the MediCare claims administrator.
+ Your Supplement company, using the approval provided in your plan application, gets your Part B expenses from the MediCare system, and pays your provider.
+ The MediCare system will mail you a coverage summary on a quarterly basis following treatment.
Note: The summary has a - Maximum You May Be Billed column and a code beside the amount which indicates it was sent to the Supplement company.
+ The supplement company also mails you an explanation of their payments.
Supplements have some federal regulation:
● Plans are identified with "lettered' names". A has the least coverage, B, C. etc. have more.
[Confusing since the parts of MediCare also have letter names. ]
● Coverage is standardized so a plan here in CT with the same letter will be the same in most states.
● A new federal regulation restricts availability of certain Supplement plans to certain people:
+ Anyone turning 65 in January 2020 or after will not be able to buy a plan that pays Part B's deductible such a Plan F. Individuals enrolled in these Plans can keep them.
Supplements also have some regulation by the CT Dept of Insurance which:
● Approves the monthly cost each private company charges for their plans. When approved the plans can be purchased in any CT County
Note - the monthly cost charged for a specific Supplement plan:
+ can vary considerably from what other companies charge for the same plan.
+ will be the same for males and females and whether a person is 65 or 95.
● Allows individuals (normally) to change their plan at any time for coverage the 1st of the next month.
● Plan N - One company offers N for over $100 a month less than their full coverage F.
Why does it cost less? With Plan N you share in paying the provider and pay:
+ Part B's annual deductible at the beginning of each year [$185 for 2019];
+ a $20 co-pay for each MD office visit;
+ a $50 co-pay if any emergency room visits.
● High Deductible Plan F. It's the lowest cost Supplement but only available from a few companies.
+ Each calendar year an individual pays their providers the first $2,300 (for 2019) of any treatment received.
+ The Plan then pays all medical related expenses above the deductible.
+ It's a good option for someone who was using a high deductible plan when under 65.
● Note: High Deductible F will not be available to individuals who turn 65 on Jan 2020 or later.
MediCare Part B does not cover any medications you purchase at a local pharmacy. Nor are they paid by a Medicare Supplement Plan.
What to do?
● Buy a Medicare Prescription Drug Plan. (PDP) It's MediCare's Part D and will pay part of your outpatient prescription cost.
● PDPs are purchased from private companies. Buying is voluntary but a penalty is added to the monthly cost if a person did not have "credible" prescription coverage, such as from an employer, when they sign up.
● Plan availability is based on the plans approved for the County you live in.
Note: There are a lot of options in New London County.
When can you purchase a PDP?
● When turning 65 you are eligible to apply during what is called your Initial Eligibility Period.
● Making a change after that is limited to the Oct 15 to Dec 7 Annual Election Period unless a person qualifies for a Special Enrollment Period.
Call John C Parker today for a (no cost to you ) appointment — to:
● Understand your situation and interest and discuss the flexibility of a Supplement! You can receive treatment, if needed, from any provider in any state who accepts MediCare.
● Answer coverage questions, review the monthly cost, and select the plan which is best for your budget.
● Talk about available Medicare PDP options to help pay for any medications.
You can also send a note with questions to - Learn@JohnCParker.agency
The Medicare-Health-Plans-Southeastern-CT content is © 2018 to 2019 by John C Parker, RHU, LTCP - All Rights Reserved.
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