Connecticut's Medicare Supplement Plans
What this "special" medical insurance can do for you!
● Pay your MD or provider most or all the 20% MediCare did not pay them when you received outpatient treatment.
● Pay your Part A deductible ($1,408 in 2020) if admitted to a hospital.
Some points on Medicare Supplements:
● They generally pay the Gap - in the treatment cost MediCare does not so are often called MediGap Plans,
● A good way to think about this special kind of insurance — plans work as a life ring over your money!
● 9 out of 10 people are happy with their Medicare Supplements.
Where can a Supplement be used!
● You can go to any provider in any state who elected to participate in MediCare. BTW they also agree to a reduced level (80%) of payment.
Note: Just tell the provider when making an appointment you have MediCare. They do not have to know what Supplement company you have.
What to do when you go for treatment?
● There is no provider office charge! The provider submits their charge for your treatment to the MediCare claims administrator.
● Your Supplement company gets your Part B expenses from the MediCare system (the claim administrator), using the approval you provided in the application. The company then pays your provider all or part of the 20% they did not receive.
● The MediCare system mails you a coverage summary on a quarterly basis when you had treatment.
Note: The summary has a column for - Maximum You May Be Billed. There is a code beside the amount indicating it was sent to the Supplement company.
● Your supplement company also mails you an explanation of their payments.
Note: Do not pay any of the many provider invoices you receive until you see the actual amount due on the supplement statement.
A look at Medicare Supplement regulation.
First - Basic plan regulation is at the federal level:
● The National Association of Insurance Commissioners was authorized by federal regulations to develop supplement plan coverage. Each state legislative body then approves them.
● Plans are identified with "lettered' names" and coverage for each letter is standardized. A has the least coverage, B, C. etc. have more.
[Confusing since the parts of MediCare also have letter names. ]
● A supplement here in CT with a specific letter will be the same as that letter in most states.
● A new federal regulation, effective Jan 2020, restricts availability of certain Supplement plans to people of a certain age:
-> Anyone who turned 65 in January 2020 or after, called newly eligible in the regulations, can not buy a supplement, which pays Part B's deductible such as F.
Note: Individuals who enrolled in these Plans prior to Jan. 2020 can keep them.
Second - Regulation on details and marketing is at the state level.
The CT Dept of Insurance (DOI) is responsible to ensure supplement companies follow state regulations and department requirements such as:
● Any company offering a specific letter plan:
-> will charge the same monthly cost whether the person enrolling is male or female or 65 or 95.
-> can not consider a person's health history.
● Individuals can normally change their plan, whether with their company or to another, at any time. The new coverage would be effective the 1st of the next month.
● Supplement companies are to submit the proposed monthly charge for their plans to the DOI. When approved a person living in any CT County can purchase the plan.
-> the monthly cost, when approved, will often increase on January 1st.
Note - coverage from any company is standard - but the monthly cost the charge for a letter plan:
-> can vary considerably from what other companies charge for the same plan.
A couple plans to think about:
● Plan N - One company offers N for over $100 a month less than their full coverage F.
Why is N less? You share in paying the provider parts of your 20%:
-> 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.
● High Deductible Plan F. It's the lowest cost Supplement but only a few companies in CT offer this plan.
-> An individual pays, at the beginning of each calendar year, their providers the first $2,350 (for 2020) of any treatment received.
-> Any medical related expenses above the deductible are paid by the company.
-> It's a good option for someone who was using a high deductible plan when under 65.
● Note: High Deductible F is not available to newly eligible individuals. [65 in Jan 2020 or later] They can buy the new High Deductible G with the same deductible.
What about getting Prescriptions at a Pharmacy?
MediCare Part B nor a Medicare Supplement Plan does not cover medications purchased at a local pharmacy.
What to do?
● Buy a Medicare Prescription Drug Plan. (PDP) It's MediCare's Part D and pays part of your outpatient prescription cost.
● PDPs are developed by and purchased from private companies. Buying is voluntary but if a person did not have "credible" prescription coverage, such as from an employer, a penalty is added.
● PDPs are available 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 Initial Eligibility Period.
● Once enrolled changes are limited to the Oct 15 to Dec 7 Annual Election Period unless a person qualifies for a Special Enrollment Period.