● 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.
● 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.
● 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.
● 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.
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.
● 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.
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.
● Understand your situation and interest!
● Review coverage, answer questions, and select the plan which is best for your budget.
● Talk about Medicare PDP options and select a plan to fit your medical situation.
Content on Medicare-Health-Plans-Southeastern-CT is © 2018 to 2020 by John C Parker, RHU, LTCP - All Rights Reserved.
Powered by GoDaddy Website Builder