Connecticut's Medicare Supplement Plans
Background on this <—> "special" medical insurance!
Today many kinds of medical treatment and services are provided outpatient!
● However, when just having MediCare's Part A & B (original Medicare) your MDs or other outpatient providers are not paid 100% for 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 *. They have to accept "assignment".
* Discounted, often deeply, from retail!
When you only use original MediCare it means:
● You are responsible for 20% of each outpatient treatment or service you receive.
Note: You also have to pay Part B's $198 annual deductible.
● When you have any in hospital treatment — MediCare pays the assigned amount for all medically necessary services — you have to pay Part A's $1,408 deductible.
Bottom line — paying 20% for all your outpatient treatment could quickly be a Big Risk to income & savings!
What to do about MediCare not paying 100% for treatment? It's quickly a BIG expense for many!
Buy a Medicare Supplement to protect your income & savings!
When you own a Supplement plan the company:
● Works with the MediCare system and pays outpatient treatment or service providers most or part of the medical treatment / service invoices MediCare did not pay.
● Pays the hospital Part A's deductible. ($1,408 in 2020)
Note: MediCare pays the hospital — the assigned amount — for all authorized treatment and services.
What are the advantages of buying a — Medicare Supplement?
● The big reason many buy — they can see any MediCare providers here in CT or in another state, when they want to or may need to.
● Another important reason to own — your income & savings is protected — from a lot of treatment bills coming in the mail! — following an unexpected medical situations!
● The company pays providers, depending on coverage in the person's Supplement, all or part of the treatment MediCare did not - the so called Gap.
[Supplements are often called MediGap Plans.]
Note: 9 out of 10 people who have a Medicare Supplement say they are happy!
How is your Medicare Supplement used when you go for treatment?
● The provider's office will want to see and perhaps copy your Medicare and Supplement plan ID cards. They do not ask for any office charge!.
● The provider submits the treatment charge for your visit to a MediCare claims administrator.
● Your Supplement company:
-> receives any expenses being charged to you from the MediCare claim administrator
-> reviews the treatment and then pays your provider the part of the treatment expense covered by your plan they did not receive.
Note: Your approval for the company to access your expenses was in the details of the plan application.
● The MediCare system sends you a coverage summary quarterly when you have treatment.
Note: The summary has a - Maximum You May Be Billed - column with a code by the amount indicating it was sent to the Supplement company.
● The Supplement company also sends an explanation of their payments.
Note: The medical treatment system sends you lots of invoices following a visit. Do not pay any of these provider invoices. Wait to see the actual amount you are responsible for, if any, on the supplement statement.
Are there any limits on the treatment a person can receive when using a Medicare Supplement?
No! They pay the amount covered by your plan for any treatment MediCare determined to be medically necessary
When you own a Supplement:
● You can receive treatment from any provider, in any state, who elected to participate in MediCare.
BTW — When making an appointment just tell the provider you have MediCare. Providers do not have to know what Supplement company you have.
Medicare Supplements are regulated — in two ways!
First — certain requirements for plans are set at the federal level e.g guaranteed at 65:
● Federal regulations authorized the National Association of Insurance Commissioners (NAIC) to develop certain plans and the coverage each plan will offerr.
● When plans were initially developed they received "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.
● Federal regulations instruct each state legislative body to approve the NAIC's recommended plans and implement them in state regulations.
.
● Thus, a Supplement with a specific letter in CT will be the same as that lettered plan in most states.
● A recent federal regulation effective Jan 2020 restricts the availability of certain full coverage plans to people turning 65 in Jan 2020 or later:
-> The new requirement states anyone 65 in January 2020 or after, called newly eligible, can not buy a plan, which pays Part B's deductible, such as Plan F.
Note: Individuals enrolled in a now restricted Plan prior to Jan. 2020 can keep it.
Second — Eligibility and marketing regulations are developed at the state level.
In Connecticut state legislation and regulations have authorized the CT Insurance Dept. (CID) to ensure all Supplement companies:
● Who offer any lettered Supplement in CT follow these state and CID requirements:
-> a person enrolling, whether male or female or 65 or 95, will be charged the same monthly cost.
-> any offered plan is available to individuals living in any CT County.
-> questions about a person's health history can not be asked.
-> when a monthly increase is proposed the company submits it to the CID. When approved, increases are often effective January 1st.
Note: CID often refers to Supplements as MediGap plans.
● Individuals who sign up for a Medicare Supplement:
-> receive their new coverage the 1st of the next month after applying.
-> can normally change to another plan 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.
When you share in what the plan pays = the cost is less! Two — plans to think about:
● First — Plan N - One companies N is over $100 a month less than their full coverage F.
Why is N less? You & the company share in what MediCare did not pay 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 such as HD F & HD G. These are the lowest cost Supplements in CT but only available from a few companies.
-> Why? Coverage is the same as Plan F or G but, a person does not share but 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 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.
What about coverage for my medications?
MediCare B and the Supplement backing it up do not cover prescriptions at the Local Pharmacy!
What to do? Buy what MediCare calls a Prescription Drug Plan (PDP) to cover part of the cost of outpatient prescriptions It's Medicare's Part D:
● A person pays co-pays and cost sharing based on the Tier level of the medication.
● Buying a PDP is voluntary but if a person does not have "credible" prescription coverage, such as from an employer, a penalty is added when they do 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 there is what is called the Initial Eligibility Period to apply for a PDP plan.
● Once enrolled a person can only change during the Oct 15 to Dec 7 Annual Election Period (AEP) unless they qualify for a Special Enrollment Period, such as after moving.
