Medicare Supplements in Connecticut
A Supplement is a medical insurance plan, which pays the part of your treatment MediCare didn't pay!
● If you went to an MD or other outpatient service and just used Part A & Part B (original Medicare) the Provider would be paid just 80% of MediCare's approved amount for your treatment/service! This means - you pay 20%.
● Since so so many medical treatments/services are provided outpatient today you can gain two things by buying a Supplement plan:
- > The Plan company will pay MDs and other treatment or service providers your 20%.
- > You save time not having to contact the provider to pay what MediCare did not pay!
How payments work:
● The MediCare system reviews all medical treatment and services and "assigns" the amount * * which can be paid for each!
** Discounted, often deeply, from retail!
● MDs and other providers who participate with MediCare agreed, when they signed up, to accept just 80% of the approved amount.
Note: This requirement for providers is called to accept "assignment".
How does a — Medicare Supplement — work?
When using any Outpatient treatment or service:
● You show the MD's office or other provider your Supplement plan ID card and Medicare ID card. They usually scan them.
● The provider submits their charges for your treatment/service to a MediCare claims administrator
● Your Supplement company is able to access your expenses in the Medicare claim administrator's system based on the approval provided in your plan's application.
● The Supplement company sends an explanation of their payments, which shows the amount, if any, to pay a provider.
Note: In addition to your treatment charges being paid, there is when just using Original MediCare an annual deductible on all Part B services. It's $226 during 2023.
Notes:
# 1 -Medical treatment providers often send an invoice right after your visit. Do not pay the amount on provider invoices. Wait to see the actual amount you are responsible for, if any, on the statement from your Supplement company.
# 2 - When making an appointment with a new provider, whether in CT or any state, tell them you have MediCare. Providers do not have to know what Supplement company you have. Nor, since they accept MediCare, can they say they do not take plans from your Supplement company.
When you are "admitted to a hospital:
MediCare coverage when an inpatient is quite good! The approved amount for all medically necessary treatment & services is paid.
Note: — When just using Original MediCare you are responsible to pay Part A's deductible. It's $1,600 in 2023 and paid each time you are admitted.
Buying a Supplement solves the <—> MediCare does not pay 100% issue?
● Buying protects your income & savings from having to pay what MediCare did not!
● Your Supplement company:
- > Works with MediCare's system and pays providers for you the 20% MediCare did not pay.
Note: The amount you pay varies based on coverage in the Supplement you select. For example, in Plan N you pay a $20 co-pay for each MD office visit.
- > Pays Part A's deductible each time "admitted to a hospital.
In addition, buying a — Medicare Supplement — means you will:
● Be able, when needed, to see any provider here in CT or in another state who accepts MediCare. The is important to many.
● Have a company to pay providers for you thus protecting your income & savings!.
[Supplements are often called MediGap Plans.]
Note: 9 out of 10 people with a Medicare Supplement say they are happy!
Are there limits on the kind of treatment YOU can receive when using a Medicare Supplement?
No! Supplements were developed to pay the 20% of the amount allowed for any treatment and service MediCare determined to be medically necessary.
Bottom line: Thus, if MediCare pays your supplement plan will pay.
The Supplement plan pays the provider, based on your plans coverage. For example, in Plan G & Plan N they do not pay Part B's deductible at the beginning of each year. It's $226 in 2023.
How Medicare Supplements are regulated — lets look:
At the federal level. — All plans are required, for example to be guaranteed at age 65. Background:
● Federal regulations authorized the National Association of Insurance Commissioners (NAIC) to develop and send to all states how each Supplement plan will cover medical treatments/services.
● Initially plans were given "lettered' names". Plan A has the least coverage, B, C. etc. have more.
[Confusing since the parts of MediCare also have letter names. ]
● Federal regulations instruct each state legislative body to approve the NAIC's recommended coverage. This means coverage in a specific letter Supplement in CT will generally be the same as that lettered plan in most states.
● State legislature's generally incorporate NAIC coverage recommendation in their legislature regulations. They do however add their specific eligibility requirements.
Note: CT is one of a few states that does not use medically underwriting at 65 or older.
● Over time the NAIC has made coverage updates. In 2010 several coverage changes were made such as dropping the limited prescription coverage.
● In 2019 federal regulation restricted the availability of any plan with full coverage of Part B's annual deductible to certain individuals.
-> Thus, individuals who turned 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 who were 65, prior to Jan. 2020, are not restricted.
Most regulations for Supplements are at the state level such as — Eligibility and Marketing.
Here in Connecticut state legislation and regulations have authorized the CT Insurance Dept. (CID) to monitor and ensure all Supplement companies offering Plans in CT:
● Comply wirh the following state and CID requirements:
-> a person enrolling, whether male or female who 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.
-> proposed monthly increases are submitted to the CID. When approved, increases become effective. Often January 1st.
Note: CID communications about Medicare Supplements, on Medicare.gov, and from federal agencies often refers to them as MediGap plans.
In addition, all companies offering Supplements in CT must:
● Offer at least Plan A to under age 65 individuals who qualified for Social Security disability after 24 months and become eligible for MediCare.
● Permit individuals who sign up for a Medicare Supplement to:
-> receive their new coverage the 1st of the next month after applying.
-> be able to change (normally) to another plan with their company at any time or to another company.
Note - Coverage in any specific lettered plan in CT from any company is the same - but:
-> the monthly cost a company charges for a plan can vary considerably from what another company charges for that same plan . For example, in January 2023 Plan N is available from $160 a month up to $400
One way to lower your monthly cost is to share in what the plan pays! Two — plans to think about:
● First — Plan N - One companies N is over $100 a month less than their full coverage Plan F.
Why is N less? You share, with the supplement company, in paying the provider the 20% MediCare did not pay for treatment by paying Plan N's:
-> Part B's annual deductible. [$226 for 2023]
-> a $20 co-pay for each MD office visit;
-> a $50 co-pay if any emergency room visits.
● Second — High Deductible (HD) Plans. HD Plan F & HD Plan G are only available from a few companies in CT. They provide the lowest monthly cost Supplements.
-> Coverage is the same as Plan F or G but you pay the first $2,490 (deductible for 2022) of any Part B medical treatment or services received each calendar year.
-> Any additional Part B medical related expenses are paid by he 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] However, they can buy the new HD Plan G with the same deductible.
What about medications?
MediCare Part B and a Supplement Plans DO NOT COVER prescriptions bought at your Local Pharmacy!
What to do? Individuals can:
-●- Get part of the cost of outpatient medications paid by — Buying what MediCare calls a Prescription Drug Plan (PDP). They are Medicare's Part D.
PDPs are developed by and purchased from a private company. Availability is based on the County a person lives in.
Note: There are 9 PDP companies availble in New London County in 2023 offering 24 plan options !.
When can you purchase a PDP?
-●- When turning 65 individuals have what is called the PDP Initial Eligibility Period (IEP) to sign up for a PDP. It's the same 7 month time as signing up for MediCare.
How to sign up! — The PDP sign up rules indicate individuals:
-●- can select the plan with the best coverage for their medications during their IEP
-●- cannot sign up whenever they want if did not sign up in the IEP.
-●- can sign up once a year during the Oct 15 to Dec 7 Annual Election Period (AEP).
-●- the only other time a change can be made is if they have a life change event such as after moving to a different area and thus qualify for a Special Election Period (SEP).
What happens at a local Pharmacy?
-●- A co-pay or cost sharing percent is charged based on the Tier level the PDP company placed the medication in. Some plans have an annual deductible to pay first. Often the deductible is only on certain Tiers.
A couple points on - I don't take any medications!
First - a look at what the "rules" say:
-●- The regulations establishing Medicare’s Part D set it up as a voluntary program!
-●- However, if you do not have "credible" prescription coverage, such as from an employer a monthly late enrollment penalty (LEP) is added for each month an individual did not have coverage when they do sign up.
-●- How much is the LEP: The penalty is 1% of the average monthly cost for Medicare's Part D plans which is $33.37 in 2022. So Part D's LEP in 2022 is 33 cents each month.
Second - a look at why you need a PDP:
-●- A study from the National Poll on Healthy Aging found 77% of older adults with health insurance were using two or more prescription medications.
-●- The study, based on data from 960 people age 65-80 found 62% had Medicare Part D, revealed of those who take two or more prescription medicines, 51% also take between two and four non-prescription medications including supplements, and 15% took five or more.
