Supplements pay MDs and other treatment or service providers the part MediCare did not pay them!
● If you went to a MD or other outpatient provider and only had original Medicare they would just be paid 80% for their services! You pay 20%.
The way this works:
● The MediCare system reviews all medical treatment and services and "assigns" an amount * * to pay for each!
** Discounted, often deeply, from retail!
● MDs and other providers who sign up to participate with MediCare have to agree to accept just 80% the approved amount. This requirement is called accept "assignment".
● Receive any Outpatient treatment or service — you receive a quarterly statement from MediCare and then call the provider and pay 20% of the approved amount.
Note: MediCare also has an annual deductible on all Part B services to pay at he beginning of each year. It's $233 during 2022.
● Are "admitted" to a hospital — MediCare coverage when an inpatient is quite good! The approved amount for all medically necessary treatment & services is paid — you just pay Part A's deductible, which is $1,556 in 2022, each time you are admitted.
Bottom line — having to pay 20% for all the many outpatient treatments you may receive could quickly be a Big Risk to income & savings!
● Buying protects you from spending income & savings to pay what MediCare did not!
● Your Supplement company:
- > Works with MediCare's system and pays providers for you the part of the outpatient treatment or service invoices MediCare did not pay.
Note: The amount the company pays and what 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.
● Will be able, when needed, to see any provider here in CT or in another state who accepts MediCare. The is important to many
● No longer have to pay 20% of a lot of treatment bills coming in the mail following unexpected medical situations!
● Now have a company to pay providers 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!
● You will show the MD's office or other provider your Supplement plan ID card and Medicare ID card. They will usually scan them.
● The provider submits their charges for your visit to a MediCare claims administrator.
● Your Supplement company can access your expenses in the Medicare claim administrator's system based on the approval provided in your plan's application.
-> they pay your provider, based on coverage in your plan, the part of your treatment expense MediCare did not.
● The Supplement company sends an explanation of their payments, which shows the amount to pay a provider.
# 1 -Medical treatment providers send lots of invoices following your visit. Do not pay the amount on provider invoices. Wait to see the actual amount you are responsible for, if any, on your supplement statement.
# 2 - When making an appointment just tell the provider 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.
No! Supplements were developed to pay the unpaid part of any treatment and service expenses MediCare determined to be medical necessary. If MediCare pays the supplement plan will pay.
The Supplement plan pays the provider, based on your plans coverage. For example, in Plan G they do not pay Part B's deductible at the beginning of each year. It's $233 in 2022.
● Federal regulations authorized the National Association of Insurance Commissioners (NAIC) to develop coverage in each Supplement plan.
● When plans were initially developed they were given "lettered' names". A has the least coverage, B, C. etc. have more.
[Confusing since the parts of MediCare also have letter names. ]
● The NAIC has made coverage updates over time. One in 2010 made several coverage changes
● Federal regulations instruct each state legislative body to approve the plan coverage the NAIC recommends. This means coverage in a specific letter Supplements in CT will be the same as that lettered plan in most states.
● State legislature then incorporate the coverage in their legislature regulations. They add their specific eligibility requirements.
● A federal regulation in 2019 restricted availability of full coverage plans for certain individuals:
-> Anyone 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.
Here in Connecticut state legislation and regulations authorized the CT Insurance Dept. (CID) to ensure all Supplement companies:
● Offering Supplements must follow the following state and CID requirements:
-> a person enrolling, whether male or female who is 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: The CID in communications about Supplements often refers to them as MediGap plans.
● Must offer at least Plan A to under age 65 individuals who qualified for Social Security disability.
● 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 .
● 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 the 20% MediCare did not pay for treatment by paying:
-> Part B's annual deductible [$233 for 2022];
-> 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. How are they are 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 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 21 PDP options in New London County in 2022 !.
When can you purchase a PDP?
-●- When turning 65 individuals have what is called an Initial Eligibility Period (IEP). It's the same 7 month time as signing up for MediCare.
How to sign up! — The sign up rules for a PDP say 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 5 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 and thus qualify for a Special Election Period.
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 it is only on certain Tiers.
I don't take any medications!
-●- 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 is added for each month you did not have coverage when you do sign up.
When we talk the focus will be to
● Understand your situation and interest!
● Review Supplement plan options, answer questions, and select the best plan for your interest & budget.
We can also talk about PDP options. If enrollment is available we can review the best plan to fit your medical situation,