Private companies developed two types of plans. Buying either means you protect your income & savings from what could be — a Very Big Risk! How? So much medical treatment is outpatient today and MediCare only pays 80% of the allowed amount!
This page was developed to — highlight how the two types of Medicare Health Plans work & times when you can sign up:
● MediCare rules say MA plans must cover everything original MediCare does and they may offer other benefits. *
( * A full annual physical and benefits such as dental & vision)
Individuals in a MA plan receive needed medical treatment through MDs and other providers who participate in the companies network. [Most MDs are in the MA plans in SECT]
Note: The focus of most MA plans is to coordinate the overall health of each individual plus their prescriptions. They are then called a MAPD.
● This page has details to help you understand how private company MAPD plans work and what individuals gain when they enroll!
● The ICEP is a seven-month period for individuals turning 65 to apply for a MA plan! — people usually select a MA which also includes prescriptions. It is then called a MAPD. The ICEP is at the same time as the seven month IEP to sign up for MediCare.
● A person who enrolled in a MA or MAPD when they were first eligible for MediCare can, if dissatisfied, drop it at any time during the next 12 months and go back to Original Medicare.
● The MA OEP is a special once a year time, Jan 1st to March 31st, when anyone, dissatisfied with their current Medicare Advantage (MA) or (MAPD), can make a change. They can:
-> Select a new MA or MAPD either with the same or another company.
-> Return to original Medicare, select a Medicare Supplement, and a stand alone Prescription Drug Plan.
● In addition, any person who enrolled in a MA or MAPD can also use a MA OEP to make a change during the first three months on the plan.
● The SEP is a time an individual, who has certain life events, can change their MAPD. There are many situations but the common Life Events would be:
-> moving to a different state.
-> learning, based on income level, they qualify for Extra Help with prescription costs.
A SEP is also available to a person in a Medicare Supplement who changed to a MA/MAPD but then became dissatified during the first 12 months. They can then:
-> Return to Medicare, apply for a Medicare Supp, and a PDP.
● The AEP is the most common time for anyone with a MA or PDP to make a change. It happens each fall and the new coverage is effective January 1st.
● The can change to a plan with their current or to another company.
● The AEP currently runs from October 15th to December 7th.
● The OEPI is for individuals in a long term care facility and gives them flexibility to meet their medical situation! They can make changes:
-> when entering,
-> while in,
-> when leaving.
When a person's situation results in being eligible for two election periods at the same time, the effective date of a plan will be determined by the period with the highest priority.
An example: A person who moves could have a SEP but if the move happens during their seven month [ICEP] their effective date will be based on the ICEP' enrollment rules, which is Priority One.
Supplements were the first private company plans to work with MediCare.
-> Named Supplements because the company supplements the 80% of the approved amount * MediCare sent your MD or outpatient provider by sendng them 20%.
[ * MediCare's approved amount for treatments & services is often deeply discounted from what can be called the retail amount]
When you own a Supplement — often called a MediGap — you gain flexibility to receive treatment from any MD or provider in any state who accepts MediCare.
Why needed! — If you were just using Medicare Part A & Part B, called original MediCare, and had a complex medicate situation, you would be responsible to pay your many outpatient provider(s) — 20% of the approved amount MediCare set for each treatment! Plus there is no limit on the amount you are responsible for. So you face — a very Big Risk!
Details to help understand how Medicare Supplement plans work, are regulated, and the eligibility and enrollment rules in CT are on this page.
OK — what can you do? Individuals using original MediCare & a Supplement can:
-> get part of the cost of the outpatient medications they get at the pharmacy paid by — Buying a Prescription Drug Plan (PDP)
When to sign up! — Medicare's PDP sign up rules say a person:
-> can select a PDP when first eligible for MediCare during their PDP Initial Enrollment Period (IEP)
-> does not have to sign up for a PDP during their IEP. But if they do not they can not sign up when ever they want.
Note: PDP sign up times are limited to the federal enrollment periods like for a MAPD! After when first eligible the Oct 5 to Dec 7 Annual Election Period is the most common time to make a change.
What about a person who does not take any medications? If they do not sign up and do not currently have "credible" prescription coverage, such as from an employer a monthly penalty will be added when you do sign up for each month without a PDP.
BTW - you can ask questions or about a time to meet and talk to learn more by sending a note - John@MedicarePlansSECT.com