Wednesday, December 26, 2018
Recently received a two-part question, which I am commenting on today.
First: I will be eligible for Medicare soon and would like to know what the options are for enrolling?
Second: You have been saying it is important to buy coverage for the part of covered treatment expenses Medicare does not pay. When can this be done and can I change this coverage later?
Medicare and a Medicare Health Plan are two separate kinds of coverage managed by two federal agencies, There is often confusion on enrollment since there are different enrollment rules for each.
The first Question is about Medicare the federal level medical insurance program. A person normally becomes eligible when they reach age 65. Individuals under 65 who have qualified for Social Security disability benefits for 24 months also become eligible.
Note: Enrollment during any of the following eligibility periods is processed by Social Security, not by Medicare.
Initial Eligibility Period (IEP): A person qualifies for this upon reaching 65 and it lasts for 7 months. They can then sign up during:
● Any of the three months before the month of eligibility (become 65) If they select one of these months their Medicare coverage would be effective the first of the month they are 65.
● The month they are 65 and coverage will be effective on the first day of the next month.
● Either of the three months after eligibility. Doing this results in different coverage dates:
+ Enroll one month after 65 – first day of second month after the person enrolls.
+ Enroll two or three months after 65 – first day of the third month after they enroll.
A Special Enrollment Period (SEP). In a situation where a person continued to work after age 65 and then decided to enroll, they qualify for an up to 8 month SEP to sign up. They should call their Local Social Security office and make an appointment with a Retirement person to enroll in Medicare. Doing this when still on an employer plan or during the first month after leaving the group plan means:
● Coverage begins the first day of the month they enroll or
● They can select to enroll the first of any of the following three monthst.
Couple special things to be aware of when eligible for a SEP:
● The SS system will set up their Part A coverage retroactive six months.
● During the appointment ask for Form CMS-L564. Take it to your employer to fill in the dates you were covered on the company medical benefit plan. When it's signed take it back to the SS office. This form qualifies you for the SEP and means you avoid Part B’s late enrollment penalty which adds 10% to the cost of Part B.
A General Enrollment Period. If a person did not enroll during the IEP period or the SEP they will have to wait to enroll in Part B. This could and has happened when a person left employment and elected to continue the group plan coverage with COBRA. In this situation when COBRA ends they have to wait to enroll in Medicare Part B between January 1st and March 31st. Coverage, however, would not start until July 1st. A person in this situation can enroll in a stand-alone Prescription Drug Plan but would not have any coverage for the 20% of outpatient expenses Medicare does not pay.
The second Question is about selecting an insurance plan to pay the part of treatment expenses Medicare does not pay. A person can request enrollment in one of two kinds of what I like to call a Medicare Health Plan. Both types are purchased from a private company:
A Medicare Supplement: A person who selects this type can receive treatment from any provider in any state who agreed to participate with Medicare and thus accept the reduced level of payment on any approved treatment/service they provide. Medicare normally just pays them 80% of the approved amount.
● Medicare Supplement plans, sometimes call a MediGap plan, are approved for use in CT by the state Insurance Department and a person can (normally) enroll/change their plan any time for coverage the 1st of the next month.
● These plans have “lettered” names. A has the least coverage, B, C. etc have more. Use of letters can be confusing since the part of Medicare also have letter names.
● Any Supplement with the same letter from any of the approved companies has identical coverage. However, there can be considerable variation in the monthly cost companies charge for their plan here in CT. CT’s DOI approves plan cost.
A Medicare Advantage Plan: A Medicare Advantage Plan (MA) is purchased from a private company and covers, as a minimum, everything MediCare does plus additional benefits. A couple points on MA plans:
● A MA company has a yearly contract with Medicare, is paid a fixed monthly payment for each person who enrolls, and administers all the medical treatment a person receives. Coordinating coverage can result in better outcomes. Plans usually include medications and are then call a MAPD. Individuals usually pay a monthly cost.
● Plans cover additional benefits such as an annual physical (Medicare does not ) and usually offer discounts on or options to buy benefits, such as fitness, dental, vision, and hearing not in original MediCare.
● All treatment is received from providers in the companies network.
● Availability is based on the County you live in. Some MA companies have plans in CT but do not offer all options or any in New London County.
If an individual is interested in a Medicare Advantage plan there are different election periods. Medicare has assigned the following priority to these periods:
● The Initial Coverage Election Period (ICEP). This occurs when a person is first eligible for Medicare. They can elect a Medicare Advantage (MA) plan or a MA plan with prescription coverage (MAPD).
Note: There is also an enrollment period at the same time called an Initial Enrollment Period for the person who wants to stay on original Medicare and buy a stand-alone Prescription Drug Plan
● The Medicare Advantage Open Enrollment Period (MA OEP) This option will again be available for 2019. It occurs from January 1st to March 31st and allows a person who was dissatisfied for some reason with their current Medicare Advantage (MA) plan to make a change. They can elect a new MA or return to original Medicare and select a stand-alone Prescription Drug Plan.
● Special Election Periods (SEP) These are for different kinds of situations such as moved to a different state.
● The Annual Election Period (AEP). A period each year in the fall to change coverage for January 1st. This is currently October 15th to December 7th.
● The Open Enrollment Period for Institutionalized Individuals (OEPI) A special period for an individual who is entering or leaving a long-term care facility.
Call today if any questions on enrolling in MediCare or about the Medicare Health Plans.
John C Parker, RHU, LTCP
Niantic - cell/text (860) 662-3000
Saturday, November 24, 2018
Many people report they are confused about Medicare Health Plans - so instead of looking at newer more economical options, they tend to continue what they have.
As a step to help understand the two typse of Medicare Health Plans the first page on this site provides some highlights. MedicareHealthPlansSoutheasternCT site.
The Annual Enrollment Period (AEP) to enroll in or change a Medicare Advantage Plans - the first type ends Dec. 7th. This page has some details on how they work:
• Medicare Advantage options available in Southeastern CT?
The second type is a Medicare Supplement. They are regulated by the state of CT and can generally be changed at any time. This page has some details on how they work:
• Medicare Supplements approved in CT?
People who are enrolled in a Medicare Supplement also are enrolled in a Prescription Drug Plan. The are also controlled at the federal level and changes are limited to the AEP
The pages on Medicare Advantage Plans and Medicare Supplements do not have specific information on any of the plans so call (860) 739-0005 for details!.
John C Parker, RHU, LTCP
Friday, November 23, 2018
The cost of a medical procedure can vary considerably between providers and in different facilities. Even those in the same general area!
Most medical plan's today have a high deductible followed by cost sharing thus when any non-emergency treatment is suggested it's important to look at the cost so you can understand what your share might be.
A great place to look for proposed procedure costs is with Fair Health. When on the site the first step is to select:
— the green medical cost button
— then the in-network button (more economical )
— then your zip code
— then the blue button to find and select the type of medical situation you are interested in
You will see a list of in-network and out of network costs.
Note: When only a few providers are shown select one and tell your MD — I found it would cost $_____ for the ______ and would like to know what your cost will be?
Saturday, November 17, 2018
Thursday, November 01, 2018
The world of going to a Doctor for a check-up or to receive treatment is changing - finally!
What does that mean?
● Individuals enrolled in Medicare now have the opportunity to participate in certain Medicare Advantage plans which are changing the focus of the relationship a person has with their Doctor.
● When this happens the person become more involved in their treatment and the outcomes are better.
This Next Avenue article is not about what is going on with plans here in CT but I want to share it because it does a good job explaining patient centered care.
One point - of interest to me - the article emphasizes talking to your Doctor about this.
There is a new Medicare Advantage plan in CT, and available in New London County, which is 100% focused on this approach.
John C Parker, RHU, LTCP
Sunday, October 07, 2018
Monday, October 01, 2018
Saturday, September 29, 2018
There will be a new Medicare Advantage plan in New London County starting January 1st. The plan will have MDs throughout the County but based on the participating hospital it will be more effective for individuals living in the Northern part of our County.
Thursday, September 20, 2018
Tuesday, September 18, 2018
Background: MediCare's agreement with MDs and other providers is to of the treatment or service they provide. Thus, since an individual is and there are so many kinds of outpatient treatment this cost could quickly become to your income & savings - but can be avoided by b a type of insurance I refer to as
Friday, September 07, 2018
A quick note to share a chart on how an average dollar a person spends each month for their medical insurance is used.
Prescription drugs take the biggest share at 23.3 cents. The other things it is spent on are also shown in cents.
Information under the chart has some points on:
☀︎ Other reasons medical insurance is expensive
☀︎ What can be done about high medical costs
☀︎ Suggestions for things to do to make a better decision on an upcoming treatment.
John C Parker, RHU, LTCP
Wednesday, August 22, 2018
This topic could have many answers and go in various directions.
Instead, I'm sharing some information from one source.
A key point for me from the article or post is: [I put bold on some text]
- - - "free-market solutions that put patients and doctors—not federal bureaucrats—in charge of health care decisions and dollars."
John C Parker, RHU, LTCP
A Health related Insurance Advisor in Niantic
Friday, August 17, 2018
Medications today can do great things for people.
Saturday, April 14, 2018
When you look into various medical situations and illnesses you find an amazing number and kinds of treatments are now available! The question then becomes - are they really all needed?
For example, let look at what we will call Procedure A. Studies and other information tell us - generally it works and good results are achieved. However, sometimes procedures don't work because humans are not all the same!
Now let's say someone comes up with the idea of another approach for the same medical situation, which we will call Procedure B. An extensive amount of work, time, and expense is required to evaluate and get approval from the FDA for Procedure B’s approach. Then one wonders - are the results to be achieved from Procedure B really so much better than from the older and still useful Procedure A? Then too, the cost to be charged for Procedure B is much higher so are the results really worth this additional cost?
A study in one state looked into this. 1.3 million people who received a service or treatment on a list of procedures known to often be over-used were reviewed and about 50% were found to be overused or considered to have low value. IOW they have little benefit for people!
There were 47 treatments/services in the study and 93% of the overuse came from just 11 of them! An image to look at low back pain was being over-used.
Some points to think about:
- If many procedures are being over-used or have little value in one state they are also happening in all the others.
- What does the cost of unneeded or low-quality treatments/services due to what we all have to pay for medical insurance?
- There is a lot of media coverage today on another overuse issue - opioids for pain. Studies have shown non-prescription treatment is often just as effective and does not have the side effects.
OK? What can be done about overuse & low quality? I encourage everyone to talk to their MD when any treatment or special test is being suggested. To help in talking to any MD the Choosing Wisely organization developed five useful questions:
☀︎ Do I really need this test or procedure?
☀︎ What are the risks and side effects?
☀︎ Are there simpler, safer options?
☀︎ What happens if I don’t do anything?
☀︎ How much does it cost and will my insurance pay for it.
Choosing Wisely is working to advance a national dialogue on avoiding unnecessary medical tests, treatments, and procedures.
You can find more information about this great program helping individuals get involved with their health and thus have a better lifestyle!