MEDICARE MADE SIMPLE? REALLY?

Posted on

Jul 27, 2015

Book/Edition

Connecticut - Southern Connecticut

With the Medicare annual election period right around the corner its that time again when your mailboxes will be filled with fliers and ads from every insurance company you have heard of and some you may not have heard of; but the question is? What do I need to know?

Oct. 1st - This is the time when brokers and insurance company representatives can tell you about their plans details, but no selling allowed!

Oct. 15th thru Dec. 7th AEP, is the election period in which a Medicare beneficiary may shop around and make a change to their current MAPD plan, which stands for Medicare Advantage plan (HMO or PPO type Plan) with Prescription Drugs, or they may elect a plan for the first time if they hadnt done so previously. If a beneficiary is on a Medicare supplement and a stand-alone Part D drug plan, they may change their plan to a MAPD plan and vice-versa. It is important to know that the last plan you enroll in is the plan that will be in affect for Jan. 1st.

Jan. 1st thru Feb. 14th is also an election period called the Medicare Advantage Disenrollment period. This period is a time where a beneficiary who has a MAPD plan can switch from the MAPD and go back to Original Medicare with a Medicare supplement and a Part D Rx Plan. Coverage would start on the first of the following month.

How to pick a plan? What company? $100 vs $0 premiums?

Words of advice: Be sure to find a plan your doctors accept, and make sure all your prescriptions are covered. Find a broker who represents all the companies who offer MAPD plans, and multiple Medicare Supp. plans so you can have choices.

When shopping for MAPD plans take careful notice of your Out Of Pocket Maximum, this is the part where during one calendar year it is the most you are responsible for paying in co-payments and co-insurances for the medical expenses covered by your plan. Prescription co-pays and co-insurances have their own guidelines. Supplement or Medigap Plans vs. MAPD plans?

Medigap supplement plans are going to run around $220 a month in premium but have little or no co-pays or coinsurance during the year for qualified Medicare expenses not fully covered by Original Medicare.
Medigap plans do not have prescription coverage but must be purchased separately for around $25 to $45 a month.

MAPD plans will have a co-pays for doctors and hospital visits and typically will have a network, so it is very important that you check with your doctors to make sure they except the plans. A plan that has no premium will have a larger out of pocket maximum, and a MAPD plan that has a $100 premium will have less of an out of pocket maximum.

Can I get some help paying for all this?

The answer is YES: Its called the Medicare Savings Program.

If you are married and make under $3266 a month in income, or $2413 as a single, you will no longer have to pay the Part B premium that is deducted from your Social Security Check every month, and you will also get Prescription help.Paying less than $7 dollars a month for brand named drugs, and about $2 dollars for generics.
If you make below 2,069.11 as a single and $2,802.08 as a couple, you are also entitled to extra benefits that will help you with co-payments and co-insurances in hospitals and doctor visits.

More info can be found on the following information on Www.figlarinsurance.com, www.medicare.gov, and www.ct.gov

This article was submitted by
Marc Figlar, Certified Senior Advisor
Marc can be reached at 203-394-3447

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