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Medicare Employer Information Form

Medicare Part A Coverage –

Are you working and Medicare eligible with insurance either through your own or your spouse’s employer?  If this is the case, you should consider taking Medicare Part A (hospital Insurance).  In most instances, there is no cost to you for the extra coverage Part A provides.  We have included a link at the bottom of the page with the Medicare Employer Information Form.  This form helps both you and your employer start your Medicare Part A coverage.

Should you take Medicare Part B coverage?

Before you sign up for Part B coverage there a few things you need to be aware of.  First of all, Part B is medical insurance, this coverage is not free and you will be charged a monthly premium.  You also need to know; when you are Medicare eligible your employer insurance may change to some extent. Check with your human resources department or benefit coordinator so they can explain any changes in coverage or concerns you have. You will also need to double check insurance information with the Social Security Administration and Medicare.

Health insurance is very important to us all.  You don’t want to make mistakes with your healthcare coverage, as that could be costly.  Each person has different needs, therefore it is entirely up to you to decide what coverage is best for you.  You also have to decide if the costs will be reasonable with regard to your coverage needs.

Primary and Secondary Insurance –

In fact, if you have primary insurance coverage with your employer, most likely you do not need Part B. If you are not satisfied with the coverage your employer provides, you may want to think about Part B coverage.  If you choose to add Medicare Part B to your employer insurance you need to find out which insurance will be primary and which one secondary.  Primary insurers will pay your approved medical claims first.

Secondary insurance will normally pay the part of your expenses left over after the primary has paid.  The amount secondary insurers pay can be either all or some of the unpaid balance. This amount may be the remaining 20% of the doctors fee after primary has paid.  If you are not enrolled in a primary insurance plan, but only a secondary plan, you will have little to no coverage.  When employer insurance becomes secondary you may be better off if you take Medicare both Parts A and B.

Enrollment Period

Medicare offers a Special Enrollment Period without penalty when you first qualify for coverage.  You may enroll in Medicare, without penalty, at any time while you have group health coverage. This enrollment period is also good for eight months after you lose your group health coverage or you (or your spouse) stop working, whichever comes first.

Sometimes your employee coverage will automatically move into a Medicare Advantage Plan (private health plan).  If you have health coverage from either a union, a current or a former employer when you become Medicare eligible.  You can keep the Medicare  Advantage Plan or switch to either Original Medicare or a different Medicare Advantage Plan.  You should know that if you switch plans, Your employer or union could lessen or even terminate your health benefits or the benefits of your dependents.  Discuss any healthcare plan changes you may want with your employer or union to make sure your coverage is safe.

Click the link below for the employer medicare Forms.

Employer Medicare Forms

Medicare Savings Program Connecticut

Crowe and Associates wants to help you sort through some of the information on the Medicare Savings Program Connecticut.

Medicare Savings Programs are designed to help Medicare recipients by paying the Part B costs for them.  Although Part A is no cost to most people, if the recipient or their spouse has not worked long enough to qualify for this benefit then,  the MSPs (Medicare Savings Program), may pay the Part A cost for you.  MSP will also pay for the monthly part B premium which everyone pays for.  Your income must be within a certain range in order to qualify for the MSP.  There are 3 types of Medicare Savings Plans available, each one is based on the recipients income level.

The income limit amounts will remain in effect through March 2018.  We have listed the three plans that are available below:

CLICK HERE FOR MSP BROCHURE

Medicare Savings Program Connecticut: First Plan:

QMB – This plan is for only people who qualify as Medicare Beneficiaries and meet the income criteria as stated below.
Qualified Medicare Beneficiaries (QMB) – There are no asset limits on this plan.
QMB income limits (211% FPL):   If you are a single person with income of $2,120.55 or less per month.
If you are a Married couple with income of $2,854.83  or less per month.

This plan pays not only premiums for Medicare Part A  and Part B but also deductibles and co-insurances as well.  It will also pay for drug plan premium up to the benchmark plan premium, provided coverage in the coverage gap and limit drug copay costs.

Medicare Savings Program Connecticut: Second Plan:

SLMB, this plan is solely for people who meet the following criteria:

SLMB or (Special Low Income Medicare Beneficiary) income limits: (231% FPL) – There are no asset limits on this paln.
If you are a single person with income of $2,321.55 of less per month.
If you are a married couple with income of $3,125.43 or less per month.

This Plan will pay only Medicare Part B premiums.  It will also pay for drug plan premium up to the benchmark plan premium, provided coverage in the coverage gap and limit drug copay costs.

Medicare Savings Program Connecticut:  Third Plan:

ALMB is also called the Q4.  This plan has limited funds, therefore it is only available until the funds are exhausted. This is not an entitlement program and applications can only be accepted while there are funds available.  ALMB, (Additional Low-Income Medicare Beneficiary)  programs also have no asset limit
ALMB income limits (246% FPL):
If you are a single person with income of $2,72.30 or less per month.
If you are a married couple with income of $3,328.38 of less per month.

This Plan will pay only Medicare Part B premiums.  It will also pay for drug plan premium up to the benchmark plan premium, provided coverage in the coverage gap and limit drug copay costs.

TO VIEW QMB vs MEDICADE COVERAGE CLICK HERE

If you would like more information about any of these programs please contact Edward Crowe at Crowe and Associates either by phone at (203)796-5403 or by email at Edward@croweandassociates.com.

FOR FAQs CLICK HERE

FOR CT MSP APPLICATION CLICK HERE

Medicare Part D Enrollment Penalty

How much is the Part D penalty?

The cost of the Medicare part D enrollment penalty depends on how long you go without Medicare Part D or creditable prescription drug coverage.

How do I know if there will be a Medicare part D enrollment penalty?

After you join a Medicare drug plan, the plan will tell you if you owe a penalty and what your premium will be. Most people will have to pay this penalty for as long as you have a Medicare drug plan. The exceptions would be for those that drop coverage or are approved for a drug help program such as MSP.

What if I don’t agree that I have a penalty?

You may be able to ask for a “reconsideration.” Your drug plan will send you a letter explaining how to appeal.  All appeals will be sent to a company called Maximus that will review appeals.  Maximus is the only company that can review them. As a result, you will need to wait until they make a decision. You must do this within 60 days from the date on the letter telling you that you owe a late enrollment penalty. Also send any documentation that supports your case.

Do I have to pay the penalty even if I think it is wrong?

You must pay the penalty until a decision has been made on the appeal. Failure to pay the penalty could result in termination of your enrollment.

How long does it take to decide on the appeal?

In general, Maximus (Medicare contractor) has 90 days to make a decision.

What happens if Maximus decides the penalty is wrong?

If Maximus decides you should not have a penalty, they will send you a letter stating that fact.   Your drug plan will then stop charging you the penalty and will send details regarding a refund of the penalty amount you already paid.

What happens if Maximus decides the penalty is correct?

They will send you a letter stating the penalty is correct. You will be forced to continue paying the penalty if you want to maintain you drug coverage.

Do you have a Medicare supplement plan (also called Medigap)?  If so, a high deductible plan F supplement may be a way to save money compared to your current supplement plan. CLICK TO LEARN ABOUT HIGH DEDUCTIBLE F PLAN SUPPLEMENTS

High Deductible Plan F

High Deductible Plan F can save substantial amounts of money on a yearly basis compared to a Medicare supplement plan F, G or N.  The following description will detail how the plan works and why it is often a better option for seniors.

What is a high deductible plan F?

A high deductible plan F is a Medicare supplement plan (also called a Medigap plan).  It has the same benefits as a standard plan F supplement but with a $2,200 deductible prior to having the coverage of a traditional plan F.  Once the deductible is satisfied, the high deductible F covers exactly the same as a plan F.  The benefit of the high F is the reduced monthly premium which can be up to 80% lower than the standard plan F premium.  Because high F is a standardized supplement, there is no provider network.  Medicare supplements do not have networks.  You may go to any doctor that accepts Original Medicare.

How does the deductible work?

The high deductible Plan F deductible does not work the same as a traditional high deductible plan.  Medicare A and B roughly covers 80% of approved services.  The 20% left over is the only amount that goes toward the deductible.  The common misconception is the insured needs to pay the first $2,200 of services which is not the case. In fact, most people enrolled in the high F plan do not meet the deductible on an annual basis.  The key is to understand what Medicare A and B covers which will provide a better understanding of what charges will go toward the high F deductible.

How much money can be saved on a high F plan?

The savings is in the reduced premium.  There is also additional savings when the annual deductible is not met.  Premiums vary by state.   We will use Connecticut as an example.  In Connecticut, one of the lower cost plan F supplements is $239 a month. One of the lowest cost high F plans in Connecticut is $53 a month which creates a substantial savings.

Plan F premium = $239 a month x 12 months = $2,868 annual premium.  This premium will be paid regardless of how often the plan is used.

High deductible plan F = $53 a month x 12 months = $636 annual premium.  This is a difference in annual premium of $2,232.   In the event the full deductible was hit for the year, the total plan cost would be $2,836 ($636 annual premium + $2,200 deductible paid).  When the deductible is met, the annual savings is marginal but the deductible is not often met for the year.

How often does the average person meet the $2,200 deductible?

The high deductible plan F works so well because the deductible is not often maxed out.  Here are some national averages to consider.

85% of people age 65 to 67 spend $541 a year toward the $2,200 deductible.  Remember that Medicare A and B is providing coverage at 80% of Medicare allowable charges and only 20% goes toward the deductible.  As a result, this will provide a total annual savings of  $1,691 using the high F plan vs. the standard F plan.

80% of people age 68-72 spend $647 a year toward the $2,200 deductible.  This would be a savings of $1,585 using the high F vs. the standard F plan

70% of people age 73+ spend $754 a year toward the $2,200 deductible creating a savings of $1,478 a year.

Those that do manage to spend $2,200 for the year will be no worse off than if they had a regular plan F.  Maxing the deductible plus the annual premium still has them spending less than the total annual cost for a standard plan F. The benefits are the same once the deductible is met for the year.

What happens if I meet the $2,200 deductible for the year?

If you do meet the $2,200 deductible for the year, your plan will pay all Medicare approved claims. It will work just like a regular plan F. The insurance carrier will track all costs and will pay your claims automatically if you have accumulated costs up to $2,200.  Everything is automated, without the need to submit any type of paperwork.  Note: Please be sure to use a carrier that provides automatic claims filing.  Using a carrier that does not auto file claims may require you to submit paper forms for claims to be paid.

What if I decide I want to go back to my old supplement?

In  CT, NY and some other states, you are allowed to change supplements the 1st of any month the entire year.  If you try the high deductible plan F and don’t like it, you can change back to your old plan F, G or N any month you like.  The change is guaranteed and can not be blocked due to health conditions in guaranteed issue states.  The process to change back is quick and simple.

Next steps

Call our office to discuss further at 203-796-5403 or email Edward@croweandassociates.com

CLICK FOR MORE DETAILS ON MEDIGAP HIGH F PLAN

High Deductible Medicare Supplement

High Deductible Medicare Supplement is usually the best option for a Medigap plan if the premium is low enough. The biggest challenge is understanding how the plan works and why it will prove to be a better choice than standard supplements such as F, G and even N.

Want a quote for the lowest cost high deductible Medicare Supplement in your state

Call our office to receive a quote over the phone (203-796-5403) or email Edward@croweandassociates.com