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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  

Medigap Plans CT

Medigap plans Ct are also called Medicare supplement plans.   They provides coverage for these “gaps” in your Medicare coverage and can save you money.  Medigap plans are not Medicare Advantage plans rather, they provide coverage after Original Medicare A and B benefits pay.  As a result, it is important to note that Medigap plans will only cover services that are approved by Medicare. They will not help cover costs that Medicare does not allow/approve.

Access all Medigap plans CT (Medicare supplement plans) with this link.  Site will show you all plans and rates in CT.

Are you a broker looking to sell Medigap plans?  If so, click here to learn more about Medigap sales.

Medicare supplemental plans are offered by private insurance companies.  These plans help to pay the ‘gap’ between costs covered by original Medicare and your out of pocket costs.  Medigap plans are regulated by national and state governments and therefore benefits are generally the same, regardless of the insurance company.   For example, Plan A has the same benefits regardless of the company you purchase it from.  As a result, rates and value add benefits are the only difference from company to company.

Medigap plans do not cover medication expenses.  If you enroll in a Medigap plan, you should also consider a Medicare Part D (prescription drug) plan.  The rule is different for drugs under medicare part B. As a result, it is important to pick the right part D drug plan.  The pharmacy you like to use and the specific prescriptions you take make all the difference when selecting a drug plan.  Call our office to learn more or use the CMS drug plan finder tool. 

Want to learn more about the differences between a Medigap plan and a Medicare Advantage plan? Click here to learn about all your medicare options.

We are one of Connecticut’s leading Medicare brokerage firms.  Please call us at 203-796-5403 or email us at edward@croweandassociates.com if you have questions.  Better yet, we can set a time to sit face to face and discuss all of your options.  If you aren’t able to travel to our office, we will gladly come to you.

What is Medicare?

This blog will attempt to answer “what is Medicare?” by  providing a basic understanding of the Medicare program and how it works. In addition, it will detail the other parts of Medicare such as C and D.  First of all lets start with the official definition:   Medicare is the federal health insurance program for people who are 65 or older. It is also for certain younger people with disabilities and with End-Stage Renal Disease.  Most people are eligible for Medicare at age 65.

Medicare is made up of four components which can cause confusion.  Original Medicare (Red, White and Blue care with a Medicare ID on it) is Medical coverage with parts A and B.    This is what provides basic medical coverage for those on the program.   Medicare Part C is different than Original Medicare.   Part C is a Medicare Advantage Plan and is something a member can enroll in if they want.  Medicare Part C replaces Medicare A and B for those that enroll in it.   Another part of Medicare is part D which is prescription drug coverage (Also called a PDP). You can enroll in Medicare part D using a stand alone drug plan or access Medicare part D through the drug benefits on an Advantage plan.

Medicare Part A (Hospital Coverage)

Medicare Part B (Medical Coverage)

Medicare Part C (Medicare Advantage Plans)

Medicare Part D (prescription drug coverage)

Medicare Eligibility

Medicare Eligibility is available to anyone turning 65, disabled prior to the age of 65 or with ESRD.  People turning age 65 need to have 40 quarters of working credits or have a spouse with 40 quarters. You must also be a U.S resident or be legally in the U.S. for 5 concecutive years.  The CMS website has a lot of very detailed information on this topic.   Click for CMS details on Medicare A and B enrollment

Steps for Medicare eligible people

Currently enrolled in Medicare: Click here to check your enrollment 

Medicare Eligibility: Other Resources

Sign up for Medicare after age 65 ( Medicare general enrollment period)

Medicare Part D Rx income penalty

Individual Dental and Vision Insurance Plans

Vision and dental needs are not typically covered by medical insurance plans.  Such expenses can total to large amounts during the year.  Dental and Vision Insurance plans help to defray the cost of routine care.  We offer individual and family dental and vision plans at competitive rates.  Both plans have very competitive  benefits and national networks.

Dental Plans

Dental insurance plans have access to two different dental benefit designs.  Both plan choices use the Ameritus dental network.  There is no waiting period for either of the plan types for preventative and basic services.  Please note: Preventative and basic services vary by plan.  Click here to view a list of services by plan.  There is a waiting period for major services.  The Choice Dental plan offers a $1,500 annual per person max benefit.  The Premier Dental plan offers a $3,000 per person max benefit.  Plans both have a $25 per visit co-pay for services.  Both plans are available for all ages.  Rates are very competitive.  Open enrollment rules do not apply.  New plans can begin the first of any month.

Hassle free, unassisted online enrollment is available.

Click for dental rates and benefits.

Ready to enroll?

Vision Plan

This vision insurance plan utilizes the VSP vision network.   The plan provides coverage for lenses, frames, exams and more.  Rates are very competitive.  Enrollment can be entered online in just minutes.   A link to benefits, rates and provider search has been provided below.

Click here to search for a provider.

Ready to enroll?

Still have questions?  Feel free to either call us at 203-796-5403 or email us at edward@croweandassociates.com.

Crowe and Associates is a full service insurance and investment brokerage.  Click here to visit our home page.

Connecticut Medicare Plans 2017

The term “Connecticut Medicare Plans 2017” can mean different things. This blog will address the options a person aging into Medicare or already on Medicare will have in Connecticut for 2017.  For additional information including signing up for Medicare A and B and rates, you can look at our other blog Medicare Plan Choices Connecticut 2017.  We will focus on basic choices for Medicare eligible people in this post.  The intent is to provide a general understanding of options available.  Look to our other blog if you already know your choices and want more detail. Please email or call us with any questions at 203-796-5403 or email admin@croweandassociates.com.

There are three basic options or types of plans seniors typically use.  The Medicare Supplements (also called Medigap) plans,  Medicare Advantage plans (also called part C, Managed Medicare or Medicare replacement plans) and finally, there are Medicare part D plans (also called Medicare Rx/drug plans or stand along PDP plans).  Medicare Advantage plans (MAPD) include a part D prescription drug benefit.  Medicare Supplements (Med Supp) do not have drug coverage so you would need to buy a Medicare part D plan (PDP) if you want drug coverage.

Original Medicare A and B

Connecticut Medicare plans 2017: First things first:  In order to enroll in a Medicare Advantage plan or Medicare Supplement plan, you must have Original Medicare A and B.  There are rules for eligibility and costs associates with Medicare A and B we will not get into detail about here.  Use this link if you want to know the rules for enrolling and costs.  Medicare A and B provides medical coverage on its own.  It does not provide Rx coverage but does a good job on the medical side.  It is feasable to have Medicare A and B only and then a PDP plan for those that want drug coverage. The only flaw with A and B on its own is the lack of an out of pocket max on the benefits.

Other than that, the 20% cost share is not as bad as it sounds due to the Medicare allowable cost amount the providers can bill.  This just means Medicare controls how much you are billed for Medical services.  Its hard to get a set number but they usually have a discount rate for charges between 50% to 75% depending the service.

Medicare Supplement/Medigap Plans

Connecticut Medicare Plans  2017: Many people choose to limit and/or cap the cost share they would pay being on Original Medicare.  A Med Supp is a policy that covers some or all of the costs not covered by Medicare A and B.  There are 11 different Med Supp plans. Each plan has a letter name that differentiates it from others.  Companies offer plans A – N.  Not all companies offer all plans.  A Med Supp Plan A or B should not be confused with Medicare A and B.  They are in  no way related.  A Med Supp A or B is just two of the 11 supplement options to choose from.

There are a number of plans that are “good deals” in Connecticut.  Plans F,N,K, L and High F are available from companies at good prices in CT.  Multiple companies offer supplements in CT.   United Healthcare is the insurer of the branded supplement plans.

Contrary to the opinion of many,

There are NOT pre-existing condition clauses on Medicare supplements in CT if you have had any type of other coverage in the last 63 days. The only time there are pre existing conditions clauses is if someone did not have any other type of coverage for 63 days and then tries to sign up for a supplement.  Some states do allow pre-existing conditions clauses even if there was other coverage in place but Connecticut (and NY for that matter) is not one of them.

The other important thing to note in CT is a person can change from one Medicare Supplement plan to another the first of any month.  This is not the case in some states.  It is possible in CT.  CT is a guaranteed issue state.  Also note: If someone is under the age of 65, they do not have access to all the plans.  In most cases, clients under the age of 65  are limited to plans A-C.

Medicare Part D Rx Plans (PDP)

Connecticut Medicare plans 2017: PDP plans are stand alone drug plans offered by insurance companies.  Medicare does not offer a plan but instead determine what the standard benefit model should look like.   Click here for the standard part D benefit parameters. Various companies offer stand alone part D plans including United Healthcare, Aetna, Wellcare, Humana, Envison, Silverscript to mention a few.  They all have different benefits and prices but work in a similar manner.  Be sure to use a plan that has your drugs in the formulary and also has your pharmacy in network.  Some plans will have preferred vs. non preferred pharmacies. It may not be obvious which pharmacies are preferred for your plan. Be sure to use a preferred pharmacy as your copays for the medications will likely be lower there.

Please note: you cannot have a stand alone part D plan and a Medicare Advantage plan at the same time.  Enrolling in one will disenroll (kick you out) of the other.  The only exception to this is if you have a Medicare Advantage plan called a PFFS plan.  They do allow someone to enroll in a PDP at the same time.

Medicare Advantage Plans

A Medicare Advantage Plan, also known as Medicare Part C, Medicare replacement or a Managed Medicare Plan,  plans offered by private insurance companies. They often combine medical and drug coverage.  While they are not group health plans, they do work in a similar manner.  Members pay copays for medical services they recieve.  Different services have different copays such as a copay for a primary doctor and a higher copay a specialist doctor.   Copays vary from company to company and plan to plan.  Most advantage plans offer a part D drug benefit which works similar to a stand alone part D drug plan.  Some plans require referrals for specialists while others do not.

Not all HMO plans require referrals but they do require members to stay in network for most services. Advantage plans may cover benefits not covered by Original Medicare and/or a Medicare supplement plan. Benefits and value added services such as dental, vision, Telemedicine, Silver Sneakers , OTC benefits and other programs.

Types of Medicare Advantage Plans

1. Health Maintenance Organization (HMO) Plans
2. Preferred Provider Organization (PPO) Plans
3. Private Fee-for-Service (PFFS) Plans
4. Special Needs Plans (SNP)

People are able to change a Medicare plan during Open enrollment.  Open enrollment runs from Oct 1 to Dec 7th every year.  They can make any changes they want for a Jan 1 start date.  Please note:  In states that allow underwriting, the member will be subject to medical underwriting if moving to a Medicare Supplement plan.  There are additional periods when you can make plan changes such as the MADP, SEP’s and if there is a Trial Right.

Call or email us with any questions regarding this Connecticut Medicare plans 2017 blog.  We are able to quote plans options and provide advice at no charge to you.  Independent brokers receive commission pay from the insurance companies.  You can contact the office either by phone at 203-796-5403 or by email to Edward@croweandassociates.com