OTC Catalog

The Aetna Medicare Over The Counter (OTC) Catalog 2019 is now available.

Carriers now offer a Medicare over the counter (OTC) benefit  to their members.  In addition to your plan benefits, over the counter benefits  defray some of the cost of necessary healthcare items not covered as a medical or pharmaceutical expense.

Aetna Medicare  offers members an Over-The-Counter benefit.  This benefit pays up to a $25 maximum amount every month for over the counter  (OTC) items.  The catalog lists eligible items.    Only items listed in the OTC catalog are covered by the over the counter benefit.  Many products you would normally purchase from a drugstore are critical to a healthy lifestyle.  These items may include non-prescription medications, vitamins,  and eye care.  In addition to these you can purchase every day items that impact your health, like hand sanitizer.  This benefit allows you to purchase these items from the catalog at no cost to you.  Accordingly, the cost of these items is part of your Medicare OTC benefit.

1. The over the counter benefit in 2019 is up to $25/member every month.  However, there are rules with regard to how items must be ordered.
2. The over the counter  benefit is included with all Aetna Medicare Advantage plans in 2019.
3. You must order from the catalog or online. Items purchased from a retail store are not part of the benefit.
4. Because this is a “use it or lose it” benefit,  benefit dollars do not carry over month to month.  Therefore,  be sure to check the catalog each months for items you will need.
5. You cannot use your CVS Extra Care card toward these purchases.
6. Free shipping!  There are no shipping or handling fees.
7. Orders typically take two weeks to arrive.  Plan ahead for adequate supplies.

Please see below to download the color format OTC catalog.  The catalog includes a newly expanded product list.

CLICK HERE TO DOWNLOAD THE AETNA MEDICARE 2019 OVER THE COUNTER CATALOG.

You can place an Over the Counter order 2 ways.  You can order either by phone at 1-888-628-2770 Monday through Friday 9:00am to 8:00pm EST, or you can order online at visit:myorder.otchs.com.

Choosing a Medicare plan can be confusing!  Remember, that is what we specialize in!    If you still need help determining which Medicare option will suit you best,  call us at 203-796-5403 and schedule an appointment today.

Agents can click for a Medicare Scope of Appointment 

Medicare Advantage or Medicare Supplement Plan

Which is better, a Medicare Advantage or Medicare Supplement plan?  Medicare Supplements are also called Medigap plans.  This is a common question and the answer is “it depends”.  Medicare Advantage Plans and Medicare Supplement plans are very different.  They both have strengths and weaknesses.  The key is to know the difference between them as well as how they work with your situation.  We can start by pointing out how each plan works and how they are different.

Medicare Supplement plans

Medicare Supplement plans are private plans that insurance companies offer.  There are a number of different plans that range from A through N.  All have different benefit structures although they are standardized in most states. This means the benefits must be the same regardless of the company that offers the plan.  If 8 companies offer a plan N in a state, they must all have the same benefits. The only difference is price.

Medicare supplement plans are secondary to Original Medicare.  When someone goes to the provider, they show their Original Medicare card.  The provider bills the card and Medicare pays their portion of the benefits.  Your Medicare supplement company will receive a charge for the portion that is left over and they will then pay that portion. It is a very simply process and offers some big positives over an Advantage plan.  Below, we will list the advantages as well as disadvantages of using a Medicare Supplement.

• Advantages
  • No network. Since Original Medicare is primary, the person using a Medicare Supplement can go to any provider that accepts Medicare. The company offering the supplement makes no difference.
  • No Managed Care. This usually means you do not need to get prior authorization on services such as surgeries, major or advanced radiology, skilled nursing and other services.
  • You can determine the exact amount of Medicare coverage you want based on which supplement plan you choose.
• Disadvantages
  • Monthly premium. In addition to your monthly part B Medicare premium, you will also pay a monthly premium for the Medicare supplement.  Premiums can range from $35 a month to $270 a month depending on the plan and state you live in.
  • Medicare supplements do not include drug coverage.   Additionally, you must purchase a stand alone part D plan if you want drug coverage.

Medicare Advantage Plans

In fact, Medicare Advantage plans are also called MAPD’s, Medicare Replacement Plans and Managed Medicare Plans. Medicare Advantage plans are not secondary to Original Medicare.  The Medicare Advantage plan becomes the primary insurance.  The insured is still in the Medicare program but Original Medicare is not used for insurance. An advantage plan works in a similar manner to a group or individual health insurance plan. (they are not the same but have a similar set up.)  This means the client has set benefits which are in the form of co-pays and cost shares.  There are some major pro’s and Con’s with Advantage plans which we have listed below.

• Advantages
  • Advantage plans have little to no premium in most states.  The insured will still pay the monthly Medicare Part B premium of $134 a month, but there will be no additional charge for the advantage plan.
  • Advantage plans include a part D drug benefit.  There is no additional premium charge for the drug plan and you can use one ID card for both Medical and RX.
  • Advantage plans may have additional value added benefits that are not covered by Original Medicare such as; dental and vision benefits.
• Disadvantages
  • Advantage plans have networks.  On an HMO advantage plan you must stay in the network to have your expenses covered. (The exception to this would be emergency room visits and urgent care)
  • Advantage plans have co-pays which can lead to higher out of pocket costs.  The out of pocket max on many advantage plans is as high as $6,700.
  • Advantage plans have prior authorization requirements on some services.
  • Some advantage plans may require referrals to see a specialist.

Overall – Medicare Advantage or Medicare Supplement Plan

In general, someone with minimum health care needs may want to try an advantage plan.  They will not be laying out any premium on a monthly basis and will only pay a copay when they do see a provider.  If someone does not want to be limited by a provider network or if they utilize a lot of healthcare, they may want to consider a Medicare supplement instead. The supplement allows them to go to any provider they want (as long as they accept Medicare) and they can choose a plan that leaves them with very little out of pocket.  The negative is the premium they will pay for the supplement and Part D Rx plan regardless of if they utilize care or not.

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

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 [email protected] 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.

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

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 [email protected]

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 [email protected]

Medicare Plan Choices Connecticut 2017

Medicare plan choices connecticut 2017 will cover Medicare Advantage (Also called Managed Medicare or Medicare part C, Medicare Supplments (also called Medigap) and Medicare Part D plans.  Various companies in Connecticut offer all three types of plans for 2017.   This post will cover all three plan types. Also it will cover how a Medicare receipient can pick the best choice for him/her.  Benefit and rate comparisons have been provided below throughout the post.  Good luck.

NOTE: There are links below which provide Medicare supplement, Medicare Advantage and PDP plan comparisons for the State of CT.  We can run any additional quotes/comparisons that are needed for any product. (MAPD, Medigap, PDP)  Call or email our office with any questions (203)-796-5403 or email [email protected]  

Quick Medicare A and B Information before getting into the plans

First of all, you need to know the basics rules of Medicare A and B. While picking the right plan is important, having Medicare A and B is probably as important.  First of all, you must have Medicare A and B to enroll in a Medicare Advantage plan (MAPD) or a Medicare suplement plan (Medigap).  A part D drug plan (PDP) requires you to have Medicare part A and/or B.  Medicare part A cost nothing for almost everyone while part B costs money every month.  CLICK FOR PART B PREMIUMS  If you are drawing social security already, the part B premium will be taken out of your check every month.  If you are not drawing social security, you will be billed quarterly.

Part A of Medicare covers hospitalization while part B covers outpatient services such as doctors and testing. CLICK FOR MEDICARE A AND B BENEFITS  You will see that Medicare covers 80% of Medical costs, as a result,  most people want to cover some or all of the other 20%.  Finally, it does not cover prescriptions drugs, therefore many people purchase a PDP plan.  As a result, those aging into Medicare likely will enrol in a Medicare Advantage plan or a Medigap and/or a PDP plan.

Medicare Plan Choices Connecticut 2017- Medicare Supplements (Medigap Plans)

Medicare Plan Choices Connecticut 2017

A Medicare Supplement Insurance (Medigap) policy, can help pay some of the health care costs that Original Medicare doesn’t cover, like copayments, coinsurance, and deductibles.

Some Medigap policies also offer coverage for services that Original Medicare doesn’t cover, like foreign travel coverage. If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare allowed amounts for covered health care costs. Then the Medigap pays its portion of the cost depending on the plan you have.

A Medigap policy is not a Medicare Advantge Plan.

Things to know about Medigap policies

1. You must have Original Medicare A and B
2. If you have a Medicare Advantage Plan, you can apply for a Medigap policy, but make sure you can leave the Medicare Advantage Plan before your Medigap policy begins.
3. You pay the Medigap premium and the Medicare Part B premium
4. A Medigap policy only covers one person. If you and your spouse both want Medigap coverage, you’ll each have to buy separate policies.
5. You can buy a Medigap policy from any insurance company that’s licensed in your state to sell one.
6. Any standardized Medigap policy is guaranteed renewable even if you have health problems. This means the insurance company can’t cancel your Medigap policy as long as you pay the premium. Furthermore, Connecticut is a guaranteed issue state for Medigap.  This allow a change form one Medigap to another throughout the year without any health underwriting.

Medigap policies don’t cover everything

Medigap policies generally don’t cover benefits such as long term care, vision and dental.

Click for Medigap rates Connecticut 2017

Dropping your Medigap and Part D Prescription Drug Coverage:

You have to pay a Part D late enrollment penalty when you join a new Medicare drug plan if:

• Either you drop your entire Medigap policy and the drug coverage wasn’t creditable prescription drug coverage, or
• You go 63 days or more in a row before your new Medicare drug coverage begins

Call or email us with any questions at 203-796-5403 or email [email protected]ociates.com. We do not charge a fee for our services.

Medicare Plan Choices Connecticut 2017-Medicare Advantage Plans

Medicare Advantage plans are sometimes referred to as Medicare Part C or Managed Medicare plans . They are Medicare-approved health insurance plans for individuals who are enrolled in Original Medicare, Part A and Part B. When you join a Medicare Advantage plan, you are still in the Medicare program and must continue paying your Part B premium. Original Medicare is not billed while in an Advantage plan, as a result, some people incorrectly think they are not part of the Medicare Program

Medicare Advantage plans provide all of your Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) coverage. Sometimes, they offer additional benefits, such as vision, dental, and hearing, and most include prescription drug coverage. These plans often have networks, which mean you may have to see certain doctors and go to certain hospitals in the plan’s network to get care.

Medicare Advantage plans may potentially save you money vs using a Medigap and PDP plan because the monthly premium is much lower in most cases. Pricing (monthly premium, copays, dedutibles and co-insurance) will vary by plan provider, so it’s worthwhile to compare all plans in your area. Your costs will vary by the services you use and the type of plan you purchase.

Medicare Plan Choices Connectict 2017- Plan options can include:

• Health Maintenance Organization (HMO)
• Preferred Provider Organization (PPO)
• Private Fee-for-Service (PFFS)  (Not currently available in CT for 2017)
• Special Needs Plans (SNPs)
• HMO Point-of-Service (HMOPOS)
• Medical Savings Account (MSA) (Not currently available in CT for 2017)

You can generally join if you:

           live in the service area of the plan you want to join (Most plans in CT are offered in all CT counties with a few exceptions)

•  have Original Medicare, Part A and Part B, coverage.
•  don’t have end-stage renal disease (permanent kidney failure requiring dialysis or a kidney transplant); however, there are a few exceptions.

Choose your plan carefully. Outside of when you first become eligible to enroll and other personal circumstances that may qualify you for a Special Election Period, you are only able to change plans once a year during the Annual Election Period. The Annual Election Period lasts from October 15 through December 7 of each year. (An exception to this rule is for those that have a “Trial Right” which allows  them to change from an advantage plan back to a Medigap and drug plan.

There is also a Medicare Advantage Disenrollment Period, which runs from January 1 through February 14. During this time, individuals enrolled in a Medicare Advantage plan can disenroll from their plan and return to Original Medicare coverage and buy a Medigap and PDP plan if they want to.

One more thing to note is that Medicare Advantage plans, with or without prescription drug coverage, vary depending on where you live. The name of this blog is Medicare plan choices Connecticut 2017.   In fact, the rules above apply to most states.

Medicare plan choices Connecticut 2017 – Click Here For 2017 MAPD Plan Comparison CT

Medicare Part D (PDP) Plans CT 2017

A prescription drug plan (PDP) is an option for those eligible that want to enroll in the Medicare Part D prescription drug coverage, which can lower the costs of prescription drugs for insured. A prescription drug plan (PDP) is a stand-alone plan, covering only prescription drugs. Enrollees who choose the option of prescription drug coverage through a Medicare Advantage plan would also have coverage for other medical expenses as part of that plan. Medicare Advantage drug plans and stand alone PDP plans are different but the drug coverage portion works in a similary manner.  Enrollees pay a co-pay for each prescription, a monthly premium (not with some advantge plans however) and an annual deductible.

Note: Please call or email our office for a full list of PDP plans available in CT

 What is Medicare Part A Coverage?

Medicare Part A coverage is hospital care coverage.  This plan covers both lab tests and surgeries.  Doctor care during the stay is also covered.  There is also coverage for supplies like wheelchairs and walkers when they are medically necessary to treat either a disease or a condition.  Part A covers in-patient hospital stays.  These plans also cover care in a skilled nursing facility or nursing home care as well as Hospice care and some home health services.  Note:  Part A will cover nursing home care for medical purposes.  Medicare will not cover the expense if custodial care is the only care necessary.

Part A includes benefits for hospital expenses.

Other expenses part A covers are, a semi-private room and meals as well as medications.  There is also coverage provided for nursing services and other supplies from the hospital.  Part A benefits will cover home health care services when deemed medically necessary.  Your doctor must order home health services in order for this expense to gain approval. Skilled nursing facility (SNF) stays coverage will only receive approval by Part A after a qualifying hospital inpatient stay for a related illness or injury. To qualify for SNF care, the hospital stay must be a minimum of three days.  A qualified stay begins on the day you are admitted. The day the hospital dischares you does not count toward the 3 day requirement.  Patients can be kept for observation.  Time spent under observation is considered outpatient.  This time does not count towards your qualifying stay.

If your doctor has certified that you have a terminal illness, you may be eligible for hospice care coverage.   Your doctor will need to determine a 6 month or less life expectancy.  In hospice care, the focus is on palliative care.  Hospice focus is not cure.  The goal is to relieve pain and make the patient as comfortable as possible.

Click here to learn how and when to enroll in Medicare.

Click here for more information regarding Medicare Part A  benefit coverage.

Connecticut residents looking to compare plan options can click here for more details about plans available.  If you still have questions or would like to set an appointment, please call the office at 203-796-5403.  In fact, we are leading Medicare experts in CT and are here to help.  We do not charge for our consultation services.

Click here for a no cost personal and confidential Medicare quote.

Medicare Supplement Rates Connecticut

Medicare Supplement Rates Connecticut are available at the bottom of this blog.  These Medicare Supplement plans are also called Medigap plans.  Connecticut is a standardized state for Medicare supplements.  Plans have identical benefits from one company to the next. The only difference is in price and value added features. Value added are things such as Silver Sneakers being available with a plan. A Medicare supplement plan is secondary coverage.  Original Medicare both A and B are the primary insurance with a supplement.  Providers bill Original Medicare first.  The portion not covered by Medicare is sent to the supplement.  The supplement covers some or all of the remainder depending on the the plan chosen. Plan F covers 100%, plan N covers most charges, plan L covers 75% and so on.  There are 9 supplement types in CT

How do you decide which one to take?

It depends on your situation.  People in very poor health may be better with a Plan F.  Someone in average health may look at plan N or plan L.  Supplements have some advantages: No network and ability to choose coverage level are two big ones.  Also, the ability to choose any Part D plan. There are also some negatives. The first is paying three premiums.

A part B premium of $121.80. The Supplement premium and the Rx premium.  Some people will make the decision to go with a Medicare Advantage plan instead. Connecticut does not allow companies to underwrite plans.  This simply means they can’t check your health.  This allows members to move from one supplement to another during the year.  Certain health conditions may cause an issue if you want to change plans.  They could also move either to an advantage during OEP or from an Advantage to a supplement.   Rates have been provided below.  In fact, the grid holds the rates for every company with a supplement in CT.

Click this link for CT rates 2016

Are you looking for Medicare Advantage Plan information instead?

If you need to sign up for Medicare A and B, Click for online enrollment with Social Security

Click here for a no obligation Medicare quote.

Anthem MediBlue Select HMO

Anthem MediBlue Select HMO is a Medicare Advantage plan with prescription drug coverage (MAPD).   In fact, Anthem Blue Cross Blue Shield offers this plan only in Hartford county in the state of Connecticut.   This, like all HMO plans, require that participants use in network providers.  If you choose to use out of network providers, this plan will not cover your expenses.  An exception to this would be urgent or emergency care which allows of of network services.

The plan has a monthly premium of $26. This would be in addition to the part B premium of $121.80.  There are no referrals required for this plan. Co-pays for a primary doctor are $15 and $40 for a specialist.  The plan has an annual out of pocket max of $6,100 per year.  Annual maximum indicates the most the insured would need to pay in medical claims for  the year.  You can not apply either Monthly premiums or cost-sharing for part D prescription drugs to the maximum out of pocket amount.

You can add dental services to the plan for an additional premium.  In Addition, Silver Sneakers is included in the $26 monthly premium and pays a local gym membership monthly fee.   If you use approved diabetic supply vendors your diabetic supplies are covered at 100%.

This plan offers prescription drug coverage with $220 annual deductible.  This deductible applies only to tiers 2-5.  The plan excludes both Tiers 1 and 6 from this deductible.  There is no limit to how much the plan will pay.

A Medicare Advantage plan should not be confused with a Medicare Supplement plan (also called Medigap).

MAPD plans offer both medical and drug benefits combined with the insurance company as the primary insurance.  With a Medicare Supplement, original Medicare is primary.  The insurance company would be the secondary insurance.  As a result, a Medicare Supplement plan does not have a network.  Because members may see any provider that participates with Original Medicare, it is different from an Advantage plan.

 HMO summary of benefits Anthem MediBlue Select

Anthem MediBlue Selelct HMO application

Click here to request a personal Medicare review.