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Medicare Excess Charges Connecticut

Medicare Excess Charges Connecticut:    Medicare excess charges or sometimes called excess billing is applied by doctors that do not accept Medicare assignment.  A doctor who chooses not to accept assignment is able to bill a patient 15% over the allowable Medicare charges.  However, Those providers are not able to bill over Medicare allowable limit on all charges.  Some items that providers cannot use the excess charge on include Durable Medical Equipment. This is true even if they are not accepting assignment.   Non par is another way of saying that the doctor does not have to accept the Medicare contracted price for services.   You should not confuse Non par with a Medicare opt out.  An opt out is when a doctor does not participate with Medicare.   Medicare will not provide any coverage for services rendered by an opted out physician or facility.

Be very careful when you ask a provider if they “take” your insurance!

You might think, if the provider says that they “take”  your insurance they participate with your insurance carrier.  This is not always the case. This only confirms that they will accept payment from your insurance company and they may submit your claim for you.  It does always not mean that they  have a contract with your carrier.

If you want to be sure, you should always ask healthcare providers if they are contracted as a participating provider with your insurance carrier.  Unfortunately, there are some providers out there who will mislead you with their wording in order to get your business.  This is more common than you would think. For this reason you must ask the right questions to avoid costly situations.  Your carrier cannot protect you from any carrier they do not have a contract with.

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Medicare Advantage and Medicare Supplement Comparison Connecticut

In this post we will give you Medicare Advantage and Medicare Supplement Comparison Connecticut.  Medicare Advantage plans and Medicare Supplement plans (also called Medigap plans) are very different.  There are positives and negatives of each depending on an individuals medical needs.  This post will provide a description of both and compare them in order to make an educated decision when choosing a plan.  The plans outlined in this post are applicable to Connecticut and may not be available in other states.

Medicare Advantage Plans  (CLICK HERE FOR MEDICARE ADVANTAGE APPLICATIONS)

Medicare Advantage Plans are offered by private insurance companies.   They offer medical and Rx benefits in one plan and act as the primary insurance instead of original Medicare.  There are 5 companies offering Medicare Advantage plans in Connecticut.  The companies are Connecticare, United Healthcare (with and without AARP logo), Aetna, Anthem BCBS and Wellcare.

Positives:

• Many have $0 monthly premium.   You will still pay your part B premium to Medicare however.
• They include the medical and Rx benefit in one package.  You do not need/cannot purchase a separate Part D Rx drug plan when you have a Medicare Advantage plan.  The Medicare Advantage plans include the Part D Rx coverage in the benefits.
• Extra benefits- some Medicare Advantage Plans provide for extra benefits such as dental, visions, podiatry visits, gym memberships, etc….

Negatives:

• Medicare Advantage plans have networks. Since the Advantage plan is your primary insurance, the provider must be in network in order for his servicesnto be covered by the plan. There are a limited number of Medicare Advantage Plans in Ct that provide out of network coverage as well.
• Copays-  You do not pay a monthly premium with Advantage plans but you do pay copays for medical services such as doctors visits, lab work, inpatient stays, etc….
• The last negative is that Medicare Advantage plans are able to make benefit changes every January.  This means that they may have a major increase in co-pays and cost share on renewal in January.  You are able to make a plan change every January.  Although, you cannot change your plan after February 14th.

CLICK HERE IF YOU WANT MORE INFORMATION ABOUT ADVANTAGE PLANS

CLICK HERE FOR MEDICARE ADVANTAGE PLAN APPLICATIONS

Medicare Supplements (Also called Medigap Plans)    (CLICK HERE FOR SUPPLEMENT APPLICATIONS)

Medicare Supplement plans are secondary to Original Medicare.  When someone purchases a supplement, the provider will bill Medicare first and then the supplement will cover a portion or all (depending on the supplement you choose) of the remaining costs.  Medicare Supplement plans cover Medical services only and do not include Rx coverage.  Those that want Rx coverage purchase a stand along Part D drug plan.   Supplements are standardized in Connecticut.  This means that there is no variance in benefits from insurance carrier to insurance carrier.  In Connecticut there are 10 supplement plan options with plans F, N and L being the most popular.

Due to the fact that the benefits are standardized, purchasing a supplement usually comes down to who has the best rates.   Currently in Connecticut the United Healthcare AARP branded Medicare Supplements have a large rate advantage over all the other companies.   In other words, it really doesn’t make sense to purchase a Medicare supplement through a different company.

Positives:

• Medicare Supplement plans are secondary to Medicare.  This allows you to see any doctor that accepts Medicare.  There is not a network to follow.  As a result, Medicare supplements are very convenient for people that travel.
• You can determine how much coverage you want. For example, if you want 100% medical coverage, Plan F supplement would provide it or for 75% coverage you could use a plan L.
• Medicare supplement do not have prior authorization requirements

Negatives:

• Medicare Supplement plans have monthly premiums in addition to the Part B premium.  For example, the lowest cost plan F in Connecticut is $220 a month.  (cost is per person)
• Medicare Supplements do not include Rx coverage.  You must purchase Rx coverage separately with a Part D Rx plan.  Part D plans range in monthly price from $14 a month to $100 a month depending on the plan chosen.
• Medicare Supplements will only cover a procedure that is covered by Original Medicare.

CLICK HERE TO LEARN MORE ABOUT MEDICARE SUPPLEMENTS

 FOR MEDICARE SUPPLEMENT APPLICATIONS – CLICK HERE

Please contact us if you have any questions.  You can either call Crowe and Associates at 203 796 5403 or email  us at [email protected]

Security Benefit has had the annuity with the highest income payout for the last two years.  Anyone looking for future income from a deferred annuity would be able to get the highest payout using the SIA product.

One of the drawbacks to this product has been that it is not available some states, Connecticut being one of them. This means that a person living in Connecticut could not have access to the product unless they signed all the documents while in a state that the product was approved in.  Security Benefit has now obtained approval for the SIA to be sold to residents of Connecticut.

The products bonus is smaller in CT at 2% but the bonus of a product really does not mean much when it comes to the bottom line.  The SIA product with a 2% bonus will stay pay a larger future income than any other income product and this includes all the big names such as NY life, Allianz, Met Life, Aviva, NorthWestern Mutual, etc…..

Compare the attached income quote to the same quote from any other company to see what I mean.   This is an illustration for a 60 year old male who puts $200000 in the SIA product and takes income in 15 years at age 75.  Security Benefit will payout $36,585.00 a year at age 75. The payout number is guaranteed.  Compare this payout to any other companies guaranteed payout and you will see the difference.

Security Benefit SIA 60 year male 200K example

Careington offers a combo vision and dental discount plan in Connecticut.  The plan is very reasonably prices at $6.95 a month for a single person, $11.95 for two people and $15.95 for a family.

I have not been an advocate of discount vision and dental plans in the past but the Careington plan has proved to be a value to our clients.  The networks are strong with VSP for vision and Aetna for a dental network and the discounts make a big difference.  We have found that people actually save more money with this discount plan than they do with traditional dental and vision insurance.   The problem with traditional dental and vision is that the average monthly premium is $30 per person which makes it hard generate an annual savings. The low premium of the Careington plan along with the major discounts make this plan a better choice for most consumers.

A link to the benefits of the plan is attached. CAREINGTON LINK TO BENEFITS AND ONLINE APPLICATIION   You may also sign up for the plan through this link for those that want to purchase it.  The online application will ask you for an agent/broker code before it will let you apply.  Our agency code is CROWE which can be entered and will allow you to move to the application section.

IMPORTANT- For people in CT and NY, be sure to select the plan choice that uses the Aetna Dental Network.  (The 2nd plan from the left) The Aetna dental network is much stronger in CT and NY.

Please call Crowe & Associates with any questions or concerns.

People that are about to turn 65 or are newly eligible for Medicare have choices about how they want to cover the gaps in Medicare. They can go with a Medicare Supplement plan, an Advantage plan, a part D plan or just Medicare A and B. This guide provides the basics on Medicare and the coverage choices available.

It may seem confusing at first but choosing the right option is not that difficult once you have a basic understanding of the programs. The attached document will certainly be a good start.

For more specific questions or information needs please email Edward Crowe at [email protected] or call at 203-796-5403.

Medicare Buyers Guide EC

One of the biggest points of confusion for seniors seems to be making a decision between a Medicare Advantage Plan and Medicare Supplement Plan. I receive phone calls on a daily basis from people either turning 65, moving from an employer plan to Medicare or just trying to decide what to do for the Medicare Annual Election period. Often they are confused and feel overwhelmed by the amount of information and plan choices available.

The reality is that it is actually very easy to learn enough to make an educated decision. This article is going to point out the basic differences between the plans and point out the strengths and weaknesses of each. With this info, anyone will be on their way to having enough information to make a confident decision on the best plan for them. (This Article is for people in Connecticut and NY- I will write one for other states in the next few days)

First, we need to break down the differences between the two types of plans and also dispel some myths about both.

Medicare supplement plans-

-They are secondary to your Medicare A and B (In other words, providers bill Medicare first and then your supplement covers some or all of the remaining costs depending on the plan you choose.

-They are for Medical only. You buy Rx coverage separately

-There is not a network. You can go to any doctor that accepts Medicare

-There are plans A-N available but only a few are popular. They Plan F, Plan N and High deductible F

-The plans are standardized in both Ct and NY. If a company offers a plan N, the benefits are identical regardless of the company offering it. Price is the only difference. Once companies plan N is not better than other companies. Just go by the price.

-There is no medical underwriting for them and in Connecticut and New York you can change them the first of any month at any time during the year.

Supplements are a good choice for people that do not want to have any network constraints. They also work well if you have doctors that do not take managed care plans (Medicare Advantage Plans) or if you travel to other states often.

Some clients like the fact that some of the supplements basically cover all of their costs for medical care. (Plan F and Plan C, Plan J for those whom still have it)

Finally, supplements work well for people that are very sick and receiving a high volume of care such as multiple injections at an outpatient facility or in the doctor’s office or people going to a number of physical therapy visits on a weekly basis. If you are on a plan F, you will not be billed for the services

I hear a tremendous amount of incorrect information being given out on a daily basis when it comes to Medicare Supplement plans. Here are some of the major areas where bad info tends to be most prevalent.

-” Such and such a company has the best Supplement plans”- In the world of supplements, there is no such thing as one companies supplement being better than the others. Supplements are mandated to have identical benefits. If United offers a plan F supplement, it has the EXACT same benefits as every other companies Plan F benefits. Supplement plans A-N are subsidized in Connecticut and New York. All plan benefits are the same. The only difference is the price that the company charges for them. If you have decided on a supplement and know which plan you want, take the company with the lowest cost for that supplement. (Example: You decide to take a plan N, Simply choose the lowest cost plan N being offered at the time.)

– “I can’t find all the companies offering supplements and the prices” – This is easy. Each state has a list of all companies in the state offering supplement plans and the prices of them. They can be found on the insurance websites of each respective state. Here is a link to Connecticut Supplement plans and prices for 2011

https://croweandassociates.com/images/stories/Medicare_Supplement_Rates_Connecticut_2011.pdf

“Supplements have underwriting outside of the guaranteed issue period”- There is no underwriting for supplements in Connecticut and NY. Both are guaranteed issue states even outside of the election periods.

“High Deductible F is not a good plan” – This could not be more off base. In Connecticut and Ny there are plans that have very low high deductible F plans. In fact, in Connecticut, Anthem BCBS offers a high deductible F plan for $39.00 a month. This math cannot be beat by any other supplement plan offered in CT. For more information on High Deductible F go to… https://croweandassociates.com/blog/?p=223 for NY

Although there are many good things about supplements, there is also a negative or two. First off is that they do not cover RX, you need to buy a separate drug plan if you want coverage. The going rate for Rx plans is about $32.00 a month. Secondly is the price of the supplements. The lowest cost plan F in CT is about $219.00 a month. When you add your Rx cost to that it brings you to about $250.00 a month for a plan. Keep in mind that you are going to be paying $3,000 in premium for the year no matter what. Even if you have a very healthy year you will have $3,000 less at the end of the year.

Medicare Advantage Plans
Medicare Advantage plans are managed care plans being offered by private insurance companies. They give you your A and B coverage, secondary coverage and Rx coverage all in one package. With a Medicare Advantage plan, your Medicare A and B is administered by the insurance company. As a result, when you go to the doctor you show them your Medicare advantage plan instead of your A and B card.

There are many positives and also negatives about an advantage plan. Here are the positives….

-They are included in your Medical and Rx in one package. You do not need to go and purchase a separate PDP plan.

-They are very inexpensive. All major carriers even offer $0 monthly premium* plans.

-They have out of pocket maximums.

-Preventative care is covered at no cost to the member.

*They can offer you a plan for $0 monthly premium because Medicare is paying the insurance company money to handle your enrollment and care for the year.

-Some carriers have national networks and plans with out of network coverage.

Some negatives about advantage plans…

-They have networks. If you take an HMO advantage plan (Which does not have out of network coverage) and you try to go to an out of network doctor, you will NOT be covered. Many people believe that Medicare will still cover them for the usual Medicare A and B amount if they go to an out of network doctor but it does not. You will need to pay the full cost.

-They have copays for services. You need to be aware of the copays on the plans you choose. Some plans cover certain services better than others. For example, one carrier may cover Major Radiology at 80% while the other covers it for an $80 copay.

-They have pre-certification requirements for some procedures. Your doctor is responsible for obtaining pre certs but they can hold things up at times.

Advantage plans tend to work very well for people in relatively good health that see a reasonable amount of doctors. You need to check to see that all your Docs and any hospitals you go to are in the network. There are now a number of plans with out of network coverage and national networks. This is good if you have a doc or two that is out of network.* The copays on most plans are reasonable and with $0 premium plans available, they can save the right person a lot of money for the year.

*Make sure your out of network doctor will bill your insurance company for you and not make you submit yourself.

Often clients get upset when they go on an advantage plan and incur a large copay. (For example, a CAT scan which is a $150 copay on some advantage plans) They will say “If I was on a supplement, I would not have paid anything”. They tend to forget that the supplement is costing them money every month when the advantage plan is not.

The math on advantage plans actually makes sense for the majority of people but not everyone. Make sure you review the benefits and check networks prior to enrolling. Do the math and see how much you will save in monthly premium vs. how much exposure you have to copays. In the end, the advantage plan will likely win out but a little time needs to be devoted to make a comparison before you make a final decision.

*Make sure your out of network doctor will bill your insurance company for you and not make you submit yourself.

Medicare Supplement Plan N was approved for enrollment on June 1, 2010. The plan is offered at a competative price point by Anthem BCBS and United Healthcare “AARP Branded”. They both offer plan N for around $150 a month depending on availability of discounts.

Plan N is a departure from other supplements in that is allows the physician to bill up to a max of $20 per visit. It also has a $50 emergency room copay and does not cover the part B deductible (disappointing) of $155 a year. Many seniors have been willing to give the plan a try in order to save $50 a month in premium. This has been especially true of those in plan F supplements. Plan J enrollees need to be careful as plan J is a closed plan an they will not be able to go back to it in the event they try plan N and decide they do not like it.

The most suprissing part plan N has been the low number of providers that actually bill any type of excess on the plan. Providers are allowed to bill up to $20 dollars but seem not to do so often. (That has been our limited experience so far anyway)

People switching from their current plan to Plan N do not need to pay the $155 part B deductible as it has already been met for the year. They will however be subject to the Part B deductible in 2011.

Individual Dental Plans in Connecticut

Purchasing an individual dental plan in Connecticut has traditionally been a difficult task.  The premiums for the plans usually cost almost as much as  the max annual benefit. (max benefit is usually $1,000 or $1,500 a year). Most  plans have have waiting periods on basic and major services of at least 6 months.  Once those waiting periods have been met the plan will pay 40% to 60% of the allowable cost.  Preventative cleanings are usually covered 100% from day one but many plans only cover one per year.  On top of this dentists often do not participate with many of the plans making it more difficult.

This has changes to a certain extent recently.  There are now some plans available that do offer a fair premium compared to the benefits you can receive.  Here are three that you may want to consider.

Ameritas- They have a variety of stand alone dental plans ranging from $25.00 to $70.00 a month.  The waiting periods are reasonable for basic services and preventative dental is covered at 100% which includes X-rays.  Be careful however, because at this time they only allow one preventative cleaning a year on the lower cost options.

Get a quote: https://secure.healthplan.com/agent_platypus/quote_start.php?go=true&cust_link=CUS1013121551

Aetna-  Aetna offers a very affordable plan ($16 a month for individuals under 65 and $15 a month for those over 65) that covers two preventative cleanings including X-rays a year.  The network has a surprising number of participating dentists as well.  Be careful when asking your dentist if they accept the plan.  There are a number of Aetna networks and you need to make sure they are in the one specific to your plan.  The Aetna Plans are not “Stand Alone” and as a result, you must be enrolled in an Aetna Individual Medical or Medicare Advantage plan to be eligible.

Get a quote: https://www.aetna.com/iqs/aimquote.do

Golden Rule “United Health One”-  This plan came out in July of 2009.  The premium for the value option is $26.00 a month and the plan covers 2 preventative cleanings including X-rays.  There is 80% coverage for basic services and 50% coverage for Major services (after a reasonable waiting period 3 months and 6 months)  The network is adequate in most areas.  This plan can be used as a stand alone option and is available to people of any age.

Get a quote: https://www.goldenrulehealth.com/Customer/QuotePages/CustZipCode.aspx?SID=bc05c0ff-2120-4705-a19b-8282fc6507a3