Choices LogoCommunity Choices, the regional Aging and Disability Resource Center, strives to support you or your loved one through a coordinated system of information and access. Using our extensive knowledge and resources, we work to connect you to the services and support you deserve, from benefits screening, information and assistance to decision support and follow-up.  It’s all in an effort to offer choices that connect you to a better way of life.

Our dedicated staff can connect you to everything from a name and phone number to more detailed information regarding community services, long term care planning, options counseling and care transitions.

Medicare 101: What you need to know!

Medicare is the National Health Insurance Program for:

  • Individuals 65 years of age and older
  • Individuals under the age of 65 with certain disabilities
  • People of any age with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant)

The Medicare Program is comprised of four parts.

Medicare Part A (Hospital Insurance)

  • Covers inpatient care in hospitals
  • Covers skilled nursing facility, hospice and home healthcare for a limited time period
  • Generally, the Part A is *premium free; individuals throughout their work history paid into Medicare and you are eligible to enroll at age 65. Hospital coverage is not covered 100%  *for more about premiums, please see the section entitled “Medicare Premiums and cost shares for A and B”

Medicare Part B (Medical Insurance)

  • Covers doctors services, outpatient hospital care, and some home health care
  • Covers some preventive services
  • Durable Medical Equipment
  • Individuals must choose to elect Part B, you are not automatically enrolled. There is a monthly *premium for Part B. Generally, medical coverage is not covered 100%. If you choose not to enroll in Medicare Part B when you are first eligible then decide at a later time to enroll, you might be assessed life-long penalties.   *for more about premiums, please see the section entitled “Medicare Premiums and cost shares for A and B”

Medicare Part C (Medicare Advantage Plans)

  • Plans are administered by Medicare-approved private insurance companies
  • Includes Part A and B benefits and sometimes D (prescription drugs) benefits, sometimes for an extra cost
  • Some plans can offer more benefits for an extra cost (for example vision and dental coverage)
  • You must still continue to pay your monthly Part B *premium; plans do not cover 100%.  *for more about premiums, please see the section entitled “Medicare Premiums and cost shares for C and D”

Medicare Part D (Prescription Drug Plan)

  • Prescription Drug plans are available through Medicare approved insurance companies
  • Is available to a Medicare beneficiary enrolled in Medicare Part(s) A and/or B.
  • Plans have monthly *premiums and cost-shares *for more about premiums, please see the section entitled “Medicare Premiums and cost shares for C and D”
  • Individuals with limited income and assets may be eligible for Extra Help through the Social Security Administration. 
  • Part D is optional; however, if you do not enroll when you are first eligible and later decide to join a plan, you might be assessed life-long penalties.

ENROLLING IN MEDICARE

The Medicare Program is very specific regarding when you can enroll into Medicare Parts A, B, C and/or D. – keep in mind – Social Security is the only agency that enrolls individuals into Medicare Parts A and B.  Medicare Parts C and D are self-enrollment procedures. 

Types of situations when an individual is automatically enrolled:

  • If you are already receiving Social Security benefits or Railroad Retirement Board, your benefits will start the first day of the month you turn 65. (However, if your birthday falls on the 1st day of the month, your benefits will start the 1st of the previous month)
  • If you are under 65 and disabled, you will automatically get Part A and B after your receive Social Security benefits for 24 months or certain disability benefits from the Railroad Retirement Board.
  • With auto-enrollment, you will receive your red, white and blue Medicare Card along with a “Welcome to Medicare” brochure.  This brochure is important.  This brochure gives you specific instructions on what you should do now.

Types of situations when an individual is NOT automatically enrolled:

  • If you are not receiving Social Security benefits or Railroad Retirement Board, contact the Social Security administration 3 months prior to your 65th birthday to enroll – this is your Initial Enrollment Period (IEP)
  • If you have End Stage Renal Disease – you must contact Social Security directly.
3 months before you turn 65

2 months before you turn 65

1 month before you turn 65

The month you turn 65

1 month after you turned 65

2 months after you turned 65

3 months after you turned 65

Sign up before the month you turn 65 to avoid a delay in coverage!

If you wait, your coverage will be delayed!

See chart below

         

If you wait until the month you turn 65 or the 3 months after you turn 65 your Medicare Coverage will begin:

If you enroll in this month of your Initial Enrollment Period

Your coverage starts:

The month you turn 65

1 month after enrollment

1 month after you turn 65

2 months after enrollment

2 months after you turn 65

3 months after enrollment

3 months after you turn 65

3 months after enrollment

ENROLLMENT PERIODS NAMES AND MEANINGS

Initial Enrollment Period (IEP)

  • This is your time to enroll into Medicare A, B, C and/or D!
  • This period lasts for seven months. It begins the three months before the month you turn 65, includes the month you turn 65, and ends three months after the month you turn 65. 
  • By enrolling into Medicare A and B three months prior to your 65th birthday, your coverage will start the 1st day of the month you turn 65.
  • If you enroll in the month you turn 65 or the three months after you turn 65, your enrollment date will be delayed.

General Enrollment Period (GEP)

  • If you did not sign up for Medicare Parts A and/or B during your initial enrollment period, you can sign up January 1st – March 31st each year
  • Your coverage will not start until July 1st. 
  • You are not able to join a Prescription Drug plan during this time; you will need to wait until the Annual Election Period.
  • You may have to pay Part A, B and/or D higher (lifetime) premiums for failure to enroll in your initial enrollment period. 

Special Enrollment Period (SEP)

  • If you did not sign up for Medicare Part A, B and/or D when you were first eligible because you or your spouse were currentlyemployed and you had a group health plan, you can enroll:

    • Anytime you are still covered by the group health plan
    • During the eight month period that begins the month after the employment ends or the healthcare coverage ends – whichever comes first!
    • You generally are not assessed a lifelong penalty because you had creditable health insurance coverage.

  • There are Special Enrollment Periods for Medicare Part C that will allow you to join, switch or drop a Medicare Advantage plan if:

    • You move out of your plan’s service area
    • You have Medicaid
    • You qualify for Extra Help (please see the Section entitled “Extra Help”
    • You live in an institution

  • There are Special Enrollment Periods for Medicare Part D that will allow you to join, switch or drop a Medicare Prescription Drug plan if:

    • You move out of your plan’s service area
    • You lose other creditable prescription drug coverage
    • You live in and institution
    • You qualify for Extra Help (please see the Section entitled “Extra Help”

Medicare Part C and D Annual Enrollment Periods (AEP) – Changes take effect the 1st of the year.

October 15th – December 7th is the Medicare Part C and D annual enrollment. Unlike Medicare Part A and B in which you do not need to re-enroll in every year, you may want to make changes to your Advantage Plans or stand alone prescription Drug plans. 

During this time you can:

  • Change from Original Medicare (A and B) to a Medicare Advantage Plan
  • Change from a Medicare Advantage Plan to original Medicare (A and B)
  • Switch from one Advantage Plan to another Advantage Plan
  • Join a Medicare Prescription Drug Plan (penalties may apply if you did not originally sign up during your initial enrollment period)
  • Switch from one Prescription drug plan to another Prescription Drug Plan
  • Drop your Medicare prescription drug coverage completely (keep in mind, if you drop your drug coverage and do not have any other source of drug coverage, you might incur lifelong penalties should you wish to sign up for a drug plan during the next annual enrollment period)

Medicare Part C Disenrollment Period

If you elected to join a Medicare Advantage Plan and decided it is not for you, there is a very brief window of opportunity to make changes, it is called the Medicare Advantage Plan Disenrollment Period.  From January 1 – February 14 (remember, you must be enrolled in an Advantage plan for this to apply to you) you can:

  • Leave your Advantage Plan and switch back to Original Medicare and join a Medicare Prescription Drug Plan (Part D). Your new coverage will start the 1st of the following month.

During this period YOU CANNOT do the following:   

  • Switch from Original Medicare to a Medicare Advantage Plan
  • Switch from one Medicare Advantage Plan to another
  • Switch from one Prescription Drug plan to another

A handy tip sheet is available which discusses the enrollment periods entitled “Understanding Medicare Part C & D Enrollment Periods”.  Click here for a copy:  http://www.medicare.gov/Pubs/pdf/11219.pdf

MEDICARE PREMIUMS AND COST-SHARES FOR PARTS A AND B

The Medicare Program does not offer 100% coverage.  There are in many cases deductibles and co-shares that you are responsible for.

Medicare Part A for 2017:

  • No monthly premium if you have worked enough quarters

  • Per benefit deductible $1,316

  • Cost shares for inpatient hospital stay:

    • Days 1-60: $0 (Medicare pays in full after the deductible for your room and board)
    • Days 61-90 $329 per day
    • Days 91-150 $658 per day

  • Skilled Nursing Facility Care (after a 3 day qualifying inpatient stay in a hospital)

    • Days 1-20 $0 (Medicare pays in full)
    • Days 21-100 $164.50 per day

  • Home Health Care

    • Medicare pays 100% *must meet certain criteria to receive home health care

Medicare Part B for 2017:

  • For individuals who enrolled into Medicare A & B BEFORE January 1, 2016 AND were collecting Social Security, the standard premium will be $109.00 for most beneficiaries. For individuals who enrolled into Medicare A & B AFTER January 1, 2016 the standard premium will be $134.00 – the premium will automatically be deducted from your social security benefit.  ** Individuals making over $107,000 per year and couples making over $160,000 per year will pay higher premiums
  • Annual deductible of $183
  • Most services covered at 80%; you are responsible for 20%
  • Most Preventative Services covered at 100%

MEDICARE PREMIUMS AND COST-SHARES FOR C AND D

Medicare Part C for 2017:

  • You must continue to pay your monthly Medicare Part B premium (this is not optional)
  • Plans range from $0 - $239/month in addition to your Part B premium
  • Some plans you may add vision/dental/hearing coverage for an additional premium
  • Most plans have per day copays for inpatient hospital stays as well as per day copays for skilled nursing facility charges.  LOOK AT EACH PLAN CLOSELY BEFORE YOU DECIDE.

Medicare Part D for 2017:

  • You must have either Medicare A and/or B to enroll in a Prescription Drug Plan.
  • Plans range in monthly premiums $14.60 - $127.50.
  • Deductibles range from $0 - $400 per year

THE MEDICARE SAVINGS PROGRAM AND EXTRA HELP

Medicare Beneficiaries in Connecticut can get financial assistance with paying Medicare Part A, B and D premiums and cost-shares, by applying to the Medicare Savings Program (MSP) if you have limited income.

The Medicare Savings Program (MSP) will:

  • Pay your monthly Medicare Part B premium
  • In some cases protect you from your Medicare Part A and B cost-shares
  • Automatically enroll you into the Extra Help (LIS)
If your gross monthly income is at or below these levels….

You may qualify for this level of MSP:

$2,088.90 Single

$2,816.85 Couple

QMB – This program will pay your monthly Medicare Part B premium.

QMB will also pay all Medicare Part A and B deductibles and cost-shares.

$2,286.90 Single

$3,083.85 Couple

SLMB - This program will pay your monthly Medicare Part B premium.


$2,435.40 Single

$3,284.10 Couple

ALMB- This program will pay your monthly Medicare Part B premium. This program is subject to available program funding.


You will automatically be granted Extra Help with your prescription drug plan if you qualify for MSP.  Extra Help is a Medicare program to help people with limited income pay Medicare prescription drug costs.

For an informational video, click here.

Extra help will:

  • Pay in full or partially pay your monthly Medicare Part D premium
  • Protect you from your Medicare Part D yearly deductible
  • Protect you from the gap in coverage (a.k.a. donut hole)
  • Lower your copays for covered generic drugs to no more than $3.30 and covered name brand drugs to no more than $8.25 per 30 day supply

Traditional Medicare VS. Medicare Advantage Plans (Part C)

It is up to you how you would like to receive your Medicare Benefits. Your Medicare Benefits come in two different ways and you must understand each way in order to make a final decision. Path #1 is Traditional Medicare. This section will provide you information about Medicare, Medicare Supplemental Plans and Medicare Part D. Path #2 will discuss Medicare Advantage Plans. For a quick synopsis, please download our "Know the Paths to Medicare Coverage" here.

Path #1 - Traditional Medicare/Medicare Supplement Policy/Medicare Part D

As you previously ready, Medicare Part A and B does not cover 100%. Here is a recap of what Medicare Part A and B coverage is and what YOUR responsibilities will be:

Medicare Part A Hospital Insurance:

  • Per benefit deductible of $1316
  • Days 0-60 - covered 100%
  • Days 61-90 - there will be a per day copay of $329
  • Days 91-150 - there will be a per day copay of $658

Skilled Nursing Facility Care (must have a 3 day qualifying inpatient stay in the hospital)

  • Days 1-20 - covered 100%
  • Days 21-100 - there will be a per day copay of $164.50
  • Days 100+ - NO COVERAGE. MEDICARE PAYMENT ENDS. If you or your loved one will need more than 100 days, then other payment arrangements will need to be made.

Home Health-must meet certain requirements to obtain home health care. Please see page 50 of the Medicare & You 2017 Book.

Medicare Part B - Medical Insurance:

  • Annual deductible of $183
  • Most services are paid at 80%

Medicare Supplemental Insurance Plans (Medigap Plans)

As you can see above, Medicare A and B do not pay 100%. Some individuals find it necessary to purchase additional health insurance in the form of a Supplemental Plan. For a list of the most current monthly rates and plans available in CT, please see the links below to download the most current rate sheet.

 

English Rate Sheet Spanish Rate Sheet French Rate Sheet
Aug 04 2017 English Monthly Medicare Supplement Rates Page 1 Aug 04 2017 Spanish Monthly Medicare Supplement Rate Sheet Page 1 Aug 04 2017 French Monthly Medicare Supplement Rates Page 1

 

Supplemental plans range in premiums and coverage. In Connecticut, plans are standardized and lettered A, B, C, D, F, G, K, L, M and N. By plans being standardized, it makes it easier to compare the plans as a Supplemental Plan F is a Plan F no matter what insurance company you decide to purchase this plan from. Here is an example of a Plan F compared to a Plan N:

 

SUPPLEMENTAL PLAN F

Service

Medicare Pays

Plan Pays

You Pay

(Part A) Hospitalization – first 60 days

All but $1316

$1316

$0

Days 61-90

All but $329/per day

$329/per day

$0

Days 91- and lifetime reserve days

All but $658/per day

$658/ per day

$0

(Part B)

Medical Expenses : Annual Deductible of $147

$0

$183

$0

After annual deductible is met

80%

20%

$0

Part B Excess Charge (above Medicare approved amounts)

$0

100%

$0

 

 

SUPPLEMENTAL PLAN N

Service

Medicare Pays

Plan Pays

You Pay

(Part A) Hospitalization – first 60 days

All but $1316

$1316

$0

Days 61-90

All but $329/per day

$329/per day

$0

Days 91- and lifetime reserve days

All but $658/per day

$658/ per day

$0

(Part B)

Medical Expenses : Annual Deductible of $147

$0

$0

$183

After annual deductible is met

80%

Balance, other than up to $20 per office visit and up to $50 for ER visit

$20 per office visit and $50 per ER visit

Part B Excess Charges (above Medicare approved amounts)

$0

$0

All charges

 

You must have Medicare Part A and B in order to select and enroll into a Supplemental Plan. You may enroll into the plan of your choice by calling the phone number listed to the right of the insurance plan on the Rate Sheet.

Supplemental plans DO NOT HAVE NETWORKS, as long as you are seeing a healthcare provider that accepts Medicare it does not matter what supplemental plan you enroll into.

But.......you are not finished yet! You still need to enroll into a Medicare Part D plan.

Medicare Part D - Prescription Drug Coverage

If you do not have creditable coverage through an alternate source (i.e. retiree drug lpan, Tricare for Life etc.) you must enroll into a drug plan during your initial enrollment period to avoid penalties.

In 2017, there are 27 plans to choose from and you must choose wisely. All plans range in premiums from $14.60 - $127.70 per month and some plans range in annual deductible from $0 - $400.

Please visit www.Medicare.gov and click on FIND HEALTH AND DRUG PLANS. Medicare has made available a short video (right hand side) to demonstrate how to use the plan finder tool to help you select a Medicare Part D Plan.

CHOICES counselors are available to help assist you with finding the right drug plan to suit your needs and help with plan enrollment. Please call 1-800-994-9422 for assistance.

OR YOU MAY WANT TO ENROLL INTO A MEDICARE ADVANTAGE PLAN (Medicare Part C)

PATH #2 - MEDICARE ADVANTAGE PLANS:

Another alternative way to receive your Medicare benefits is through a Managed Care Plan, for example and HMO or a PPO Plan.

You must enroll into Medicare Part A and B (and continue to pay your monthly Medicare Part B Premium) in order to obtain a Medicare Advantage Plan.

You cannot purchase a Supplemental Plan if you are enrolled in a Medicare Advantage Plan.

A Medicare Advantage Plan replaces your Traditional Medicare coverage. By enrolling into an Advantage Plan, the Advantage Plan becomes your only source of insurance. Most Advantage Plans have the drug benefit added in, so there is NO NEED TO PURCHASE A PART D PLAN. Again if you DO NOT have a creditable drug plan and wish to enroll into Managed Care, you must select a Managed Care plan with drug coverage; otherwise, you may face penalties later on if you decide you now need drug coverage.

Medicare Advantage Plan Premiums:

Remember, you must still pay your monthly Medicare Part B premium in addition to and Medicare Advantage Plan premiums. For 2017, the premiums range from $0 - $239/month.

Medicare Advantage Plan Cost-share/Co-pays:

By enrolling into an Advantage plan, you must use the healthcare providers that are in the plans network. Some plans offer out-of-network coverage. Each service may have a co-pay/co-insurance due at the time of service.

Medicare Advantage Plans Drug Coverage:

Annual deductibles for prescription drugs range from $0 - $400.

Questions to ask yourself BEFORE you enroll into a Medicare Advantage Plan:

Please see the Medicare Rights Center article here.

This article provides a list of questions that you need to know the answers to BEFORE you enroll into a particular plan.

To learn more about the Medicare Advantage Plans, please visit www.Medicare.gov and click on FIND HEALTH AND DRUG PLANS. Again, Medicare offers a video to guide you through the plan finder tool.

For more detailed information, please follow the link to “Medicare Basics: A Guide for Families and Friends of People with Medicare”. http://www.medicare.gov/Pubs/pdf/11034.pdf

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