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Medicare Supplement (or Medigap) plans in Connecticut are available through private insurance companies, and they’re designed to help pay for certain out-of-pocket costs in Original Medicare, like copayments, coinsurance, and deductibles. As a Medicare beneficiary in Connecticut, you may have several Medigap plan options, depending on the zip code you live in. Understand what each Medigap plan covers, and get help selecting the one that works best for your health and budget needs.
Medigap plans in Connecticut are designed to help cover health-care costs associated with Original Medicare, Part A and Part B, such as copayments, coinsurance, plan deductibles, and other out-pocket expenses. These plans can’t be used to cover Medicare Advantage costs.
There are 10 standardized plans available in most states, each identified by one of 10 letters (A, B, C, D, F, G, K, L, M, and N). Each plan of the same letter offers the same benefits. The same 10 plans are available in 47 states, including Connecticut. Three states – Massachusetts, Minnesota, and Wisconsin – offer different Medigap plans.
To join a Medigap plan in Connecticut, you must already be enrolled in Original Medicare, Part A and Part B. Your Medigap Open Enrollment Period is generally the best time to join a Medigap plan. This period lasts for six months and starts the first day you are age 65 or older and also enrolled in Medicare Part B. During this time, you have guaranteed-issue rights, meaning you can sign up for any Medicare Supplement plan offered in your area, with the insurance company of your choosing, and not be subject to medical underwriting or rejected because of your medical status. Keep in mind that insurance companies may make you wait up to six months for coverage of pre-existing conditions, even if you enroll in a Medigap plan during this period; after this waiting period is over, the plan will cover your pre-existing conditions. Unlike other parts of Medicare, there aren’t annual enrollment periods besides your Medigap Open Enrollment Period, and you can enroll in a plan at any time. However, if you want to join a Medigap policy outside of this time and you have health issues, you may be denied coverage or charged more for the insurance policy.
Medigap plans in Connecticut do not offer prescription drug coverage. Instead, Original Medicare beneficiaries can enroll in a stand-alone Medicare Part D Prescription Drug Plan, available through Medicare-approved private insurance companies, to receive coverage for prescription drug expenses.
It’s very important to remember that even if you sign up for a Medigap plan, you must remain enrolled in Original Medicare, Part A and Part B, and go on paying your Medicare Part B premium, in addition to the premium for your Medicare Supplement coverage. Since Medigap plans are meant to supplement and not replace Original Medicare, failure to pay your Medicare Part B premium may result in your being disenrolled from Medicare and losing your health coverage.
Here’s a look at the 10 standardized Medigap plans available in Connecticut so that you can familiarize yourself with what each plan has to offer. In this chart, X indicates that the service (or item) is 100% covered; a percentage indicates what percent of the service/item is covered; and a blank cell indicates it is not covered.
|Medicare Supplement Plans|
|Medicare Supplement Benefits||A||B||C||D||F*||G||K||L||M||N|
|Medicare Part A coinsurance and hospital costs up to an additional 365 days after Medicare benefits are exhausted||X||X||X||X||X||X||X||X||X||X|
|Medicare Part B copayment or coinsurance||X||X||X||X||X||X||50%||75%||X||X***|
|First three pints of blood||X||X||X||X||X||X||50%||75%||X||X|
|Medicare Part A hospice care coinsurance or copayment||X||X||X||X||X||X||50%||75%||X||X|
|Skilled nursing facility care coinsurance||X||X||X||X||50%||75%||X||X|
|Medicare Part A deductible||X||X||X||X||X||50%||75%||50%||X|
|Medicare Part B deductible||X||X|
|Medicare Part B excess charges||X||X|
|Foreign travel emergency coverage (up to plan limits)||80%||80%||80%||80%||80%||80%|
|Out-of-pocket limits apply.**|
*Medicare Supplement Plan F offers a high-deductible version in which beneficiaries pay a certain deductible amount before the plan begins coverage. This amount may change from year to year.
**Once you reach the out-of-pocket limits (including the Part B deductible), both Medicare Supplement Plans K and L pay 100% of covered services in the above chart for the remainder of the calendar year.
***Medicare Supplement Plan N pays 100% of the Medicare Part B coinsurance, except for a copayment of up to $20 on doctor visits and up to $50 on emergency room visits that don’t result in an inpatient admission.
As explained earlier, Medicare Supplement plans in Connecticut with the same letter designation don’t vary in coverage or benefits. However, each independent insurance company offering Medicare Supplement plans can charge different premiums for the same coverage. This means that if you live in New Haven, in New Haven County, you may pay more or less than a resident of Bridgeport in Fairfield County for an identical Medicare Supplement plan. You may not realize that the premium pricing method that the insurance company uses affects the cost of the plan when you enroll and how much it may go up later on. It may be a good idea for you to compare all Medicare Supplement plans available in your Connecticut area, and then make a selection based on your individual budget and health needs.
To get help choosing the plan that best suits your individual needs, contact eHealth today to speak with a licensed insurance agent.