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Senior Citizen's Guide to Connecticut

Medicare 911

Medicare, America’s first public healthcare option, was created in 1965 to provide healthcare coverage to older adults aged 65 and over and persons under 65 who are disabled. Medicare just celebrated it’s 45th birthday last year. Today, Medicare is bigger and more comprehensive than ever. Navigating the Medicare maze however is not for the faint of heart. The options are overwhelming to even the savviest consumer. Within several months of one’s 65th birthday, the mailbox begins to overflow with postcards, enrollment packets and invitations to health insurance informational forums. Turn on the TV and the ads are there too, you can’t escape the mad mad world of Medicare. Words like Medicare Supplement plans, Medigap, Medicare Advantage, PPOs, HMOs, Part D prescription plans, are all swirling around you. How does one make sense of it all and more importantly, what is this all going to cost? For many of us, during our working years, we are lucky if our employer gives us two or at best three options to choose from for our healthcare coverage. Many employers only give their employees one option.

However when you enter the world of Medicare, the options are endless. In Connecticut alone, there are twelve Medicare Supplement Companies, each offering as many as 11 standardized plans to choose from. There are over a dozen Medicare Advantage plans to choose from and if that’s not enough, you have 34 Part D Prescription plans to choose from. Overwhelmed yet? Wait, don’t walk away. Although the task at hand may seem daunting and the choices are endless, there are a few basic things that you need to know before tackling the tremendous task of choosing what you need. First you need to understand what all these options mean.

Medicare

Traditional Medicare has two components, Part A (hospital coverage) and Part B (medical coverage) Most folks do NOT have a Premium for Part A because they’ve already paid into Medicare for at least 40 quarters during the time they were actively employed. Part B will cost you a premium, for most individuals newly eligible for Medicare in 2011 it will be $115.40 per month. Individuals with annual incomes over $85,000 will pay more. Parts A & B provide basic coverage but there are deductibles and co-insurance amounts that the beneficiary has to pay out of pocket.

Medicare Supplements:

Also called Medigap plans do just that. They are a supplement to Medicare Parts A & B and cover the deductibles and co-insurance amounts that Medicare doesn’t. There are 12 companies approved in the state of CT to sell Medigap insurance. Medigap plans are standardized which makes it easy for the consumer to compare plans from company to company. Premiums vary from company to company. With Medigap plans you also have the freedom to see any Medicare provider even if it’s out of state.

Medicare Advantage (MA):

Medicare Advantage Plans are private health plans that Medicare contracts with to administer your health care costs. Formerly known as Medicare part C, these plans are another option to traditional Medicare. Medicare Advantage have to provide the same services that Original Medicare covers except Hospice Care. Many Medicare Advantage plans also provide drug coverage and some may provide limited vision and dental care. All MA plans in CT are HMOs or PPOs and therefore, members have to see network providers or pay higher costs for out of network providers. Someone can either have traditional Medicare with an (optional) Medigap and a Part D drug plan OR a Medicare Advantage Plan which includes the Part D drug benefit.

Medicare Part D

The prescription drug benefit offered under the Medicare program. Part D coverage is provided by private insurance companies that contract with Medicare to provide prescription drug coverage. Monthly premiums, deductibles and co-pays for drugs vary from plan to plan. In Connecticut there are 34 Part D plans to choose from. Each plan has their own list of drugs that they will cover. Therefore careful consideration should be taken based on your individual drug regimen in choosing a plan that best meets your needs.

Low Income Subsidy

(Extra help) this is the federal government subsidy that helps low income Medicare beneficiaries with limited means pay for most of their drug costs, including the monthly premium for their Part D plan and deductibles if applicable.

Medicare Savings Programs (MSP)

These are a group of three programs that are funded in part by the Federal government but administered by the state of Connecticut. Medicare Savings Programs pay the Medicare Part B monthly premium for eligible individuals. This means an extra $96-$115 in your pocket each month. In addition to this, anyone on a Medicare Savings Program automatically qualifies for the Low Income Subsidy for their drugs. This will save you even more money on your drug costs. The state of Connecticut passed legislation last year that substantially increased the income limits for these programs and removed the asset test. If you are a single person with a gross annual income below $25,100 or a married couple with a gross annual income below $33,800 you may qualify for one of these programs that can save you hundreds of dollars a month on your Part B premium and your drug costs.

This is just a very basic introduction into the world of Medicare. The Centers for Medicare & Medicaid Services (CMS) realizes how overwhelming this is for beneficiaries. In recognition of this, CMS provides funding to each state to administer a State Health Insurance Program (SHIP). SHIPS provide free and objective information and assistance to Medicare beneficiaries to them understand all their options and apply for benefits. SHIPS do NOT endorse any specific companies and DO NOT SELL insurance. Connecticut’s five Area Agencies on Aging administer the regional SHIP programs.

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