Ask almost any agent who helps seniors with their Connecticut Medicare Supplement Plan needs, or other expert, and he or she will tell you a combination of Original Medicare (Medicare Part A and Part B) a Medicare Supplement Plan (Medigap) F and a solid Prescription Drug Plan is the safest option for Medicare Enrollees in any state including Connecticut.
I’ve come to a similar conclusion after looking at all options available for in Connecticut. Medicare Supplement Plan F provides strong coverage and is the best plan for almost all scenarios. However, there are two holes in this otherwise perfect combination.
The first hole is the drug benefit limitations. However, this is a hole that cannot be filled completely. No option covers drugs without any cost shares. (A cost share is a deductible, copay or coinsurance that you are responsible for.)
Since the drug coverage options are similar with all plans that provide prescription coverage, the rest of this post will focus on other costs covered by Medicare. These costs include costs for hospital stays plus treatments and exams received from doctors and other providers in their offices or clinics.
We will talk about the second hole, or uncovered exposure, in a minute. This second hole is smaller, in a way. You are much less likely to be impacted by it. However, if you are, you will want to know the solution outlined below.
Connecticut Medicare Supplement vs Connecticut Medicare Advantage Plans
If you are insured by a Medicare Supplement Plan (Medigap) you will be covered when visiting any doctor in or out of Connecticut who accepts Medicare. The lack of network restrictions is the biggest reason to purchase a Supplement plan instead of an Advantage plan.
The reason to purchase a Medicare Advantage plan instead is mainly cost. Many Medicare Advantage plans have $0 monthly premiums. (There are three $0 premium plans available in each county in Connecticut for 2017.) A competitively priced Medicare Supplement Plan and Prescription Drug Plan combination will cost around $300 per month (based on 2017 Medigap rates). (The average cost of plan F is a higher, but we can help you shop around.)
If you choose to ask me for advice, I will first look for a plan that has all your doctors in their network and see if the network restrictions are likely to impact you. (I’ll also check your list of drugs against the carriers’ formularies.)
Even if a plan exists, the network restrictions could still hurt you in certain scenarios. You might be told the specialist your doctor wants to refer you to is not in the network or the hospital that provides the best treatment options for a rare condition is not available to you.
Most of my Connecticut clients feel this is a risk worth taking. When they see how easy it is to switch to a Medigap plan during any Annual Enrollment Period and hear there are no network restrictions during medical emergencies, they often decide to enroll in a lower cost plan.
However, not everyone makes the same decision and for good reason. Everyone’s situation is a little different. My job is to give you the facts and the benefit of my three decades of experience. But I don’t have your perspective. Only you can decide whether how much you value freedom to visit doctors outside the network verses the cost of a non-network plan.
Therefore, I offer both types of plans. The best option for the client I spoke with last, may not be your best option.
Medicare Supplement Plan F Copays and other Cost Shares
All Connecticut Medicare Supplement Plans and Connecticut Medicare Advantage Plans, require you to pay cost shares (deductible, copay or coinsurance) for medical services.
This is true for all plans including Medigap Plan F. However, Plan F is the only plan that pays both the deductible in the doctor’s office and will also pay excess charges if the doctor charges over the Medicare approved amount.
You are unlikely to have to pay any cost shares for medical services if you enroll in a Medicare Plan F. But it does not cover everything in every scenario.
What Does Plan F Cover?
When combined with Medicare Part A and Medicare Part B, Plan F covers Hospital stays, Emergency Room visits, outpatient surgery, plus visits to doctors and other medical providers as well or better than any other option available to the general public. It does not cover any prescription benefits, but you can get drug coverage from a separate Prescription Drug Plan.
The Other Hole in Plan F
Neither Plan F nor any other CT Medicare Supplement Plan (Medigap) covers the longest hospital stays fully. But this only impacts a very small percentage of us.
Since all Medigap plans cover 365 additional days after Original Medicare stops paying, you will have time to switch to a Medicare Advantage Plan that does not limit the number of days you spend in a hospital. Unless you have end state renal disease, you will be able to make the change during the next Annual Enrollment Period.
Several Medicare Advantage Plans will cover hospital stays with no limit on the number of days.
Medigap Plan F when combined with a strong prescription drug plan will give you the best coverage for the most important medical exposures.
Many of my clients feel the additional cost for this plan is worth it.
Plan F Alternatives
However, I often recommend one of the other Medicare Supplement options. These other options will cover any doctor who accepts Medicare, just like Plan F does. But can cost a lot less.
The best Medicare Supplemental plans for most of my clients (who do not select Medicare Advantage Plans) are:
- Medicare Supplement Plan F
- Medicare Supplement Plan K
- Medicare Supplement Plan N
The coverage is only a little less robust in the other plans, but the price is a lot lower when compared to a Connecticut Medicare Supplement Plan F. You will see my reason for recommending these other non network plans in my post.
Complete our questionnaire, if you to know which Connecticut Medigap or Advantage plan I recommend for you.