UNITED STATES—Toni: When I first enrolled in Medicare in 2019, I picked a Medicare supplement plan F. In 2021 I was approached by a telemarketer on my cell phone, and he talked me into Plan K which cost less than Plan F since I was in good health. I was hospitalized in November 2022 due to diabetic issues when I passed out in the doctor’s office. Now I am a serious diabetic causing me to have kidney issues needing dialysis to survive.
Since I have Plan K, I must pay the deductible plus 50 percent cost until I meet the Medicare Supplement’s maximum out of pocket which is almost $7,000. I tried to go back to Plan F, but the agent said I couldn’t because of the dialysis.
I thought with Medicare pre-existing conditions did not count. Can you help me to understand this? Your assistance would be appreciated. Thanks, Anthony, Las Vegas, NV.
Anthony…What a great question: Americans who do not have health problems need to realize that a health care crisis can happen when you least expect it! While they want to save a few dollars, they don’t realize that they must answer health underwriting questions to qualify for a new Medicare Supplement!
Anthony, you went from the top-of-the-line Medicare Plan “F” Supplement, where you would have zero out-of-pocket and all Medicare covered expenses would be covered 100 percent to a Plan “K” with an out-of-pocket of $6940 for covered Medicare expenses for 2023.
Because you now have End Stage Renal Disease (ESRD) which requires dialysis; you cannot qualify for a new Medicare Supplement since you cannot pass the health underwriting.
Your options are to either stay on your Medicare Plan “K” or go with a Medicare Advantage HMO or PPO plan. But you will have to wait until the Medicare Annual Enrollment Period beginning October 15-December 7 if you would like to change to a Medicare Advantage Plan which unlike a Medicare Supplement, has no health questions.
I would advise you to talk with your healthcare providers about which Medicare Advantage Plan meets their qualifications.
There are 2 chapters in the Medicare Survival Guide Advanced Edition which explain the difference in Medicare Supplements and Part C Medicare Advantage Plans. In chapter 6, I explain what Medicare Part C (aka Medicare Advantage plans) are and the different type of plans…HMO, PPO, PFFS (Private Fee for Service), SNP (Special Needs Plans). In chapter 8, I discuss Medicare Supplements, also known as Medigap policies.
With a Medicare Supplement, the most comprehensive plans that cover more of your Medicare expenses are Plan F, Plan G and Plan N.
- Medicare Supplement plan “F” covers most of the Medicare approved amounts with zero out of your pocket, but one must have enrolled in Medicare Part A prior to January 1, 2020, to enroll in Plan F.
- Medicare Supplement Plan “G” is like Plan “F” and is available to Medicare beneficiaries whose Medicare Part A starts after January 1, 2020. The difference in Plan F and G is that Plan G does not include the Part B deductible of $226 for 2023.
- Medicare Supplement Plan “N” has lower premiums with higher out-of-pocket costs. There is a $20 co-pay for a doctor’s visit and a $50 co-pay for the emergency room with the Part B deductible not covered and, in addition, Part B excess charges are not paid for by the insurance company (which Plan G covers).
Take time to discover which Medicare option is right for you. For more Medicare information, email info@tonisays.com or call 832-519-8664.
Visit www.seniorresource.com/medicare-moments to listen to Toni’s Medicare Moments podcasts and to also download the Toni Says® Medicare Prescription Drug Survival Guide. Toni’s book “Medicare Survival Guide Advanced” edition available at www.tonisays.com.
