Tony,
When I first signed up for Medicare in 2019, I chose a Medicare Plan F supplement. In 2021, I was approached by a telemarketer, and since I was in good health, he convinced me opt for Plan K, which costs less. I was hospitalized in November 2022 due to diabetes issues after passing out in the doctor’s office. Now I am a serious diabetic with kidney problems and need dialysis to survive.
Since I have Plan K, I have to pay the deductible plus 50% of the costs until I reach the maximum amount of the supplement, which is almost $7,000. I tried to go back to Plan F, but the agent said I couldn’t because of dialysis.
I thought pre-existing conditions didn’t count with Medicare. Can you help me understand this? Your help would be appreciated. Thanks Toni.
–Anthony, Las Vegas
Anthony,
What a good question.
You went from the top-of-the-line supplement Medicare Plan F, where you would have no out-of-pocket and all Medicare-covered expenses would be paid 100%, to a Plan K with an out-of-pocket limit of $6,940 for covered expenses by Medicare for 2023.
Since you now have end-stage kidney disease and need dialysis, you cannot qualify for a new Medicare supplement because you cannot answer health underwriting questions.
Your options are to stay on your Medicare Plan K or go with a Medicare Advantage Health Maintenance Organization or Preferred Provider Organization Plan. But you’ll have to wait until the annual Medicare enrollment period from Oct. 15 to Dec. 7 if you want to switch to a benefit plan — which, unlike a Medicare supplement, has no health questions.
I would advise you to discuss with your health care providers which Medicare benefits plan meets their qualifications.
There are two chapters in the Medicare Survival Guide Advanced Edition that explain the difference between Medicare supplements and Medicare Part C benefit plans. In Chapter 6, I explain the different types of Part C plans: health maintenance organization, preferred provider organization, private fee-for-service, and 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 Plans F, G, and N:
— Plan F covers most Medicare-approved amounts with zero out of pocket, but you must have enrolled in Medicare Part A before January 1, 2020 to enroll in Plan F.
— Plan G is like Plan F and is available to Medicare beneficiaries whose Medicare Part A started after January 1, 2020. The difference between Plans F and G is that Plan G does not cover the deductible Part B of $226 for 2023.
— Plan N has lower premiums with higher out-of-pocket expenses. There is a $20 co-pay for a doctor’s visit and a $50 co-pay for the emergency room. The Part B deductible is not covered, and additionally, Part B excess charges are not paid by the insurance company, which is what Plan G covers.
Americans without health problems need to understand that a health care crisis can strike when you least expect it. While they want to save a few bucks, they don’t realize they have to answer underwriting questions to qualify for a new Medicare supplement.
Toni King is an author and columnist on Medicare and Medicare issues. She has spent nearly 30 years as a sales leader in the field. If you have a question about Medicare, email [email protected] or call 832-519-8664. You can visit seniorresource.com/medicare-moments to listen to his Medicare Moments podcasts and other information for seniors.