UNITED STATES—Morning Toni: When I first got Medicare, I picked a Medicare supplement plan F. The next year, I was approached by a telemarking phone call. He talked me into plan L to save me a few bucks since I was in good health and could answer the health questions.
I was hospitalized in January 2018 due to low sugar when I passed out in doctor’s office. This incident caused me to need dialysis when my kidneys stopped working properly.
Since I was now in Plan K, I must pay the Part B deductible plus 50 percent copay for all Part B services. I tried to go back to plan F, but the agent said I can’t because I’m doing the dialysis.
I thought with Medicare that pre-existing conditions did not count. Can you help me to understand this? Your assistance would be greatly appreciated? Thanks, Terry
Wow, Terry…What a great question: Americans that do not have health problems need to realize that a healthcare crisis can happen at a second’s notice. Everyone wants to save a few dollars and do not realize what having to be medically underwritten means with any type of insurance plan, especially a Medicare Supplement.
Terry, you went from a Medicare supplement plan “F,” where you would have zero out of pocket and all Medicare covered expenses would be covered 100 percent to “Plan K” which does pick up Medicare expenses, but has more out of pocket on your side.
Because you now have End Stage Renal disease which requires dialysis; you cannot qualify for a Medicare Supplement or even to change to a Medicare Advantage plan. Even an AARP Medicare Supplement asks “do you have end stage renal (kidney) disease’ and it is one of the easiest Medicare Supplements to qualify for.
There are 2 chapters in my book, Medicare Survival Guide® Advanced edition which explains the difference in Medicare supplements and Part C Medicare Advantage Plans. In chapter 4, I explain what Part C or Medicare Advantage plans are and the different type of plans…HMP, PPO, PFFS (Private Fee for Service), SNP (Special Needs Plans). In chapter 3 of the Medicare Survival Guide, 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 and G.” Now remember that Medicare Supplement Plan “F” will not be available for those turning 65 beginning January 1, 2020, but will be available to those already on Medicare except you will have to answer underwriting questions.
Medicare Supplement plan “F” picks up most of your Medicare approved amounts with zero out of your pocket. Plan “G” is similar to Plan “F” except it does not include the Part B deductible. Your out of pocket is that deductible, which for 2019 is $185 once a year.
Both Plans “F” and “G” include Medicare Part B “excess” charges which your Plan “L” and other Medicare Supplements do not. This may be where a lot of your out of pocket could be coming from because your healthcare provider wants their Medicare “excess” Part B charges.
Terry, please be careful when answering phone calls and giving out your personal information. Medicare telemarketers are lurking around waiting for the right person to attack and have them make an important decision when they only need proper Medicare information to make the right Medicare decision.
For help with making the proper Medicare decisions, contact Toni Says® at 832-519-8664 or email email@example.com.
Toni King, author of the Medicare Survival Guide® is giving a $5 discount to the Toni Says® readers on the Medicare Survival Guide® Advanced book at www.tonisays.com.