Toni,
When I first enrolled in Medicare in 2019, I picked a Medicare supplement Plan F. In 2021, I was approached by a telemarketer, and since I was in good health, he talked me into Plan K, which costs less. I was hospitalized in November 2022 due to diabetic issues after I passed out in the doctor's office. Now I am a serious diabetic with kidney issues and need dialysis to survive.
Since I have Plan K, I must pay the deductible plus 50% of costs until I meet the supplement's maximum out-of-pocket -- almost $7,000. I tried to go back to Plan F, but the agent said I couldn't because of the dialysis.
I thought preexisting conditions did not count with Medicare. Can you help me to understand this? Your assistance would be appreciated. Thanks, Toni.
– Anthony, Las Vegas
Anthony,
What a great question.
You went from the top-of-the-line Medicare Plan F supplement, where you would have zero out-of-pocket costs and all Medicare covered expenses would be paid 100%, to a Plan K with an out-of-pocket limit of $6,940 for covered Medicare expenses for 2023.
Because you now have end stage renal disease and require dialysis, you cannot qualify for a new Medicare supplement because you cannot pass the health underwriting questions.
Your options are to either stay on your Medicare Plan K or go with a Medicare Advantage health maintenance organization or preferred provider organization plan. But you will have to wait until the Medicare annual enrollment period from Oct. 15 to Dec. 7 if you would like to change to an advantage plan -- which, unlike a Medicare supplement, has no health questions.
I would advise you to talk with your health care providers about which Medicare advantage plan meets their qualifications.
There are two chapters in the Medicare Survival Guide Advanced Edition that explain the difference between Medicare supplements and Part C Medicare advantage 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 of the Medicare approved amounts with zero out of your pocket, but one must have enrolled in Medicare Part A prior to Jan. 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 Jan. 1, 2020. The difference between Plan F and G is that Plan G does not cover the Part B deductible of $226 for 2023.
-- Plan N has lower premiums with higher out-of-pocket costs. There is a $20 copay for a doctor's visit and a $50 copay for the emergency room. The Part B deductible is not covered, and, in addition, Part B excess charges are not paid for by the insurance company, which Plan G does cover.
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 underwriting questions to qualify for a new Medicare supplement.
Toni King is an author and columnist on Medicare and health insurance issues. She spent nearly 30 years as a top sales leader in the field. If you have a Medicare question, email info@tonisays.com or call 832-519-8664. You can visit seniorresource.com/medicare-moments to listen to her Medicare Moments podcasts and get other information for seniors.