Boomer with End-Stage Renal Disease Has to Pay $7,000 with His Medicare Supplement
Toni,
When I first enrolled in Medicare in 2019, I picked a supplement plan F. In 2021 I was approached by a telemarketer 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% of the 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,
A healthcare crisis can happen when you least expect it! While everyone wants 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 had zero out-of-pocket costs and all Medicare-covered expenses would be covered 100% to a Plan K that does have an out-of-pocket, which is $6,940 for covered Medicare expenses for 2023.
Because you have end-stage renal disease, 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 Plan K or go with a Medicare Advantage HMO or PPO plan. But, if you’re switching to an Advantage plan, you will have to wait until the Medicare Annual Enrollment Period, which is October 15-December 7.
Toni Says: I suggest you talk with your healthcare providers about which Medicare Advantage Plan meets their qualifications!
There are 2 chapters in the Medicare Survival Guide Advanced Edition that explain the difference between Medicare Supplements and Part C Advantage Plans. In Chapter 6, I explain what Medicare Part C plans are and the different types to choose from: HMO, PPO, and PFFS. In Chapter 8, I discuss Medicare Supplements, also known as Medigap policies.
Which Medicare Supplements Cover the Most?
With a Medicare Supplement, the most comprehensive plans that cover the most 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 January 1, 2020, to enroll in Plan F.
- Plan G is like F, and is available to Medicare beneficiaries whose Medicare Part A started after January 1, 2020. The difference between plan F and G is that plan G does not include the Part B deductible of $226 for 2023.
- 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. 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 information, email info@tonisays.com or call 832-519-8664.
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Originally published April 05, 2023
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