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. 

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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.

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). 

Medicare Survival Guide Advanced Edition

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What You Don’t Know Will Hurt You!

Turning 65 in America is a milestone and one of the markers is enrolling in Medicare. But the system is so complicated, and there is a lot of false information out there.

In Toni King’s Medicare Survival Guide Advanced: Basics and Beyond, Toni gives you the critical steps you need to enroll in Medicare properly. Toni shares various situations that she has experienced with her many clients during Medicare consultations, and gives you the information and tools you need to enroll on time to avoid the “famous” Medicare Part B and D penalties.

Medicare Survival Guide Advanced helps you understand Medicare step by step…

Learn How to Enroll the Correct Way
• Still Working Past 65
• Turning 65
• VA Benefits
• Laid-off or Retiring

What Medicare Option Is Best for You
• Medicare Supplement vs. Advantage
• Losing Retirement Benefits

How to Avoid
• The Donut Hole
• Part B Penalties
• Part D IRMAA Penalties

If you are enrolling in Medicare and are confused by the commercials and telemarketers, or from the information that well-meaning friends or family members give, let Toni guide you through the maze of Medicare. Order TODAY!

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