Stress Changing Medicare Plan

Morning Toni:
When I first got Medicare, I picked a Medicare supplement plan F. Two years ago, I was approached by a telemarking phone call. He talked me into plan K to save some money since I was in good health and could answer the health questions.

I was hospitalized in March 2020 due to low sugar when I passed out at home. I had no idea that I was a severely insulin-dependent diabetic. The diabetes has caused me to need dialysis when my kidneys stopped working.

With Plan K, I must pay 50% of the Medicare Part A hospital deductible and the Medicare Part B costs is astronomical.  I now pay the Part B deductible plus a 50% copay for all Part B services.  I had to pay over $5,000 in 2020. I made an awfully bad decision to change!

I tried to apply for a Medicare Supplement during Medicare Annual Enrollment last fall, but the agent said I cannot because I am having dialysis.

I thought with Medicare that pre-existing conditions did not count. Can you help me to understand this?  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 has 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 expenses would be covered 100% to “Plan K” which does pick up Medicare expenses, but has a tremendous out of pocket as you are experiencing. Because you now have End-Stage Renal disease which requires kidney dialysis; you cannot qualify for a Medicare Supplement.

Good News because beginning 2021 certain Medicare Advantage plans are now accepting those with ESRD (end-stage renal disease).

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. Chapter 3 of the Medicare Survival Guide discusses Medicare Supplements, also known as Medigap policies. In chapter 4, I explain what Part C or Medicare Advantage plans are and the different types of plans…HMO, PPO, PFFS (Private Fee for Service), SNP (Special Needs Plans).

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” is not available for those who turned 65 beginning January 1, 2020, but is still available to those who are Medicare Part A began prior to January 1, 2020.  To make a change to their Medicare supplement they may 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 that is $203 once a year for 2021.

America should be made aware of telemarketers that call to try and change one’s Medicare plan options.  Please be careful when answering phone calls and giving out 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.

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Toni King, Medicare author/advocate is giving a $5 discount to the Toni Says® readers on the Medicare Survival Guide® Advanced book at www.tonisays.com. Have a Medicare question? Call 832/519-8664 or email info@tonisays.com.