Janie Slaven: TONI SAYS: Changing Medicare plans can be nerve-wracking

Janie Slaven, The Times-Tribune, Corbin, Ky.
Updated ·3 min read
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Apr. 11—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 pre-existing 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 (ESRD) and require dialysis, you cannot qualify for a new Medicare Supplement since you cannot pass the health underwriting questions.

Your options are to either stay on your Medicare Plan K or go with a Medicare Advantage HMO or PPO plan. But you will have to wait until the Medicare Annual Enrollment Period from October 15 — December 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 2 chapters in the Medicare Survival Guide Advanced Edition which explain the difference between Medicare supplements and Part C Medicare Advantage Plans. In chapter 6, I explain the different types of Part C plans: HMO, PPO, PFFS (Private Fee for Service) and SNP (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 Plan F, Plan G and Plan N:

—Medicare Supplement 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.

—Medicare Supplement Plan G is like Plan 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 cover the Part B deductible of $226 for 2023.

—Medicare Supplement 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. 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. If you have a Medicare question, email info@tonisays.com or call 832-519-8664.