Janie Slaven: TONI SAYS: Does 'original' Medicare have a health care network?
Apr. 7—Hi Toni,
I am turning 65 this August and have no idea what I should do because I have coronary heart disease. Currently I am on a COBRA policy from my former employer, with all my medical bills now being paid because I have met my deductible.
I am extremely concerned about what I should do with Medicare, because my heart specialist is telling me that one of my options to improve my health may be a heart transplant.
Do I enroll in 'original' Medicare's network with a Medicare supplement, go with a Medicare Advantage plan, or stay with my current COBRA plan until it ends in about 15 months? If you could help me sort through this, I would greatly appreciate it.
—Jeremy, Spring, Texas
Hello Jeremy:
I have great news for you and the Toni Says readers because there is NO network of hospitals, doctors or any medical provider for original/traditional Medicare.
I repeat: NO NETWORK! Not having to worry about finding a network provider or facility is hard to understand for those leaving employer benefits.
Your medical provider must, however, be willing to bill Medicare. How easy is that? There are medical facilities, doctors, and providers available nationwide. Which means if you are traveling anywhere in the United States and need medical care, you are covered.
I recently received a phone call from a frantic daughter, who was trying to help her father after he had been diagnosed with pancreatic cancer. He had chosen a Medicare Advantage HMO when he turned 65, but the cancer facility he is using is not in that plan's HMO network. Her father is locked-in to his Medicare Advantage plan and now must wait until Medicare's annual enrollment in the fall (October 15-December 7) to switch to original Medicare.
Not you, Jeremy. Because you are turning 65 in August, there is an enrollment time called Medicare Supplement /Medigap open enrollment period.
As I have said before, this is the best time for someone to purchase a Medicare Supplement, because the Medicare Supplement/Medigap open enrollment period lasts for 6 months beginning the first day of the month in which you are 65 or older and have just enrolled in Medicare Part B for the first time.
During this Medicare open enrollment period, you may enroll in a Medicare Supplement and will not have to answer even one health question to be accepted by a Medicare Supplement insurance plan. If you decide to not keep your COBRA plan and enroll in a Medicare Supplement, you do not have to worry about your medical care being taken care of because you are in your 6-month Medigap Open Enrollment Period.
You should be concerned that after the 6-month window, you will have to submit a completed underwritten application answering health questions for a Medicare Supplement to be approved.
I have been advised by healthcare professionals that some of the newest healthcare procedures are not readily approved by Medicare Advantage plans. They tell me the medical industry must fight every day to get the care many desperately need when one has a Medicare Advantage plan, but these same procedures generally are approved with original/traditional Medicare, as are clinical trial prescription drugs that can be rather costly.
Jeremy, talk to your medical professional, who knows your health situation, when you are ready to make your Medicare plan choice.
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.
