UNITED STATES—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 old 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 discussing that one of my options to improve my health is having a heart transplant.
Do I enroll in Original Medicare’s Network with a Medicare supplement, go with a Medicare Advantage Network 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, TX.
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 be willing to bill Medicare. How easy is that? There are medical facilities, doctors, and providers available nationwide. Which means if you are traveling throughout the US and need medical care you are covered.
Recently, I had a phone call from a frantic daughter, who was trying to help her father who had been diagnosed with pancreatic cancer and he had chosen a Medicare Advantage HMO when he turned 65. Now her father must wait until Medicare’s Annual Enrollment Period in the fall to make a change back to Original Medicare because the cancer facility he is using is not in that Medicare Advantage plan’s HMO network.
Her father is locked-in to his Medicare Advantage plan and one must wait until October 15 –December 7 to make any changes back to Original Medicare for the following year.
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 a 6-month period 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 not have to answer “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 Medicare Supplement/Medigap Open Enrollment Period.
You should be aware 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. These procedures are generally approved with “Original/Traditional Medicare” as well as clinical trial prescription drugs that can be rather costly.
Jeremy, talk to your medical professional who knows your health situation when you are trying to make your Medicare plan choice. For information about specific Medicare options, email info@tonisays.com or call 832-519-8664 to have your Medicare questions answered.
Visit www.seniorresource.com/medicare-moments to listen to Toni’s Medicare Moments podcasts and to also download the Toni Says® Medicare Prescription Drug Survival Guide. Toni’s book “Medicare Survival Guide Advanced” edition available at www.tonisays.com.
Written By Toni King
