Hi Toni:
I need your guidance. In September I turn 65, and I am unemployed. I’m on COBRA since retiring in May after I had a heart attack, and I don’t know what to do about enrolling in Medicare. The cardiologist informed me last week that the only thing that will improve my health is having heart surgery.
What health network does Medicare use? I’m confused about which Medicare option to enroll in because I cannot lose my cardiologist. Should I enroll in Medicare’s network with a Medicare supplement, go with a Medicare Advantage Network plan HMO or PPO, or stay with my current COBRA plan until it ends in about 15 months? I am overwhelmed with the confusing mail and telemarketing I am receiving since it is my time to enroll in Medicare. Thanks, Toni.
—Kenneth from Tulsa, Okla.
Hello Kenneth:
I have good news for you and the Toni Says Medicare column readers who are turning 65 or older and enrolling in Medicare for the first time, because there is NO network of hospitals, doctors, or any other medical providers for Original Medicare. I repeat … there is NO NETWORK!!
Kenneth, you do not have to worry about finding a network provider or facility if you decide to enroll in Original Medicare with a Medicare Supplement and leave the employer COBRA plan that your cardiologist is in. Your medical providers must be willing to bill Medicare. How easy is that?
Medical facilities, doctors, and providers who accept Medicare are available nationwide. When you are traveling throughout the U.S. and need medical care, you are covered.
You asked me about enrolling in a Medicare Advantage plan. I recently had a phone call from a frantic daughter who was trying to help her father, who had been diagnosed with pancreatic cancer. He had chosen a Medicare Advantage HMO when he turned 65. Now her father must wait until Medicare’s Annual Enrollment Period (AEP) in the fall from October 15–December 7 to make a change back to Original Medicare, since the cancer facility he is using is not in that MA plan’s HMO network. For her father to qualify for a Medicare Supplement, he must answer underwriting questions. This will not be an easy process, and he can be turned down.
It won’t be hard for you, Kenneth, since you are turning 65 in September, when your Medicare Supplement/Medigap Open Enrollment period begins. The best time for someone to purchase a Medicare Supplement is during the Medicare Supplement/Medigap Open Enrollment 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 special Open Enrollment period, you may enroll in a Medicare Supplement without having to answer even one health question to be accepted.
If you decide not to 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 unique six-month Medicare Supplement/Medigap Open Enrollment Period.
You should be aware that after the six-month window, you will have to submit a completed underwritten application answering health questions for a Medicare Supplement to be approved. Kenneth, you mentioned that you had about a 15-month window before your COBRA plan ends. If you choose to stay on COBRA past Medicare Supplement/Medigap’s six-month Open Enrollment window, then you will have to answer health questions that can keep you from being approved by the specific Medicare Supplement insurance company chosen. I would not advise you to consider this option.
Always discuss with a medical professional who knows your specific health situation which Medicare plan is the best choice for you, either Original Medicare (with no network) and a Medicare Supplement or Medicare Advantage (MA) plan.
Toni King is an author and columnist on Medicare, Social Security and long-term-care issues. She has spent nearly 30 years as a top sales leader in the field. If you have a Medicare question, email info@tonisays.com or call 832-519-8664. Sign up for the Toni Says newsletter at www.tonisays.com to keep up to date on Medicare changes.