Hi Toni,
I have just been diagnosed with breast cancer. My husband and I been enrolled in a Medicare Advantage HMO for about 5 years. I now, take expensive RX meds. When we enrolled in this Medicare Advantage HMO, it seemed like a good fit because most of our doctors are providers on this plan.
Now the co pay for each chemo-therapy treatment on this Medicare Advantage HMO is a set co pay with a maximum out of pocket of about $3400 for this year. In September, I already met the $3400 for this Medicare Advantage HMO plan year.
I’m trying to decide, if I should go back to regular Medicare and purchase a Medicare supplement with a Part D Medicare prescription drug plan.
Any advice you can give me would be greatly appreciated.
Thank you, Mary… A loyal weekly reader
Hello Mary:
Changing from a Medicare Advantage plan back to Original Medicare with a supplement is not as easy as one might think when you have a serious health condition as you have.
When receiving your Medicare benefits from Medicare Advantage plans, there is protection in place to keep from spending a lot of money on co pays. This is called “maximum out of pocket” or MOOP.
A Medicare Advantage plan’s “maximum out of pocket” is a safety net, which is much less than being on only “Original” Medicare. “Original” Medicare Part B has an unlimited amount of 20%, which can be spent for any type of outpatient or medical care such as your chemo-therapy treatments.
Under the Medicare Advantage plan the “maximum out of pocket” is a surprise blessing when someone has a serious illness as you have. You have met your “maximum out of pocket” of $3,400 and different Medicare Advantage plans have different maximum out of pockets. I tell everyone to learn what their “maximum out of pocket” or MOOP is for their own Medicare Advantage plan they are deciding to enroll in.
Applying for a Medicare supplement when you have a serious illness can be difficult, but not impossible. When you are past 65 and 6 months, you are not in a Medicare supplement’s open enrollment or guaranteed issue period, then you will have to answer the application’s health questions.
Serious illnesses such as cancer, COPD, Alzheimer, MS, lupus, heart or vascular conditions including stroke, insulin dependent diabetes can keep you from qualifying for most Medicare supplements.
There are a few Medicare supplement plans that can accept those who have health issues, but you still have to meet their underwriting requirements.
The positive side to being on “Original Medicare” with a Medicare supplement is that you can go to any doctor or Medical provider that accepts Medicare anywhere nationwide.
Currently, you belong to a Medicare Advantage HMO plan that your doctors/providers are included in the network and once you have met your “maximum out of pocket” for this particular Medicare Advantage plan, then you will not spend any more out of your pocket for your medical needs until January 1 of 2014. Each January 1, begins a new calendar year and your “maximum out of pocket” starts all over.
My advice to you, Mary would be:
1) Talk to your doctor before you make any changes to your Medicare and for those reading this article if you are new to Medicare always talk to you doctor about what Medicare option fits your health needs.
2) See what the cost will be for a Medicare supplement that accepts your health situation.
3) Be sure of the cost for your prescriptions if you change Medicare Prescription Drug “Part D” plans. You might spend more on your prescriptions.
4) You have until Medicare’s Open Enrollment ends Saturday, December 7th, to make a change from your Medicare Advantage plan to “Original Medicare” by enrolling in a standalone Part D prescription drug plan.
Toni King, advocate/author of the Medicare Survival Guide, her simple guide that puts Medicare in “people” terms, is on sale at www.tonisays.com. Contact Toni directly at 832/519-TONI (8664) for help.
