America, it has finally happened because I, Toni King, who has been writing the Toni Says® Medicare column is turning 65 in May. I am now experiencing, the excessive marketing and confusion regarding finding a Medicare plan due to the amount of junk mail which is hitting my mailbox whether it is a Medicare Supplement or Medicare Advantage Plan.
This week a rather troubling letter came that showed different Medicare Supplement plans and quoted a low rate for Medicare Supplement plan K. I remembered a reader’s question from 2017 who changed from Medicare Plan G with low out of pocket to Plan K that has a higher out of pocket, but could not change to any plan whether Medicare Supplement or Medicare Advantage plans because he was receiving kidney dialysis due to end stage renal disease. ESRD is a kick out question for Medicare Supplement or Medicare Advantage plans.
Had I not known the difference in what Medicare plans offer, I would call for that insurance company’s information because the insurance premiums are so low.
Below is information regarding the difference in Medicare Supplement Plan G and K:
Medicare Supplement Plan G: Pays Medicare Part A(In-Hospital) coinsurance and hospital coverage(up to an additional 365 days after Medicare benefits are used up), Pays Medicare Part B(Medical) coinsurance or copayment, Blood (first 3 pints), Part A hospice care, Skilled nursing facility coinsurance, Part A deductible, Part B excess charge, Foreign Travel emergency (up to plan limits) Part B deductible Not Covered…$198 out of pocket which is 2020’s Medicare Part B deductible.
Medicare Supplement Plan K: Pays Medicare Part A(In-Hospital) coinsurance and hospital coverage(up to an additional 365 days after Medicare benefits are used up), 50% Medicare Part B(Medical) coinsurance or copayment, 50% Blood (first 3 pints), 50%Part A hospice care, 50% Skilled nursing facility coinsurance,50% Part A deductible, Part B deductible Not Covered, Not Covered Part B excess charge which will be an extra of out of pocket without a maximum amount that you will be responsible for, Not Covered Foreign Travel emergency (up to plan limits), Maximum out of pocket $5,880 of what Medicare covers and does not include the Medicare Part B excess charge or foreign travel expense that other Medicare Supplement plans cover. You will be responsible for these charges which can be rather expensive.
As you can see by the Medicare plan information above that Medicare Plan G has a maximum out of pocket of $198 where Medicare Plan K has a maximum out of pocket of $5880 not including additional charges if your provider’s costs exceed Medicare-approved amounts.
Let’s discuss what can happen when one is turning 65 like me and receiving Medicare Part B for the first time. This special time discussed in the Medicare & You handbook is called “Medigap Open Enrollment Period” which states, “The best time to buy a Medigap policy is during your Medigap Open Enrollment Period. This 6-month period begins on the first day of the month in which you’re 65 or older and enrolled in Part B.” (Some states have additional Open Enrollment Periods.) During this period an insurance company can’t use medical underwriting because of your health problems. After this enrollment period, you may not be able pass underwriting questions for a new Medigap policy because of your health issues such as the reader who had kidney issues and was not able to make a change.
Toni Says®: Take your time when enrolling in Medicare. Know your Medicare options. For questions regarding the maze of Medicare, call the Toni Says Medicare hotline at 832-519-8664.
