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Does original Medicare have a network of specialists? I have cancer!

Hi Toni,

Turning 65 this October and have no idea what I should do because I have lung cancer. Currently I am on a COBRA policy from my old employer, with all my medical bills paid since I have met my deductible.

I receive my care from MD Anderson and am currently taking chemotherapy, with my radiation treatments to start in November.

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 appreciate it. Jeremy, St. Louis, MO

 

Hello Jeremy:

I have great news for you and the Toni Says® readers, because there is NO Network of hospitals, doctors, or medical providers for Original/Traditional Medicare.

I repeat…NO NETWORK with Original Medicare!

            Not having to worry about finding a network provider is hard for those leaving employer benefits.

Your medical provider must be willing to bill Medicare. How hard 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, 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 in the fall to make a change back to Original Medicare, because MD Anderson is not in that Medicare Advantage plan’s network.

Her father is locked into his Medicare Advantage plan and must wait until October 15 to December 7 to make any changes back to Original Medicare for the following year.

Not you, Jeremy…because you are turning 65 in October, there is a special 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 open enrollment period lasts for a 6-month period, beginning the first day of the month in which you are 65 – or you are older and have just enrolled in Part B for the first time.

Enrolling in Medicare Part B for the first time is the key, because during this open enrollment period you may enroll in a Medicare Supplement and not have to answer ONE health question to be approved by any Medicare Supplement.

Jeremy, if you decide not to keep your COBRA plan and apply for a Medicare Supplement, you do not have to worry about your medical care being taking care of. After the six-month window has passed, however, then you would have to submit to a complete underwritten application for a Medicare Supplement.

I have been advised by healthcare professionals that some of the newest healthcare and cancer procedures are not readily approved by Medicare Advantage plans. They must fight every day to get the care they desperately need when they have a Medicare Advantage plan. These types of procedures are approved with “Original/Traditional Medicare” as well as clinical trial prescription drugs that can be costly.

Jeremy, talk to a 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 call1/888-TONI-SAY (888-866-4729) to have your Medicare questions answered. The 2021 Confused about Medicare Zoom webinar is Thursday, August 26 at 4 p.m. Visit www.tonisays.com to sign up for Toni’s online webinar event. Toni King, Medicare author/advocate is giving a $5 discount to the Toni Says® readers on the new 2021Medicare Survival Guide® Advanced book at www.tonisays.com.