Which health network does Medicare use?
Dear Toni: In September, I will turn 65. I’m on COBRA from my job, which I retired from in May when I had heart surgery. The cardiologist informed me last week that the only thing that will improve my health is a heart transplant.
I do not know what to do about enrolling in Medicare. Should I enroll in 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 16 months?
Please help me because I am overwhelmed with the confusing mail and marketing I am receiving. — Jay, Knoxville, Tennessee
Dear Jay: Here’s some good news for you and anyone else 65 or older and enrolling in Medicare for the first time: There is no network of hospitals, doctors or other medical providers with original Medicare.
Jay, you do not have to worry about finding a network provider or facility since you are leaving your employer COBRA plan with the plan’s network.
Your medical providers simply must be willing to bill Medicare. How easy is that? Medical facilities, doctors and providers that accept Medicare are available nationwide. When you are traveling throughout the U.S. and need medical care, you are covered.
You asked about enrolling in a Medicare Advantage plan. I had a phone call from a frantic woman, 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 he must wait until Medicare’s annual enrollment period, Oct. 15-Dec. 7, to change back to original Medicare, since the cancer facility he is using is not in that plan’s HMO network.
For her father to qualify for a Medicare supplement, he must answer underwriting questions. Because he has cancer, this may not be an easy process.
You will not have this problem, Jay, since you are turning 65 in September and are entering your Medigap/Medicare supplement open enrollment period.
The best time for someone to purchase a Medicare supplement is during this period, which lasts for six months, beginning the first day of the month when you are 65 or older and have just enrolled in Medicare Part B for the first time. During this period, you may enroll in a Medicare supplement and not have to answer any health questions.
Be aware that after this six-month window, you will have to submit an underwriting application answering health questions for a Medicare supplement to be approved.
You mentioned that you had a 16-month window for your COBRA plan to end. If you wait past Medigap’s six-month 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 advise you not to consider this option, given your need for a transplant.
Toni King is an author and columnist on Medicare and health insurance issues. If you have a Medicare question, email info@tonisays.com or call 832-519-8664.