Medicare Q & A

Wednesday, May 22, 2019

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

Hi Toni,

I am turning 65 this August 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 now being paid because I have met my deductible.

I receive all of my care from MD Anderson and am currently taking chemotherapy with my radiation treatments to start in July.

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 greatly appreciate it. Jeremy, Spring, TX

Hello Jeremy:

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

I repeat…NO NETWORK!!

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

Your medical provider must be willing to bill Medicare. How easy 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, who was trying to help her father who had been diagnosed with pancreatic cancer and he had chosen a Medicare Advantage HMO when he turned 65. Now her father has to 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 HMO network.

Her father is locked-in to his Medicare Advantage plan and one must wait until Oct. 15 –Dec. 7 to make any changes back to Original Medicare for the following year.

Not you, Jeremy…because you are turning 65 in August, 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.

During this open enrollment period, you may enroll in a Medicare Supplement and not have to answer “ONE” health question to be accepted by any Medicare Supplement plan.

If you decide not to keep your COBRA plan, you do not have to worry about your medical care being taking care of with the Medicare Supplement, but after the 6 month window, you will 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 many desperately need when they have a Medicare Advantage plan. These procedures are generally approved with “Original or Traditional Medicare” as well as clinical trial prescription drugs that can be rather costly.

Jeremy, talk to your 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 call 832-519-8664 to have your Medicare questions answered.

If you are still confused and would like to discuss your specific Medicare circumstances either email info@tonisays.com or call 832-519-8664 and the Toni Says® team can help you.