Cheaper Medicare option can prove costly down the road

Dear Toni: When I first enrolled in Medicare in 2019, I picked a Medicare supplement, Plan F. In 2021, I was approached by a telemarketer, and since I was in good health, he talked me into Plan K, which costs less. I was hospitalized in November 2022 because of diabetic issues. Now I am a serious diabetic with kidney issues and need dialysis to survive.

Since I have Plan K, I must pay the deductible plus 50 percent of costs until I meet the supplement’s out-of-pocket limit — almost $7,000. I tried to go back to Plan F, but the agent said I couldn’t because of the dialysis.

I thought pre-existing conditions did not count with Medicare. — Anthony, Las Vegas

Dear Anthony: You went from the top-of-the-line Medicare Plan F supplement, where all Medicare-covered expenses would be paid 100 percent, to a Plan K with an out-of-pocket limit of $6,940 for covered Medicare expenses for 2023.

Because you now have end stage renal disease and require dialysis, you cannot qualify for a new Medicare supplement, which requires health underwriting questions.

Your options are to stay on Plan K or go with a Medicare Advantage HMO or PPO plan. But you will have to wait until the annual enrollment period (Oct. 15-Dec. 7) if you would like to change to an Advantage plan (which has no health questions).

Talk with your health care providers about which Advantage plan meets their qualifications.

When it comes to Medicare supplements, also known as Medigap policies, the most comprehensive types are plans F, G and N:

■ Plan F covers most of the Medicare-approved amounts with zero out of your pocket, but one must have enrolled in Medicare Part A before Jan. 1, 2020.

■ Plan G is like Plan F and is available to Medicare beneficiaries whose Part A started after Jan. 1, 2020. The difference is that Plan G does not cover the Part B deductible of $226 for 2023.

■ Plan N has lower premiums with higher out-of-pocket costs. There is a $20 copay for a doctor’s visit and a $50 copay for the emergency room. The Part B deductible is not covered, and Part B excess charges (which Plan G does cover) are not paid for by the insurance company.

A health care crisis can happen when you least expect it. Trying to save a few dollars now might cost you dearly later on.

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.