Does original Medicare have a health care network?

Dear Toni: I am turning 65 this August and have no idea what I should do because I have coronary heart disease. Currently, I am on a COBRA policy from my former employer, with all my medical bills now being paid because I have met my deductible.

I am extremely concerned about what I should do with Medicare, because my heart specialist is telling me that one option to improve my health may be a heart transplant.

Do I enroll in original Medicare’s network with a Medicare supplement, go with a Medicare Advantage plan or stay with my current COBRA plan until it ends in about 15 months? — Jeremy, Spring, Texas

Dear Jeremy: Great news: There is no network of hospitals, doctors or any medical provider for original Medicare.

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

However, your medical provider must be willing to bill Medicare.

I recently received a phone call from a frantic woman who was trying to help her father after he had been diagnosed with pancreatic cancer. He had chosen a Medicare Advantage HMO when he turned 65, but his cancer facility is not in that plan’s HMO network. Her father is locked in to his Medicare Advantage plan and now must wait until Medicare’s annual enrollment (Oct. 15-Dec. 7) to switch to original Medicare.

But because you are turning 65 in August, there is a window called the Medicare supplement/Medigap open enrollment period.

This is the best time for someone to purchase a Medicare supplement, because the Medicare supplement/Medigap open enrollment period lasts six months, starting the first day of the month when you turn 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 will not have to answer any health questions. If you decide not to keep your COBRA plan and enroll in a Medicare supplement, you do not have to worry about your medical care because you will be in your six-month Medigap open enrollment period.

You should be aware that after the six-month window you would have to submit an application answering health questions for a Medicare supplement to be approved.

I have been advised by health care professionals that some of the newest health care procedures are not readily approved by Medicare Advantage plans. But these same procedures generally are approved with original Medicare, as are clinical trial prescription drugs that can be rather costly.

Talk to your medical professional, who knows your health situation, when you are ready to make your Medicare plan choice.

Toni King is an author and columnist on Medicare and health insurance issues. She spent nearly 30 years as a top sales leader in the field. If you have a Medicare question, email info@tonisays.com or call 832-519-8664.