Navigating the Nuances of Medicare

The Story

Michael retired at age 65, and after thorough discussions with his advisor he chose a Medicare Advantage plan. After all, he was the embodiment of health so why would he need more coverage?

The Problem

Five months after Michael selected his Medicare Advantage plan, he was diagnosed with cancer. Due to his diagnosis and Medicare Advantage plan*, Michael could encounter a possible 20% coinsurance charge for chemo and radiation until the out-of-pocket max is met. He could also expect possible restriction to only seeing doctors in a network. Meaning if he needed to travel to a specialty hospital for treatment, he might not have that option if the Medicare Advantage plan is not a part of the specialty hospitals network.

Client Profile

• Male, age 65
• Healthy and active with no prior medical conditions, but recent cancer diagnosis
• Needs to minimize the out-of-pocket costs
• Ensure his family can be financially supported without needing to tap into savings

How/Why

There are several nuances of Medicare Plans — the best plan for prescriptions, where it is accepted, what each plan covers, when there will be underwriting, specific regions and hospital networks, which hospitals only take original Medicare and which ones work with the Advantage plans, when you can enroll, when you can’t, when there is guaranteed issue, and when there isn’t. If you aren’t familiar with the ins and outs, an expert can help you figure out what to do.

The Result

Luckily, Michael was still on his Medicare Advantage Trial Right Period — the one-year time frame window where, with Medicare Advantage plans, it is an easy transition to Medicare Supplemental Guarantee Issue.

Michael and his advisor were able to get him on a Supplemental Plan to allow for full coverage — meeting his needs on a coverage basis during a crucial time. And even with his recent diagnosis, he had no underwriting to work through. In Michael’s case, he could ease the worry and ensure his family would be financially secure during his treatment without any need to dwindle savings for out-of-pocket medical expenses. The Supplemental Plan could cover a large part, if not all, of the health bills.

*This case pertains to one client and does not reflect all Medicare Advantage plans. Each client scenario should be properly reviewed in order to make the best decision for that particular situation.