Fran and Eric were new clients who had just turned 65 and were delighted with all the research we provided in helping them select their Medicare plans. They were particularly surprised to learn there were so many plans to choose from! "I don't know how the average person is supposed to know how to do all this research," Fran lamented. "It's all so confusing," added Eric. They both chose Original Medicare with a Plan G Medigap and a Part D prescription drug plan to have freedom of choice.
Months later, one day, Eric wasn't feeling well, and his feelings persisted for several days. He had constant nausea, fatigue, and a slight fever. He ignored his symptoms, passing them off as a lingering cold or flu. Finally, by the third week, Fran insisted he go to the local emergency room where he was readily admitted to undergo tests and scans. There were also more than a few specialists involved in reviewing his results.
An Unexpected Diagnosis
The next day the hospitalist came to visit Fran and Eric in his room with news that was not good. Cancer. They were both understandably shaken and stunned, but the doctor explained that it was slow-moving cancer with a good chance of beating it. As the doctor outlined the treatment plan he was recommending, Fran and Eric were both wondering... can Eric recover from this, and what would treatment cost? For example, one treatment involved an infusion process that Eric would need every few weeks, which was several thousand dollars per treatment.
They arrived home, expectedly tired but preoccupied with planning. As they rested in the family room, Fran noticed the American Retirement Advisor newsletter on the coffee table. "Eric, we should contact our Medicare advisor to help us understand how our Medicare plan will cover our expenses," Fran commented to Eric. "Talking with them might help soothe some of our financial concerns." Fran called us bright and early the next day.
Medicare Coverage Provided Relief
After speaking with the Client Care team, they were relieved to learn how their Medicare plan worked. Medicare covered most infusions at 100%, so thankfully, they could focus on Eric's treatments and not worry about the financial issues that could have cost them thousands of dollars or, worse, delayed treatment.
Remember, if you need guidance on how your Medicare plan works, we are always here to help!
By David Edge
David Edge is a retirement lifestyle writer and contributor to the ARA monthly newsletter. His articles blend personal stories with practical insights on living well in retirement.
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Easy Eddie's Take
David's story about Fran and Eric shows exactly why understanding your Medicare coverage before you need it makes such a difference. Most people are surprised when they learn this, but Original Medicare Part A covers cancer treatments like chemotherapy infusions at 100% of the Medicare-approved amount when they're given in a hospital outpatient setting. That Plan G Medigap policy they chose covers the remaining 20% that Medicare Part B doesn't pay, which is why they had such good coverage.
A lot of people ask me, "What's the difference between Medicare Advantage and Original Medicare with a supplement for cancer treatment?" Here's the thing: with Original Medicare plus a Medigap plan like Plan G, you can see any oncologist or cancer center that accepts Medicare without needing referrals or staying in a network. Medicare Advantage plans often have lower monthly premiums but require you to use their network of providers, which might limit your choice of cancer specialists.
The key is choosing your Medicare coverage during your Initial Enrollment Period when you first turn 65, just like Fran and Eric did. That's when you have guaranteed acceptance for any Medigap plan, regardless of health conditions. Once you understand how the pieces fit together, it's actually pretty straightforward.