What health network does Medicare use?

on Aug 15, 2024

Hi Toni,

In September I turn 65. I’m on COBRA from my job, which I retired from in May when I had heart surgery. The cardiologist informed me last week that the only thing that will improve my health is a heart transplant.

I need your guidance because I do not know what to do about enrolling in Medicare. Should I enroll in 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 16 months?

Please help me because I am overwhelmed with the confusing mail and marketing I am receiving since it is my time to enroll in Medicare. Thanks, Toni.

--Jay from Knoxville, Tenn.

Hello Jay:

I have good news for you and the Toni Says readers who are turning 65 or are past 65 and enrolling in Medicare for the first time: There is NO network of hospitals, doctors, or any other medical providers for Original Medicare. I repeat … there is NO NETWORK!

Jay, you do not have to worry about finding a network provider or facility since you are leaving your employer COBRA plan with the plan’s network.

Your medical providers must be willing to bill Medicare. How easy is that? Medical facilities, doctors, and providers that accept Medicare are available nationwide. When you are traveling throughout the U.S. and need medical care, you are covered.

You asked me about enrolling in a Medicare Advantage plan. I had a phone call from a frantic daughter, who was trying to help her father who had been diagnosed with pancreatic cancer. He had chosen a Medicare Advantage HMO when he turned 65. Now her father must wait until Medicare’s Annual Enrollment Period (AEP), Oct. 15 - Dec. 7, to change back to Original Medicare, since the cancer facility he is using is not in that Advantage plan’s HMO network. For her father to qualify for a Medicare supplement, he must answer underwriting questions. Because he has cancer, this may not be an easy process.

You will not have this problem, Jay, since you are turning 65 in September and are entering your Medigap/Medicare Supplement Open Enrollment Period. The best time for someone to purchase a Medicare Supplement is during their Medigap/Medicare Supplement Open Enrollment Period, which lasts for 6-months, beginning the first day of the month in which you are 65 or older and have just enrolled in Medicare Part B for the first time. During this Medicare Open Enrollment Period, you may enroll in a Medicare Supplement and not have to answer ONE health question to be accepted by a Medicare Supplement insurance plan.

If you decide to not keep your COBRA plan and enroll in a Medicare Supplement, you do not have to worry about your medical care being covered because you are in your unique 6-month Medicare Supplement/Medigap Open Enrollment Period. You should be aware that after the 6-month window, you will have to submit a completed underwritten application answering health questions for a Medicare Supplement to be approved.

Jay, you mentioned that you had a 16-month window for your COBRA plan to end. If you do wait past Medigap’s Open Enrollment 6-month window, then you will have to answer health questions that can keep you from being approved by the specific Medicare Supplement insurance company chosen. I would advise you NOT to consider this option, given your need for a transplant.

Readers, you should always talk with your medical professional who knows your specific health situation to determine which Medicare plan is the best choice for you, either Original Medicare (with no network) and a Medicare supplement or Medicare Advantage plan.

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Toni King is an author and columnist on Medicare and health insurance issues. She has spent nearly 30 years as a top sales leader in the field. For a Medicare checkup, call the Toni Says call center at (832) 519-8664 or email info@tonisays.com regarding your Medicare plans and options. Toni Says Medicare Survival Guide Advanced edition is available at www.tonisays.com. Toni’s Medicare Moments articles have just been released: https://familytalktoday.com/medicare-moments.