My parents, ages 90 and 91, can no longer afford their Medicare Supplement Plan F and do not qualify for Medicaid. What happens if they cannot pay the 20% not covered by Medicare after cancelling the supplement?
Answered by 12 licensed agents
Going without a Medicare supplement can get risky fast because Original Medicare has no cap on the 20% they leave behind. One hospital stay, surgery, or ongoing treatment can create bills that are hard to recover from at their age. Before cancelling Plan F, it’s worth checking whether they could switch to a lower-cost supplement or even another company offering the same coverage for less. A Medicare Advantage plan may also be worth looking at since those plans are required to have a yearly max out-of-pocket limit.
Unfortunately, they may be faced with a lot of debt. You may want to look at a Medicare Advantage Plan that has a low Max Out Of Pocket. Traditional Medicare does not have a Max Out of Pocket.
This is a common question. They can get on a medicare advantage. But unfortunately Medicare Supplements go up every year.
Some hospitals also offer financial help but if they does qualify for medicaid I dont know if they would for that either. It is tough to say without sitting down and going over there drs, medications.
Without a supplement, there is no 'cap' or 'out-of-pocket maximum' on what your parents might owe. A single major surgery or hospital stay could result in thousands of dollars in personal liability. If the 20% remains unpaid, healthcare providers may eventually turn the debt over to collection agencies. To avoid this, it is often better to switch them to a Medicare Advantage (Part C) plan or a cheaper Supplement Plan N, which can significantly lower monthly premiums while still providing a safety net for that 20% gap.
there are a few options so it would take a deep dive into your parents situation. This is a difficult question to answer without a thorough interview.
However, remember that Medicare still pays first. This means Part A and B pays and the 20% is based on the Medicare allowed amount.
Also, there may be a possibility to 'downgrade" their Plan F to a less expensive plan, however, certain carriers have implemented changes to the ability to do this so it would depend on the carrier they currently have.
And lastly, there is always a Medicare Advantage plan as an option during the Annual Election Period.
Before cancelling anything I would encourage you to speak with a licensed agent whom can possibly reduce their rates. Yes even at their ages this is possible. There are plans that offer comparable coverage for a fraction of the cost. Some states also offer Guaranteed issue policies meaning no medical underwriting under certain time frames. To answer your question specifically, they would be liable for all charges. There may be some state assistance programs that arr not medicaid they may be eligible for.
As far as what would happen if they had claims and had dropped their Medicare Supplements they would be at the mercy of the providers who had treated them, I have no way to answer that, but with Medicare having no limit, no max out of pocket on the 20% You could be speaking of incredible financial exposure. If they were my parents and they in fact had no choice but to drop their Medicare Supplements I would definitely recommend that they locate an Independent Agent whose focus is Medicare solutions and see what they would suggest in the way of the "best fit" Medicare Advantage Plan(s) for each of them, at least with the Advantage Plans there is a "MOOP" Maximum out of pocket safety net, usually capping anywhere from $4,000.00 for a year on up to 8 or $10,000.00, a much better option thanno cap whatsoever. Good Luck and God Bless You Folks! PS: Those MAPD plans have to by law be equal to or better than traditional Medicare A and B.
First off the only difference between Plan F and Plan G is that plan F pays the part b deductible which is only $283 this year and often the premium is much higher. Some states have a birthday rule which then can move from a like to like plan or a like to less which in this case from Plan F to Plan G 60 days around their birthday. I recommend contacting a local agent to talk about options. If they move during AEP to a MAPD plan then then need to consider the Max out of pocket they may pay and that they will be confined to a network either in a PPO or HMO
Since they do not qualify for Medicaid, dropping all supplemental coverage is highly dangerous. Instead, the best path forward is looking into Medicare Advantage.
Many Medicare Advantage plans have $0 monthly premiums. Your parents will have to pay copays as they use the plan, but the plans have Maximum Out-of-Pocket (MOOP) limits. Once they hit that limit in a calendar year, the plan covers 100% of their medical costs, giving them the exact financial safety net they need without the heavy monthly premium of a Plan F.
They can enroll during the Annual Enrollment Period with no underwriting.
At ages 90 and 91, it may make sense to consider moving to a Medicare Advantage Prescription Drug (MAPD) plan if their Medicare Supplement premiums have become unaffordable. Unlike Original Medicare alone, MAPD plans include an annual out-of-pocket maximum, which can help provide more predictable healthcare costs and limit financial exposure from the 20% coinsurance under Part B.
