In a recent episode of "Talking Retirement," host Ken Connolly sat down with Medicare broker Jo Gallo to discuss a critical but often overlooked aspect of Medicare Advantage plans: cancer and heart attack coverage. This conversation revealed important insights about the potential financial risks seniors face and how to protect themselves against them.
Understanding the Medicare Advantage Coverage Gap
Medicare Advantage plans offer low or no-cost premiums but come with significant out-of-pocket expenses through copayments and coinsurance. These plans require beneficiaries to share in the cost of their healthcare through various payment structures, which can add up quickly during major health events like cancer treatment.
"The coinsurance comes into play on, usually, the big-ticket items such as major tests, operations and one that really, you know, is a little disturbing, is that it could be an up to 20% copay on chemotherapy and radiation. There is where you're gonna hit that out of pocket max whether you like it or not. We all want to live. We all want to live healthy. We all want to do the right thing for ourselves, the right thing for our families," explains Gallo.
One of the most concerning aspects is the out-of-pocket maximum. In New Jersey, many Medicare Advantage plans have a $7,500 annual out-of-pocket maximum for in-network care, which can increase to $10,000-$14,000 for out-of-network services.
The Real Cost of Cancer Treatment
The financial impact of cancer treatment under Medicare Advantage plans can be substantial. Gallo points out that "it could be an up to 20% copay on chemotherapy and radiation." Speaking from personal experience, she shared how her family hit their out-of-pocket maximum in just one day following a cancer diagnosis, leading to years of financial recovery.
Cancer and Heart Attack Insurance: A Safety Net
To address these coverage gaps, specialized cancer and heart attack insurance policies are available for individuals of all ages. These policies provide:
Lump-sum payments upon diagnosis
Coverage for out-of-pocket maximums
Funds for additional expenses not covered by medical insurance
Financial support for home care and medical equipment
As Gallo emphasizes, "A $25,000 cancer policy or a heart policy will afford you to pay that $7,500 maximum out of pocket and still have enough money left over to get the help you need during the times when you need it the most."
Affordable Protection
These supplemental policies are surprisingly affordable, especially when purchased early. "You can cover the maximum out of pocket for about $25 to $30 a month," Gallo notes. For those concerned about affordability, Gallo suggests considering family support: "If you can't afford this as a senior on a fixed income... if you have children or friends or relatives that are willing to pay for this, it's like a monthly subscription."
Why Act Now?
The importance of early enrollment cannot be overstated. As with most insurance products, purchasing coverage at a younger age typically results in more affordable premiums while providing valuable protection for the future.
Expert Guidance Available
For seniors seeking to understand their coverage options, professional guidance is available. The team at NJ Life and Health, where both Connolly and Gallo work, offers comprehensive consultations to explain coverage options and potential costs.
"Our education takes about an hour. We don't shy away from any of it. We tell you bluntly, this is what it will cost," Gallo explains, emphasizing the commitment to transparent, detailed explanations of coverage options.
Conclusion
The rising costs of managing cancer and heart disease make it crucial for seniors to carefully consider their Medicare coverage options. While Medicare Advantage plans may offer attractively low premiums, acknowledging and understanding their coverage limitations, and preparing for potentially exorbitant out-of-pocket costs, makes good sense, supplemental cancer and heart attack policies can provide vital financial protection when it is needed most.
For more information about Medicare coverage options and supplemental policies, talk to the brokers at NJ Life and Health. Call our Toms River, NJ office at 848-226-6897 or visit our website at www.njlifeandhealth.com
Jo Gallo is a licensed Medicare broker and writer for The Berkeley Times, Corner Cafe, and Moments.
Ken Connolly is a licensed Medicare broker. He creates videos on NJ Life and Health’s YouTube Channel and hosts the podcast Talking Retirement.
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