Question

Mrs. Davenport enrolled in the ABC Medicare Advantage (MA) plan several years ago. Her doctor recently confirmed a diagnosis of end-stage renal disease (ESRD). What options does Mrs. Davenport have in regard to her MA plan during the next open enrollment season?

Answer 1

Answer:

Medicare Advantage (MA) plans are privately planned healthcare offered by contracting with Medicare to provide Part A and Part B health benefits to patients. MA part A plan covers hospital insurance and MA Part B plan covers medical insurance. Most of the MA plans also covers prescription drugs and most of the Medicare services are covered. Common MA plans include Health Maintenance organization (HMO) plans, Preferred provider Organization (PPO) plans, private fee-for-service (PFFS) plans, and Special Needs Plan (SNPs).  

Explanation:

Mrs. Davenport is already enrolled in a MA plan before she has developed ESRD. Therefore, her plan will continue after getting the ESRD diagnosis and the MA plan chosen by Mrs. Davenporrt cannot charge more than the original Medicare cost for dialysis and coverage of immunosuppressant drugs. Moreover both part A and part B medicare plans have annual budget for out-of-pocket costs thus the increasing healthcare cost of Mrs. Davenport after the ESRD diagnosis can be covered through renewal of annual budgeting. Moreover, if the previous Medicare advantage plan is not functional in the service area, then Mrs. Davenport could enroll in Special Enrollment period and may get another Medicare advantage plan in their area.  

Answer 2

Answer:

She can remain in the ABC (MA) plan or enroll in a special needs plan for people with ESRD.

Explanation:

Mrs. Davenport has two options, the first one is to remain in the ABC (MA) plan, which should not charge for the treatment. The second option is to enroll in a special needs plan for people with end-stage renal disease (ESRD) if there is one available in her area, but this plan will only cover the treatment.