4 Tips To Make You Smarter About Your Parents’ Medicare
“My dad doesn’t have Medicare!” A friend said to me on the phone a few months ago.
“What?” I responded. Thinking: This seems unlikely. Pretty much everyone over age 65 has some form of Medicare and my friend’s dad is at least 90 years old.
Then he explained, “Dad has something called ‘Blue Cross advantage.’”
“Ohhhhh…. Okay.” I got it now.
I explained that his dad does have Medicare but it’s a particular form of Medicare that private health plans (like HMOs) offer. It’s called “Medicare Advantage” and people eligible for Medicare can sign up for it instead of the original or traditional Medicare.
Medicare Advantage plans often fill the gaps in traditional Medicare coverage — like vision or dental coverage– and often at a lower price than the supplemental “Medigap” policies older adults typically buy to get these benefits and cover Medicare cost-sharing.
Medicare Advantage can be a simpler and more streamlined way to deal with Medicare. You get everything — usually including drug coverage — in one big package. That can be nice because traditional Medicare is a complicated alphabet soup of different parts that Congress keeps tacking onto the program.
So, your dad automatically gets something called “Part A” coverage. This is the part of Medicare that pays for hospital and post-hospital care.
But, THEN, to get coverage for physicians, he’ll sign up for Part B, which requires a monthly premium payment to the government that gets deducted out of his social security check.
To get drug coverage, he’ll go out and buy “Part D” benefits from a private health plan, appropriately called a “part D plan” or PDP.
And, then he might get a whole separate, other private policy called (also appropriately named) “Medigap” to cover the holes – the stuff that is amazingly not included in Parts A, B, and D.
What happened to Part C you ask? Oh, well now we are back to Medicare Advantage part of Medicare where you can turn all your coverage over to one plan – you pay your Part B premium and one other premium to the plan and you’re done.
Sounds GREAT! Sign Mom up for Medicare Advantage.
Not so fast.
As with everything in your world now, this is COMPLEX. There are trade-offs and challenges in choosing Medicare Advantage.
Here’s one more thing you probably don’t feel qualified to be in charge of but you are. It’s your job to figure out how to navigate the Medicare Advantage plan coverage that your Dad – who is now frail – signed up for 10 years ago when dental coverage was his biggest health worry. Or, figuring out how to switch plans or disenroll altogether!
So, I’m going to boil it down here. Whether or not your mom or dad is in a plan now, or if you are considering one for them, you DO have power and you DO have choices.
The trick is knowing how and when to take control. Here are four things you CAN do to get what you need for your parents.
Push Back on the Plan’s Coverage.
Medicare Advantage plans are not usually super flexible organizations.
And, while some of their rules for covering services can work in your favor (for example, most plans do not require a 3-day prior hospitalization for skilled nursing care), they also limit your parent’s network of providers, and impose rules that reduce access to services your parents might need.
For example, another friend thought his dad should have been discharged from the hospital to a special rehabilitation center but this center isn’t part of the plan’s network. So, his dad ended up going home without any post-hospital care.
Someone else I know thought her mom was discharged much too early from a skilled nursing facility. However, when she questioned this, she was told that this was as much care as the plan would cover, even though it was far fewer days than is usually paid for by traditional Medicare.
What you need to know is that you have the RIGHT to ask your parent’s plan to provide or pay for services you think should be covered or continued.
And, if the plan won’t cover what you ask for, there’s a four step appeals process, you can pursue, you know… with all your extra leisure time.
So all is not lost….except maybe your time and sanity.
Get Expert Help Picking a Plan
Your parent will get a lot of lovely, glossy marketing materials from some of the plans. And it would be easy to see one that looks good and sign up.
But, be cautious here. These plans can be so different in what they cost and cover — and marketing materials aren’t the best way to pick the plan that will work best for your individual circumstances.
Please don’t feel like you have to do all of this by yourself. It’s really okay to ask for help.
You can start by using the government plan finder! It’s at www.medicare.gov. Click on “Find health & drug plans” on the home page.
But, before you do this, invest in AARP’s Medicare for Dummies, and consult Chapter 11 as you go through the plan finder. The author guides you through the process. And, this is just a good book to have as a general reference on Medicare.
But there’s no substitute for sitting down with a live person. And, the good news is that the government funds a resource in every state called the state health insurance program (SHIP). SHIP is a FREE, confidential and unbiased insurance counseling service.
Go to this website and call to make an appointment with your expert and free SHIP counselor. This can be especially helpful if your parent is also eligible for Medicaid, which is available to individuals whose income and assets are below certain levels. When your parent is eligible for BOTH Medicare and Medicaid, the SHIP can help you find special programs for “dual eligibles” that may be available in your state — like my very favorite, the Program for All-Inclusive Care for the Elderly (PACE).
Know the Rules for Making Changes in Coverage
You can make changes if you don’t like your parent’s plan or situation. But you need to just know the general rules about when and how to do it because there are restrictions.
Here’s the way it works. If you want to sign up for Medicare Advantage, change plans, or change back from Medicare Advantage to traditional Medicare, the general time to do that is during the annual open season, which runs from mid-October to early December.
As Patricia Barry, author of Medicare for Dummies explains, in addition to the open season, there’s also a special season devoted exclusively to dis-enrolling or switching out of Medicare Advantage and into traditional Medicare. During this season that starts January 1st and runs through mid-February, you can even drop Medicare Advantage if you just signed up for it!
Okay – as if this wasn’t already really complicated, there are a bunch of special enrollment periods that provide additional opportunities for changing your situation if… you move permanently outside a plan’s service area, you move in or out of a nursing home, you are new to Medicare, your plan withdraws from the program or somehow misleads you…and there are more.. all explained in Patricia Barry’s book.
Remember Not to Be Too Hard On Yourself
I have worked for 25 years on various aspects of Medicare (and Medicaid) and this was a hard blog to write. A good friend of mine, who has has even more experience with these programs, reported that figuring out her Medicare coverage was a nightmare.
What that means is that you should not feel frustrated with yourself if you have to struggle to understand all the options. You could go to Medicare SCHOOL and still flail around.
Handling your parents’ insurance coverage will be one of the most time-consuming and anxiety-producing parts of your new job as their care manager. So, give yourself permission not to get it just right, to let something slip through the cracks, and to need help!
Your efforts ARE enough and, more importantly, just being there for your parents — all of the paperwork aside — is what matters most.
I’d LOVE to know your experiences figuring out your parents’ insurance options. Please go to the comments section and share what has helped you.
Anne – in my blog http://www.thelastjourney.net I have written about my personal experiences navigating Medicare, nursing homes, rehab and the like. Along the way, I learned A LOT about the fine print these programs have. Your readers may find my experience to be helpful to them.
Before my Dad died Mom had a limited Medicare advantage plan & pharmacy plan through Dad’s company retiree plan. After death she got 6 months of pharmacy at no cost to her. After dealing with Dad’s administrative company (they were switching administrators) I just expanded her original plan to include pharmacy (additional $48/month). this after retiree administrator cut her off accidentally for 2 weeks & she had to pay out of pocket. It was so stressful not being able to figure out problem. Administrator admitted her error but I couldn’t stomach the thought of it happening again during the transition to the new administrators.
I really appreciate the tip on receiving help with medicare. It can be difficult to pick the best plan for your parents. You want them to have the best coverage possible. Speaking with agents about your specific situation and seeking guidance is a good idea when choosing plans.
Recently I have been trying to help my mother with her Medicare. So, I liked that you talked about how you shouldn’t get mad at yourself if you don’t understand everything. That is good for me to know and it might be a good idea for me to find a professional to help me with it.
I’m dying INSIDE just trying to figure out my mom’s medicare. She’s been in a SNF for 2 years now and her life savings is almost gone. I don’t think I’m doing things right and I am SCRAMBLING to try and save her some money and I don’t even know where to start. It’s totally depressing. Thanks for your encouragement, though, in the blog. I do feel really stupid…..it’s way over my head, and I thought I was an intelligent person! ;(
I have been in the nursing home industry for 20+ years on the finance and billing side. The best advice I can give you is to get an elder law attorney. You don’t want to accidentally do something you are not suppose to and get yourself in trouble and her disqualified for Medical Assistance. Ever state has different laws regarding gifting, assist reduction and Medical Assistance elgibility an Elder Law attorney will help you navigate that and set aside what you can legally. Most states allow the money spent on an Elder Law attorney to be paid by the parent(s) as part of assets spend needed to qualify for Medical Assistance.
Hi, Anne! I would like you t know that your post provides relief to a confused mind of those who are in the middle of decision making about Medicare. I’m sure they are sufficiently forewarned about what to expect in a plan, in different scenarios and what to look for in a policy that they would be getting for themselves or their parents. Gash, why Medicare, Medicare Supplement Plans and Medicare Advantage Plans should be complicated and confusing like this? Anyway, thanks for this awesome and helpful post.
Hi. Mom lives in another state with family. She is scheduled to spend extended time with me, if there are any medical needs how do I handle them? Should I do anything prior, fill out forms, alert my physician, etc.?
Any insight would be helpful.
I just noticed you reside in Washington DC, which we are currently visiting.
The most important thing is to make sure you understand any prescription drug needs she may have and have the prescriptions from her doctor so you can get refills, if necessary. You may need to fill out a HIPAA form that gives any doctor permission to talk to you about her I medical history and needs. Your doctor or hers should be able to send that to you. I think it’s a great idea to see if your doctor is willing to support any needs your mom may have while she’s visiting. He or she may also be able to make some appropriate referrals. Good luck!!
I’m moving my 90 year old mom from Brooklyn, NY to Tamarac, FL. She currently has Empire Blue Cross Blue Shield and tells me she’s not on Medicare. Empire is useful only if you live in NYC. To establish similar coverage here in Florida does she need to reapply for Medicare? I suspect she signed up for Medicare because she has a Red, White and Blue card but doesn’t understand how it works. Where do I start?
Hi Gina – Your mom likely is enrolled in a “Medicare Advantage” plan. This is a private insurance plan (blue cross/blue shield probably in your case) that provides Medicare benefits plus extras like dental coverage. About 30 percent of people age 65 and over are getting their Medicare benefits through a private insurer. Lots of times people are enrolled in Medicare Advantage plans and think they’re not in Medicare because they are dealing with an insurance company instead of the federal government. The possibility here is that she’s in traditional Medicare but with a supplemental insurance policy that pays for co-pays and cost sharing. Either way, you can check on the coverage options by going to this website. https://www.medicare.gov/find-a-plan/questions/home.aspx. Don’t go to any non-governmental websites as they almost always send your information to a broker who will call and harass you. If you need more help, you might be able to get in touch with the Florida State Health Insurance assistance program. This is a free and non-biased source of information: https://www.shiptacenter.org/allstate/fl/
I totally agree with you in that it is important to understand how your Medicare plan works. I understand that doing some research can help you find the best way to get the health care you need. My brother was talking about how he needed to find a good way to get the health care he needs, so I wanted to help him research.
I do like that the article recommends getting some help when it comes to picking a plan. After all, you will want to make sure that you are choosing the best medicare plan for your elderly parents. If that is the case then it might help to talk to a professional that might have a better grasp of what they need.
Getting ready to navigate the Medicare system. Ugh. (Anxious to be getting closer to my retirement age, NOT the Medicare jungle!)
Thank you for the heads up. Good information.
Thank you for the helpful article as I’m in my twenties and helping my dad who is in his 70s navigate this labyrinth of health care. And pretty soon my mother as well.
this medicare a and b crap has done zero for me ive repeatedly tried getting a plan but an refused all the time i have a b and d blue cross blue shield denied me humana denied me not a single company will give me any type of coverage im beyond done with this crappy medicare its not worth a penny im forced against my will and penalized every month to pay for there is zero affordable about the affordable care act scam artist and con men is what every one of these crooks are im ready to take my pension and move to another country
“Your frustration is real. I read on twitter a comment that sums it up. It says, “Our system is so screwed up that it’s a surprise there isn’t an open revolt”
These are some fantastic tips, especially the one about getting expert help with picking the plan. After all, anything from medicare to medicaid can be incredible confusing. That is why it helps to have a professional along for the ride that can help you get your loved ones set up with the right plan.
Hi ! HELP! I’m 67 I have Medicare. Its breaking me. I can’t afford a supplemental ins for prescriptions that’s worth anything. I have small savings that they ( Medicare) are forcing me to live off of savings until its mostly gone before i can get help with my prescriptions. Then there’s the 20% that I’m stuck paying. How? I don’t know what to do or where to turn.
In this article it stipulates the Medicare Advantage Disenrollment Period of January 1 througj February 14, however this year thete is a change and that period now runs from January 1 through
March 31 and also includes a one time ability to change Medicare Advantage Plan to a different Medicare Advantage Plan
Some people are not fully aware about the different terms and policies of the health insurance plan. Therefore taking the supplement quotes is very important before buying any health plans. There are various ways to acquire supplement quotes https://www.thehealthexchangeagency.com/medicare-supplement-medigap-quotes, one can directly go to the insurance provider company or can talk to the agent who works for the company about the plans.
I actually just got off the phone this morning with a Power of Attorney holder who was referred to my office regarding this issue. Her uncle got a phone call from a Medicare agent telling him he could switch over to a Medicare Advantage Plan and it wouldn’t cost him anything, but he’d get more benefits. Now his home healthcare agency can’t work with him, and his scheduled cataract surgery (today) had to be canceled.
Why is that?
The Medicare Advantage Plan doesn’t cover the providers that he’s using.
Some insurance agents only see dollar signs when talking with our loved ones. There is a lot of money involved for the insurance company and the agent who sells it. Some of these agents just don’t know, and others (like any industry) are taking advantage of our loved ones.
Insurance agents are NOT allowed to make unsolicited calls regarding Medicare Advantage Plans. If you find an agent doing this, call 1-800-Medicare and turn them in.
Although I’m an insurance agent, I ask all my prospective clients to watch a video that explains the differences between original Medicare, Medicare Advantage, and Medicare Supplement Plans. And if someone chooses Medicare Advantage, we try to make sure that they understand the consequences.
I realize you wrote this several years ago. But the information still holds up.
Thanks for spreading the word.
nice collection ….keep posting such things
Thanks for sharing such an amazing blog. I must say you are doing a great job. Keep doing such hard work. Your blogs are very informative. Keep posting! Good Luck with your upcoming updates.
Thanks for this blog/post – It was very helpful!