Making Medicare Choices for Your Parents

“My dad doesn’t have Medicare!” A friend said to me recently.

“What?” I responded. This seemed 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.’”

I explained that his dad does have Medicare but it’s a particular form of Medicare that private health plans (like BlueCross BlueShield) offer. It’s called “Medicare Advantage.”

Older adults sign up for Medicare Advantage because private insurers often fill the gaps in traditional Medicare coverage — like vision or dental coverage – and sometimes at a lower price. Also, 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.

Sound good?!
Not so fast.

As with everything in your world now, this is COMPLEX. There are trade-offs in choosing Medicare Advantage. Here are some tips and resources to help you figure it out.

Timing for Making Decisions

If you want to sign up for Medicare Advantage, change plans, or change from Medicare Advantage to traditional Medicare, the window for doing this is during the annual open season, which runs from mid-October to early December.

After that point, you’re generally locked into your decision for one year. But, you do get a test period from January 1st through mid-February to drop the coverage and return to traditional Medicare. And there are some other exceptions to the lock-in. Some examples of this are moving out of the plan’s service area or entering a nursing home.

Picking a Plan

Your parent will get a lot of lovely, glossy marketing materials from some of the plans. And at first glance it may seem easy to see which one looks like the best choice.

But, be cautious here. Plans can be really different in their cost and coverage. A good place to start is to use the government plan finder! It can be found at www.medicare.gov. Just click on “Find health & drug plans” from the home page.

To help you navigate the government website, invest in AARP’s Medicare for Dummies, and consult Chapter 11. The author guides you through the process.

If you want to sit down with a live person, 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.

Appealing Coverage Decisions

The Daughterhood inbox is mostly filled with daughters upset about Medicare Advantage coverage decisions. While the private insurers are required to cover Medicare benefits, they can limit your provider network, and make decisions about how much of these benefits you can use.

For example, one daughter thought her dad should have been discharged from the hospital to a special rehabilitation center but the center wasn’t part of the plan’s network. Someone else I know couldn’t get as much skilled nursing facility care covered as she thought her dad needed. So she ended up paying out of pocket for the additional services.

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.

And finally, download here the one-page Daughterhood Understanding Medicare Options and put it on your fridge. When you look at it, imagine that we’re all having a pumpkin spice latte or a glass of wine together and know you’re not alone.

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.

3 Resources to Ease Caregiver Money Worries

In a recent survey, AARP found that about three-quarters of all caregivers spend, on average, 20 percent of their household income on caregiving.

This is on top of the estimated $470 billion in unpaid care that they provide; and doesn’t include the potential lost income due to work-related strain that over half of caregivers report.

It’s clear that caring for a family member creates a financial hardship for many, and even a catastrophe for some; especially when caring for someone with dementia or Alzheimer’s Disease.

If you’ve experienced it, you know that there’s nothing worse than feeling financially strapped! Especially if you’re also feeling overwhelmed by caregiving responsibilities. So, if you are facing economic strain because of a caregiving situation, here are a few organizations that may be able to help.

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5 Dos and Don’ts for Staying Independent in Old Age

My inbox is filled with emails from caregivers trying to figure out how to pay for their parents’ care. They’re facing complicated and hard choices.

The big choices? Whether they should quit their job, move a parent into their home to avoid expensive care, or pay for care and risk running out of money. Or some combination of any or all of these.

That’s a really crappy set of choices.

We all agree that, regardless of your financial situation, it’s hard to be a caregiver… But, the truth is that it’s really scary to be a caregiver when you or your parents don’t have much money to pay for care….

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Don’t be Surprised by Medicare’s Out-of-Pocket Costs

My friend Quentin Fottrell is the Moneyologist columnist over at MarketWatch. He recently shared with his facebook group a reader question about whether a woman should help her 75-year-old sister with medical-related credit card debt.

Two commenters asked, “Why does she have medical costs? Isn’t she on Medicare?” They thought that Medicare covered most healthcare costs for older adults.

Unfortunately, this simply isn’t true. While Medicare is the primary health insurer for most older adults, it only pays a part of the healthcare bill. There are three kinds of out-of-pocket costs that we face!

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3 Medicare Benefits You MUST Know About

“What do you mean Medicare doesn’t cover this?” My friend Sarah was caught off guard when I told her that her parent’s health insurance program doesn’t cover her parents’ care.

What I explained is that there’s a lot Medicare doesn’t cover and one of the biggest gaps is the ongoing, long-term care that people need when they become frail or disabled.

This care is expensive! Hiring someone to help with cooking, laundry, transportation or personal hygiene can cost around $20 per hour!

So what do families do? Well, one of two things. They pay for this care out of their savings… or much of the time, DAUGHTERS PROVIDE THE CARE THEMSELVES.

In fact, new research shows that most of the really frail older adults in this country don’t live in a nursing home. Most live at home and the vast majority — 2/3rds to 3/4s — are being cared for ONLY by family members — unpaid.

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3 Powerful Ways to Avoid the Hospital

Americans have a love affair with hospitals.

We tend to think of doctors and nurses as the people who were working hard to make good grades while the rest of us were skipping class. I am pretty sure my brilliant, doctor friend Heather was walking around with a stethoscope at age four while I was still sticking Play-Doh up my nose.

This romantic affection for hospitals is not entirely misplaced. There are zillions of people who need life-saving surgery and who live longer because a hospital was able to treat them effectively. ERs in public hospitals handle an onslaught of some of society’s toughest cases; drug addiction, mental illness, and homelessness.

But, you don’t want to start your caregiver journey in a hospital.

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Medicare Therapy Rules Made Easy

Most of us take for granted that we can get out of bed in the morning and do all the things necessary to head out and face our day. You know… the simple everyday things like moving around our house, showering, getting dressed and eating breakfast. I might be a little foggy most mornings but I don’t think about whether I’ll face an enormous challenge in measuring out the coffee or pouring the milk. The point is the routine is just that…routine.

But if your parent is frail, you know that there’s nothing routine about these activities — that for them, doing even the simplest things just can’t be taken for granted anymore.

The mobility and functioning that’s essential to independence and safety suddenly becomes a big effort. And, Daughterhood really happens when we have to get involved in helping our parents do the things that they can no longer do by themselves. This is when their lives and ours get hard.

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A Go-To Guide For Understanding Your Aging Parents’ Rehabilitation

I was 30 weeks pregnant with my daughter when a routine doctor’s visit uncovered the fact that a disconnected placenta had cut her off from getting food and water. Essentially, she was starving in utero. Later that same day, my girl was born by emergency C-section weighing in at just over 2 pounds.

Her early birth kicked off years of specialized healthcare and education, most of which was therapy to help her walk, talk and manipulate the tools she’d need to do even the simplest things like eat, use a pencil, and play with her toys.

I’m happy to report that today she’s a strapping 5’7” teenager who plays softball and the piano. And, while her gritty personality had a lot to do with her success, so did the physical, occupational and speech therapists working with her.

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5 Common Misconceptions About Medicaid

I have a confession. I’ve been avoiding writing about Medicaid. It’s so complicated it scares me. But, Medicaid can be really important to daughterhood because someday you might have to decide if it’s right for your parent. So you have to get smart about it.

Here’s why Medicaid is important: It’s the safety net for when everything falls apart.  

When your frail mother has been caring for your Dad at home alone for five years and she can’t do it any longer. When 24 hour a day home care is too expensive and it still wouldn’t be enough to keep your dad safe. And, then when his nursing home care quickly depletes their savings.

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6 Features of Long-Term Care Insurance You’d Never Guess But Need to Know

It feels a little silly to be writing about long-term care insurance because only about 10% of the older adult population has purchased it.

But, it comes up a lot in conversations I have with friends and family… either they’re thinking of buying it or they or their parents have a policy that’s hard to understand.

Also, many, many women want to know… “What can I do to make sure I can pay for care when I need it?”

Because remember… as women, we especially face the possibility that old age will bring with it the need for a lot of help with basic life activities that we do for ourselves now without even thinking: like bathing, eating or dressing.

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