“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.
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.