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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Caring for Aging Parents – A Sibling’s Survival Guide

There are many heartbreaking moments to navigate when our parents start to depend on us for care. But few are as painful as fighting with our siblings.

This doesn’t always happen. Sibling relationships can be a source of strength and comfort as parents grow older. But, more often than not, friends tell me about severe conflicts they have with their brothers and sisters, and the suffering it causes.

Like so much to do with caregiving, these clashes often come as a surprise. No one imagines that by caring for their aging parents, they’ll be thrust into such emotionally charged interactions with their siblings. It’s such a shock to go from seeing family once a year over the holidays to navigating our parents needs together daily.

Taking care of parents puts incredible stress on interactions between adult children. The fragile scaffolding of sibling relationships, so carefully constructed over a lifetime, often comes crashing down.

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Ending Loneliness in Caregiving

Other than death of a loved one, few things are more disorienting than making the shift from being cared for by your parents to caring for them.

This transition is made even more challenging because it usually comes as such a surprise. And it’s not just the biologically wired blind spot we have against our parents’ vulnerability. It’s the utter shock that, when it happens, there’s no place to turn for help. It’s like trying to climb a rock face without any toeholds or crevices where you can grab on, and then scaling it without a net.

The problem with our aging system is that even though there’s a lot of information out there to help, the situations most caregivers confront are so incredibly complex, unique and specific (e.g., Why won’t rehab providers accept my Dad?) that they can’t find exactly what they need. Or they want the one exact right answer to a very complex question that doesn’t have right answers.

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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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4 Tips for Talking to Your Parents About Death

Earlier this year, I wrote a blog about how important it is to prepare for end-of-life decisions you might have to make on behalf of your parents. I wrote about advance directives, and having important conversations with doctors and family.

I culled so much good advice from books and articles that it inspired me to talk to my own family.

Here’s how that went down.

Me to Dad: So, Dad, I’m writing a blog about preparing for end-of-life decisions and it occurred to me that we haven’t really talked about what you and mom want.
Dad: You think we’re DYING!?
(End of conversation)

Me to Sister: So, I’ve figured this all out. I’ll tell Mom and Dad that you should be the financial power of attorney because you’re good with money and I’ll be the healthcare power of attorney because I’m good with healthcare
Sister: * ? *
Me: Oh, see, I was thinking we should get Mom and Dad to focus on creating their advance directives — you know, end-of-life planning
Sister: Is there a book I can read about this?
Me: You know I’m an expert, right? Don’t you trust me?
(End of conversation)

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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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Creating a Resilient Response to Loss: The Special Challenge of Dementia

I’ve said many times that few things are more disorienting than the shift from being cared for by your parents to caring for your parents. The only thing that makes it harder is when your parent (or spouse) has dementia. This is quite possibly the most challenging of all situations.

Every Sunday, I allow myself the pleasure of spending time on Krista Tippett’s website, www.onbeing.org. A couple of weeks ago, I stumbled onto a podcast entitled, “The Myth of Closure” with family therapist Pauline Boss.

She’s coined the phrase “ambiguous loss,” which I find revelatory. Ambiguous loss refers to “a loss that is unclear, that has no resolution or closure”…. Where a loved one’s “status as absent or present remains hazy.

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Essential Websites for the Daughterhood Journey

These days you can barely open up your internet browser without stumbling across a website for caregivers. On the one hand, this is great but it can also be a problem — There are so many websites with advice and information for caregivers that it can be hard sometimes to find what you need or to even know where to start.

So I want to share some of my favorite sites, organized by topic — in the hopes that you can get what you need more easily.

But before I do, please promise me that you won’t let all these websites and the information they provide make you feel MORE overwhelmed than you already feel. You don’t have to consume it all in one sitting and you don’t need it all right now.

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