As our parents age, we often take on more responsibilities to help care for their needs. In this stage of life there can be both great joys as well as new challenges.
Taking care of aging parents introduces us to all sorts of new encounters – and one of those is learning how Medicare works.
Medicare can be confusing. With all of the information available on the topic, you might find yourself unsure of where to start. The following 5 tips for helping your parents with their Medicare benefits will help you navigate through the confusion.
To be a resource for your parents as they enroll in Medicare coverage, first you need to know the basics of how Medicare works. We’ll start by answering “What are the different parts of Medicare?”
Medicare A acts as hospital insurance and covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. When you help your parents sign up for Medicare they will automatically be enrolled in Part A.
Most people qualify for Part A premium-free. If one of your parents paid Medicare taxes while working, then they don’t have to pay a monthly premium for Part A (this is the most common scenario).
Hospital expenses aren’t completely free, though, with Part A Medicare insurance.
Medicare charges a deductible each time a beneficiary is admitted to the hospital. The deductible cost changes every year. In 2021 the deductible was $1,484. If this cost is a concern, consider looking into a Medicare Supplement plan.
Medicare B acts as general medical insurance and covers certain doctors' services, outpatient care, and preventative services. Preventative services covered by Medicare Part B include annual wellness visits, diabetes screenings, flu shots, and many other screenings and tests.
Unlike Medicare Part A, Part B comes at a cost.
The monthly premium for Medicare Part B changes each year. In 2021 the premium started at $148.50 and increased for people with higher incomes. Additionally, there is an annual deductible and beneficiaries pay a percentage of the bills for doctor visits and other outpatient services.
Technically, your parent does not have to sign up for Part B. But, if they’re not covered by other qualifying insurance and do not sign-up for Part B when they first enroll in Medicare, then they will incur a costly penalty for as long as they’re in the program.
Wait… is there a Medicare Part C? We’ll come back to that in a moment. First, it’s important to know that Medicare Part D covers prescription drugs and is purchased in addition to Medicare Parts A & B.
Medicare Part D plans are offered by private insurance companies approved by Medicare. Every Medicare Part D plan is different, including which prescriptions are covered, which pharmacies are in-network, and what the out of pocket costs are for prescriptions.
If you want to take a deep-dive into prescription drug coverage, we recommend taking a look at this article about the details of Medicare Part D.
Parts A, B, and D of Medicare can be combined through Medicare Advantage Plans (aka Part C).
Medicare Advantage plans are offered by private insurers approved by Medicare. These plans are great because they bundle all of the coverage under a single plan. They also often include additional coverage not offered by Original Medicare such as dental and vision.
What do Medicare Advantage plans cost?
Beneficiaries enrolled in Medicare Advantage pay both a premium for their Part C plan as well as the standard Part B premium.
While paying two monthly premiums may seem costly, often beneficiaries save on their overall healthcare expenses. Some Medicare Advantage plans even have a $0 premium or may help pay for Part B premiums.
It's important to note that your parents must enroll in Medicare benefits during their Initial Enrollment Period (IEP).
The IEP is the seven-month window around their 65th birthday (three months before and the three months after their birth month). If they miss their window, they could face gaps in health insurance coverage, incur late enrollment penalties, and have to wait for another enrollment period such as the Annual or General Enrollment Periods, which at specific times of the year.
Like other personal health information, there are regulations around what can and cannot be shared with someone other than the patient unless authorized.
If your parent would like you to speak to Medicare on their behalf, they will need to complete an Authorization to Disclose Personal Health Information form.
Without this form, a Medicare representative will be unable to speak directly with you regarding your parent's program options.
For complete information, visit the Centers for Medicare and Medicaid Services website.
Oftentimes, the best Medicare plan for your parents will be based on their healthcare needs.
Talk with your parents to understand what their health needs are. Knowing what they are hoping to get out of their Medicare coverage can help narrow down their options. Of course, each plan’s coverage varies and talking to a Medicare expert will help ensure your parent is enrolled in the best plan for their needs.
Ask your parent the essential questions:
Allow those questions to transform into a conversation in which you can fully understand your parent's position.
It is best to be proactive with their healthcare providers to avoid any hold-ups with your parent's care.
A little-known fact is that health care providers must enroll in the Medicare Program to receive payment for covered services from Medicare. So, be sure to check with them to ensure that they are enrolled in the Medicare program.
Additionally, some plans only cover services provided by doctors who are in-network. If your parent has a preferred provider, it’s important to make sure that they are in-network for the plan when doing a plan search. Our Medicare Advisors, for example, can search for plans by doctor to ensure that they only show you options that cover the desired physician.
There's a lot of information out there about Medicare. If you're feeling overwhelmed while trying to help your loved one find the right Medicare plan, you're not alone.
With all of the responsibilities that come with helping an aging parent, navigating the complexities of Medicare shouldn’t consume all of your time and energy. Consider turning to an experienced advisor who can help you compare options and guide you through the enrollment process. If you're simply looking for more information, learn more about how to help enroll your parent in Medicare.
