As caregivers, we become resources for our loved one in so many ways. Often, as our loved ones age, their healthcare becomes more complicated and staying on top of their Medicare coverage becomes crucial. Caregivers are a lifeline to help beneficiaries navigate their Medicare enrollment and benefits each year.
If you're wondering where to start or how to help a parent or loved one enroll in Medicare, know that you’re not alone! We help caregivers support their loved ones daily. One of the most common questions we receive is “Can caregivers legally help a loved one enroll in Medicare?”
The short answer is, “Yes!” But it’s important to know the specifics.
Helping a loved one sign-up for Medicare involves their protected health information. So, you'll need to make sure that you are authorized to speak on their behalf about their healthcare. They will need to complete an Authorization to Disclose Personal Health Information form to give you the authority to discuss their healthcare with other individuals.
The document is an essential first step to being able to coordinate your loved one's Medicare needs. Without this form, a Medicare representative will be unable to speak directly with you regarding your loved one's plan and benefit options.
Having open lines of communication helps to ensure that your loved one gets the Medicare coverage that best suits their needs. As their caregiver, you will need to talk with them to understand what their health needs are. Knowing what they are hoping to get out of their Medicare plan can help direct your focus to the aspects that will best aid them.
It’s important to know the following about their healthcare needs:
When it's time to speak to a Medicare agent regarding your loved one's benefits, make sure that you have all the pertinent information at hand. You will be asked to provide specific personal, financial, and medical information on the individual's behalf.
To ensure that this process goes smoothly, work hand-in-hand with your loved one and their medical providers to ensure that you have the big picture of their current healthcare.
There's a lot of information out there about Medicare. Gain peace of mind by working with a Medicare Advisor. Licensed, local agents understand the ins and outs of Medicare and streamline your efforts to get your loved one the most appropriate plan.
Are you helping a loved one navigate Medicare? Our experienced advisors are here to walk alongside you on this journey. Schedule a complimentary call with one of our Medicare advisors.
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.
As we age, our health needs change, and older adults, especially, face many challenges when it comes to taking care of their health. Among the most challenging is navigating the government-sponsored healthcare coverage program for seniors. The golden years of retirement can be overshadowed by the bombardment of telephone calls and excess junk mail all about Medicare. It’s no wonder so many older adults get confused when it comes to making the right choices for their healthcare coverage and therefore rely on outside help.
About 19% of Americans act as caretakers for a spouse, parent, grandparent, or community member; and the majority of individuals being cared for rely on Medicare or Medicaid. Even adult children whose parents and grandparents are still independent often end up helping their loved one navigate the healthcare system.
One of the first steps to being able to help your parent, grandparent, or other loved one enroll in Medicare is to understand the process. Keep reading to learn more about the different parts of Medicare, how Medicare enrollment works, and how to find the Medicare plan that best fits your loved one’s needs.
Medicare is a complex system that can be difficult to fully understand, especially when there is a wealth of information available. We’ll start simple by defining Medicare and all its basic parts.
Medicare is the U.S. government’s largest health insurance program that provides affordable healthcare coverage to eligible adults. With Medicare, there are a few different options for how to get coverage.
Medicare Parts A and B, or Original Medicare, offer hospital coverage and outpatient coverage respectively. Part A pays for room and board at the hospital and some other healthcare facilities. Part B includes almost everything that Part A doesn’t cover, like doctor visits, medical equipment, lab work, surgeries, therapy, and more.
With Original Medicare, the recipient pays for services as they get them. While Medicare will cover a lot of costs, your loved one could still be responsible for deductibles, copayments, and coinsurance. However, they may also be eligible for Medigap, supplemental insurance, to help cover those costs. If your loved one needs prescription drug coverage, they can also apply for Medicare Part D.
Medicare Part D provides coverage for prescription drug costs. This plan is offered by private insurance carriers and is available for purchase as a separate stand-alone plan for those with Original Medicare or can also be included as part of a Medicare Advantage plan.
Medicare Part C, or Medicare Advantage, is an optional, low-cost alternative to Original Medicare offered by private, Medicare-approved insurance companies. These “all-in-one” plans bundle Medicare coverage, including Parts A and B and usually Part D prescription drug coverage as well. Medicare Advantage can also cover things that Original Medicare does not, like vision, dental, and hearing insurance.
A Medicare Supplement Insurance (Medigap) policy can help pay some of the remaining health care costs that Original Medicare does not cover. This may include copayments, coinsurance, and deductibles. Not everything falls under Medigap, however. A supplement plan may not cover long-term care, vision or dental care, hearing aids, eyeglasses, or private-duty nursing. Medicare Supplement plans are offered by private insurance carriers.
There are multiple Medicare enrollment periods that your parent or loved one may be eligible for. Individuals become eligible for Medicare when they turn 65. Younger adults who are disabled or have End-Stage Renal Disease may also be eligible for Medicare.
It is important to do your research and know the date cutoff for their enrollment period in order to make sure they are enrolled without any penalties.
Initial Enrollment Period: IEP begins three months before your 65th birthday and ends three months after the month that you turn 65. In most cases, if you don’t sign up for Medicare Part B when you’re first eligible, you will have to pay a late enrollment fee for as long as you have Part B and could have a gap in your health coverage.
Annual Enrollment Period: AEP begins October 15 and ends December 7 each year. During this time, beneficiaries are able to make changes to their existing Medicare plans.
Open Enrollment Period: OEP allows beneficiaries to make a one-time change to their Medicare Advantage Plan from January 1 through March 31. During this time, you can also sign up for Medicare if you missed your window, but fees and gaps in coverage may apply.
Special Enrollment Periods: SEPs are available under certain circumstances throughout the year, such as moving out of your existing plan’s service area or retiring from a job that previously provided your benefits. Generally, there are no late fees associated with signing up for Medicare during an SEP, but the eligibility requirements vary.
There are pros and cons to each Medicare plan, but the most important thing is to find the plan that best fits your parent or loved one’s needs. Determining this will depend on a few factors unique to their circumstance, such as where they live and what kind of care they expect to need.
Here are a few other things to consider:
Cost: How high will the beneficiary’s out-of-pocket expenses be? This could include monthly premiums, deductibles, copayments, or coinsurance.
Benefits: Does the plan cover any additional healthcare services they need? For example, prescription drugs, vision, dental, or hearing insurance.
Convenience: Are the in-network providers conveniently located? Are their preferred healthcare providers in-network?
Needs: Have they required healthcare in the past few years? Do they anticipate an increased need for care? Do they often see specialists for a health condition?
All of these factors impact which plan is right for your loved one. And often two plans can seem very similar, yet the smallest difference can dramatically change their fit.
To make sure you get it right the first time, your best option may be to discuss your parent or loved one’s situation with a Medicare advisor. A professional can help you weed through the excess information and find the exact plan that will best serve your loved one.
If you're helping a loved one or parent enroll in Medicare our experienced Medicare Advisors are here to support you if you have a question. You can also explore more of our Medicare Resources to educate yourself on all things Medicare.