If you’re a caregiver helping a family member or friend enroll or manage their Medicare plan, navigating the complexities and nuances of healthcare plans can be challenging.
However, learning some basics can make managing Medicare easier for caregivers, which helps ensure the right coverage for the needs of the person they are caring for. Here are some tips that can help caregivers navigate the Medicare landscape.
1. Familiarize yourself with the Medicare alphabet
- Take the time to learn the ABCs of Medicare – Medicare has parts A, B, C, and D.
- Part A is hospital insurance
- Part B is medical insurance
- Part C, known as Medicare Advantage, covers both hospital and medical insurance and is offered by private companies approved by Medicare.
- Part D provides prescription drug coverage, and most Medicare Advantage plans include Part D. Part D can also be purchased as a stand-alone plan to cover costs when a Medicare supplement plan is in place.
Though Original Medicare covers most healthcare costs and supplies, there are healthcare costs that aren’t covered. This includes copayments, coinsurance, and deductibles. Purchasing a Medicare Advantage or Medicare Supplement plan, also known as Medigap, might be a good option. These plans cover gaps in coverage that exist with Original Medicare.
With a Medicare Advantage plan, both providers and facilities need to be a part of a specified network. These plans often include prescription coverage (Part D) and may also include hearing, dental, vision, fitness memberships, and other additional benefits. Premiums are usually low for these plans compared to Medicare Supplement plans.
Medicare Supplement plans are another option to help cover Medicare expenses after Original Medicare pays its share of the Medicare-approved amount for healthcare costs. Medigap policies are only available for seniors with Original Medicare plans and not Medicare Advantage plans. Medicare Supplement plan benefits are determined by Medicare and are sold by private insurance companies. These plans allow the plan holder to see any provider that accepts Medicare, though they generally don’t cover long-term care, prescription drugs, vision, or dental. You will need to get a stand-alone drug plan to accompany your Medicare Supplement plan.
2. Financial assistance may be available
There are options for those with lower incomes to qualify for financial assistance to help pay for their prescription drug costs. As a caregiver, investigate to see if this is an area where you might be able to help the senior you’re assisting save money.
3. Remember deadlines
There are specified enrollment periods where people can sign up for Medicare, and if they miss this window of opportunity, they might have to pay penalties. Caregivers can help so that deadlines are not missed. As a person gets ready to turn 65, they can sign up during their Initial Enrollment Period (IEP), which spans seven months total: three full months before the 65th birthday, the entire month in which a person turns 65 and three full months after the birthday month. Individuals who miss the IEP can enroll during the General Enrollment Period (GEP), which happens every year from January 1st through March 31st.
In some situations, people become eligible to apply for Medicare during a Special Enrollment Period (SEP). This is outside of their IEP and the GEP.
4. Stay organized
To enroll for Medicare, be sure to communicate with the person you are caring for to make sure they have the documents they’ll need to sign up for Medicare. This generally includes a birth certificate, proof of U.S. citizenship or residency, social security card, and tax information. In some cases, you might also need to provide health insurance information when using Medicare in conjunction with existing coverage. Individuals receiving military or veteran benefits might also need to show records that indicate proof of military service.
5. Obtain permission to speak on their behalf
To represent another person when calling an insurance company or doctor, the caregiver must be listed as someone allowed to speak on their behalf. To obtain this permission, both a caregiver and the person who needs assistance need to call the insurance provider or doctor together so that permission can be given, allowing the caregiver to call on their behalf in the future. Sometimes verbal consent is enough, but you might need to fill out paperwork to gain permission in some cases.
6. Consider talking to an expert
Medicare information can be a bit confusing, if all these moving parts seem like a lot to manage, or if you want to make sure you’re helping the loved one or friend in your life choose the best option for their situation, consider speaking to a licensed agent who can answer your questions and help you pick a plan tailored to their needs.
Choosing a Medicare plan for a parent, friend or a loved one is a big decision: you don’t have to put together the pieces on your own. Contact the Guided Medicare team today for personalized, attentive, and expert service that can help so you best support your loved one and their needs.