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.