Medicare 101: A Guide for Helping Aging Parents Navigate
It’s really easy and - to be truthful - kinda fun to tease your aging parents when they can’t figure out how to post on Instagram or refuse to believe that a mobile boarding pass will work – so they insist on a printout. But you may lose that superior ‘tude when you try to help them tackle Medicare.
What’s that? You assume Medicare, federal health insurance for people 65 and older, was purposefully designed to be simple and straightforward? Well, once you sit down with your parents to decipher its ins and outs, you’ll be too busy scratching your own head to make fun of them. Medicare is the equal opportunity confuser.
To Begin…
Medicare is one of the largest social programs available in the US. And FYI, before seniors gain an understanding of the program, many assume it is free. It is not. They may also assume it covers all of their medical needs. It does not.
What It Is
The program consists of several different parts, each offering a different type of health coverage. Your parents will be asked to make choices between different supplemental insurance companies, and prescription plans which can be used in conjunction with or instead of Medicare.
How You Can Help
The more information you have, the better you can support your parents and assist them with their choices. The first order of business is to be aware of the sign-up time frame and remind them to enroll.
There are 3 ways to sign up:
· During your initial enrollment period – the 7-month period that begins 3 months before you turn 65 and ends 3 months after your birthday month.
· During the General Enrollment Period, which is annually between January 1 and March 31.
· During Open Enrollment October 15 – December 7.
It’s as Easy – or Complex - as ABC…D
Once enrollment is accomplished, your parents will be faced with an alphabet soup consisting of Medicare Part A, Medicare Part B, Medicare Advantage Part C, and Medicare Part D. Medigap insurance is available to supplement parts A and B. The challenge is to figure out which combination of parts works best for your parents’ health and wallet.
Medicare Part A
Medicare Part A is known as hospital insurance. It will cover inpatient care if you are in a hospital, skilled nursing facility, or nursing home. It will also pay for hospice care and some home health care. For most people, Part A is the free part.
Medicare Part B
Medicare Part B is medical insurance similar to the health insurance you are familiar with. It comes with a monthly premium payment. So, not free. It covers medical services and supplies, and preventive healthcare like wellness visits and vaccines. For preventive care, you won’t pay anything out of pocket. For other services, you’ll have a deductible like you do, or did, with traditional insurance.
Medicare Part D
Part D is the prescription drug portion of your Medicare story. Again, not free. It is regulated by the government but provided by private companies. Each company – and there are a wide variety to choose from - has a formulary, or list of the drugs it covers. For your prescription coverage, you will pay a premium, deductible, and co-pay which will vary depending on the drug.
FYI Medicare Part D has a coverage gap, known as a donut hole. Once you’re in it, your plan will cover less of your expenses and you will pay 25% of your prescription drug costs.
Medigap
Even the best Medicare plan for seniors will have some gaps in its coverage. Hence, the need for Medigap, or Medical Supplemental Insurance. These policies, offered by private companies, are designed to supplement your basic Medicare coverage. Some companies will cover additional services like emergency medical care in a foreign country. What they will not cover is:
· Long-term care.
· Hearing aids.
· Glasses.
· Dental care.
· Vision care.
· Private nursing services.
If you are flummoxed as to why health insurance designed for elderly people does not cover issues that clearly impact elderly people, well, Grasshopper, it’s a conundrum.
Medicare Advantage
If you were paying attention, you noticed Part C was not mentioned…until now. That’s because Part C, otherwise known as Medicare Advantage, is essentially all the different parts of Medicare rolled into one. Medicare Advantage is similar to traditional health plans. Generally, you will need to stay within a set network of medical professionals in order to be covered. It includes preventive and outpatient medical care, hospital care and prescription drugs. It also often covers services that Medicare does not cover, like dental vision and hearing services. You would not need to purchase supplementary coverage. If you opt for Medicare Advantage, you will pay both a Medical Advantage and a Part B premium.
Be Part of the Team
Nobody knows your parents as well as you. Support their Medicare journey by sitting down to assess their health needs and helping them wade through the maze of options to piece together the strongest healthcare plan for them.
And while you’re on the subject of planning for their senior chapter, encourage them to shed the burden of the family home and embrace the best of an empty nester, retirement living. Book a tour at the Overture senior living community of their choice and let the active adult party begin.
Medicare may be difficult, but nothing will be easier or more beneficial for your parents than joining a fun-loving community of like-minded peers.
Talk about a prescription for happiness.