Since 2005, our agency has helped Medicare beneficiaries navigate the enrollment and plan selection process. The confusion that comes with Medicare’s rules and regulations is frustrating for the beneficiaries trying to figure it all out. Likewise, the process is overwhelming for adult-children trying to help their parents get on the most budget-friendly yet dependable Medicare insurance plan.
The good news is, if you get the Medicare basics under your belt, deciding on a plan and managing annual renewals becomes much easier. We have outlined 10 steps to follow to get the best coverage for your parents’ health and budget.
Know the four parts of medicare
Once you nail down the four basic parts of Medicare, you will be able to start the process of picking the right insurance plan. Medicare eligibility for both U.S. citizens and permanent residents begins at age 65.
Traditional Medicare began in 1965 and still has the same two original parts. Part A covers inpatient hospital benefits and Part B covers outpatient medical services. For most people that have worked in the U.S., there is not a monthly cost for Part A. However, there is a monthly premium for Part B that is usually deducted directly from your parent’s S.S. benefits check.
The next part to know is Part C, the Medicare Advantage program. Part C is an option that your parents have in which their Medicare coverage would come from a private insurance company instead of the Federal Government. We will go over that in more detail below.
Part D is the fourth and last part of Medicare. Part D is optional prescription drug coverage. Enrolling in Part D is optional for your parents but t they will pay a late penalty should they choose to enroll at a later date unless they had other creditable coverage.
Understand the Two Insurance Coverage Options
Despite what you’ve heard, Medicare will not cover 100% of your parent’s healthcare services. Your parents will be responsible for additional costs such as deductibles, copays, and coinsurance.
Due to these costs, many beneficiaries get supplemental (Medigap) coverage to help pay for the additional costs beyond what Medicare covers. Medicare supplement plans help to pay the remainder what is left after Medicare pays its portion. In most states, there are ten standardized supplement plans to choose from.
Medigap plans usually have higher premiums but they leave your parents with more predictable coverage at the time of healthcare services. Many beneficiaries select this type of coverage because of the freedom to access any Medicare provider in the nation without a referral.
As mentioned before, Part C Plans are also referred to as Medicare Advantage plans. These plans are private insurance policies that cover healthcare expenses instead of Medicare. A major difference in these plans (versus supplement plans) is their provider networks. Should your parents choose a Medicare Advantage plan, they will have specific doctors that they can see in accordance with the plan’s network.
The Part C plans usually have lower monthly premiums though they can come with more frequent copays and costs on the back end.
Know Your Parents’ Medical Usage
If you have the responsibility of helping your parents to make this decision, it can be hard to know if you are making the right decision. We always encourage those that are responsible for their parents’ Medicare decisions to get familiar with their medical usage.
If you know that your mom or dad frequently see the doctor or use their healthcare benefits often, a Medigap plan may be the most cost-efficient option. For example, a beneficiary that is enrolled in a Plan F or a Plan G would pay zero copays throughout the year.
Then again, beneficiaries that rarely see the doctor may find that they prefer a lower monthly premium and don’t mind paying copays at the times they do receive healthcare services. Going with a Medicare Advantage plan may be a good option in this type of situation.
What Will Give You and Your Parents Peace of Mind?
Can you put a price tag on your peace of mind? It is always difficult to watch beneficiaries decline medical treatment to avoid costs and medical bills. If that sounds like your parents, a Medigap plan may be the best way to go. In any given year, you would know exactly what they would be paying with no unexpected bills or surprises.
In contrast, peace of mind may come from knowing the monthly premium for coverage will be lower. In this case. a low-premium Medicare Advantage plan might feel right to you.
Consider Your Parents’ Providers
Chances are that your parents have doctors and medical providers that they prefer to see. If you are leaning towards selecting a Medigap plan, all you need to ask is if your parents preferred providers accept Original Medicare. Alternatively, with a Medicare Advantage plan, you will want to confirm that the providers are in-network with the specific plan before they enroll.
Use a Medicare Insurance Broker
Even after 13 in the industry, we still talk to people every day that are not sure what a Medicare insurance broker is. Going with a broker allows you to get an unbiased opinion and coverage options for your parents.
A broker can help your parents apply for Medicare initially. They will be able to go through each plan and help you do some of the legwork that would otherwise fall solely on you or your parents. In the case that issues arise with Medicare claims down the line, you will be able to rely on the broker to help you rather than dealing with the insurance companies on your own.
Get an “Authorization to Disclose” on File
There could be times where you need to call Medicare on behalf of your mother or father. The Medicare representatives must have written permission from your parents for you to speak with them on your parents’ behalf. Complete an Authorization to Disclose and mail it into Medicare.
Keep Things Organized
Keeping your parents Medicare cards and paperwork organized can eliminate a headache for you both. After enrollment, your parents will get multiple different cards in the mail. It is important that these are kept in a safe place. Creating a file system where you can organize paperwork from doctors, pharmacies, and insurance companies will make things easier when you need to reference their medical history.
Make Sure Their Medication List is Current
It is almost inevitable for your parents’ medication list to change from time to time. Having this list accurate and up-to-date is very important. Having this list available will help to avoid missing anything in the case that your parent visits a new physician. You can also use it to analyze Part D plans yearly to make sure they have the plan that is best for them and their medications.
Get a Yearly Quote on Their Policy
Each year there is an Annual Election Period for Medicare beneficiaries. This period begins every October 15th and gives you an opportunity to change their drug plan or Medicare Advantage plan.
Entering their list of medications into Medicare’s Plan Finder Tool will populate a list of plans available that will cost them the least amount out-of-pocket for the following year. This plan does not always have to change. It is possible that their current plan is still a good fit for the following year. Other times you may find that another plan will provide significant savings for the next year.
Switching drug plans is simple to do when going through your Medicare insurance broker or by calling 1-800-MEDICARE for assistance right over the phone.
Written by Danielle Roberts.
Danielle Roberts and her team of Medicare insurance experts at Boomer Benefits help beneficiaries with their Medicare decisions in 47 states.