by: Margie Johnson Ware, Aging and Health Specialist. Originally published on AgingCare.com.
Part one of a blog series aimed at caregivers who are trying to enroll a loved one in Medicare.
There is hardly any greater gift you can give to an older person than offering to help them navigate Medicare. A variety of life situations may make it difficult, either temporarily or permanently, for an older person to make health care choices and absorb complex information. Your willingness to take the plunge, educate yourself, and run interference for the person you care for will be much appreciated. And just think, when you turn 65, you’ll already be an expert!
So to begin, what are the key things you need to know about signing up for Medicare?
In general, individuals enroll in Medicare during a period called “Initial Enrollment” that begins three months before the month they turn 65, and continues until the end of the three months after the month they turn 65 (seven months total). As a caregiver, you need to know: a) what choices your loved one needs to make; b) what kinds of costs are associated with those choices; and c) what kinds of help—both financial and consultative—are available for you and your family. As an initial step, try taking the Medicare Questionnaire from the National Council on Aging’s MyMedicareMatters.org for access to free professional advice and a personalized report.
Parts A and B
If your loved one took Social Security benefits before age 65, they will automatically be enrolled in Medicare Parts A and B (often referred to as “Original Medicare”). Make sure you and your family look for envelopes from the federal government that arrive approximately three months before the person’s birthday.
If the person is still covered by their employer or spousal employment, they may not need to sign up for Part A or B. Special Enrollment Periods allow most actively employed 65 year olds with employer health care coverage to delay enrollment in Medicare Parts A, B, C and D until they retire, without incurring fines. But don’t under any circumstance choose not to sign your family member up for Part A or Part B unless you have been assured that they do not need it. That assurance needs to come from a government official or certified Medicare counselor.
Those who haven’t signed up for Social Security benefits need to sign up for Medicare A and B (if they are not otherwise covered through employment) when they turn 65, even though full Social Security benefits don’t begin until age 66. Those who don’t receive Social Security will be billed quarterly for their Part B premium. As a caregiver, it is very important that you make sure these premiums are paid. If a payment is not made within three or four months, the individual will lose their Medicare coverage.
Much of the Medicare sign-up can be done online. The Social Security website can give you step by step information about signing up. Start familiarizing yourself with the website early so that you have plenty of time to discuss things with family.
Once your loved one is signed up for Medicare Parts A and B, they will have coverage for hospital visits (with a deductible) and doctor’s visits (with a deductible and 20 percent copays.)
Medigap, Part C and Part D
Does your loved one go to the doctor frequently? Then they might want to arrange for extra coverage through either a “Medigap” policy (a fee-for-service policy that covers gaps in Medicare) or a managed care policy, known generally as a “Part C plan” or a “Medicare Advantage Plan,” unless their former employer offers this coverage.
This is the point at which you meet your new best friend, the local SHIP (State Health Insurance Program) counselor. These individuals can give you advice about Initial Enrollment in Medicare, but are especially helpful when it comes to figuring out which “path” you want to follow for extra coverage – Medigap or Medicare Advantage.
Medicare also offers prescription drug coverage, or Part D, to everyone with Medicare. To get Part D, you must join a plan run by an insurance company or other private company approved by Medicare. Most Medicare Advantage policies include prescription drug coverage. Each plan can vary in cost and which drugs are covered, and plans can change from year to year. A plan that covers your prescriptions this year might change and not cover them next year. If you choose not to enroll in Part D, you may face a late penalty, depending on your circumstances, and have to pay higher monthly premiums for the rest of the time you have drug coverage from Medicare.
A general rule of thumb is that, if your loved one can afford it, a Medigap policy with an additional Part D prescription drug benefit gives the most flexibility and can potentially cover all your family member’s medical costs, including copays, deductibles and care outside of the United States.
Medicare Advantage plans, which use the managed care model you are probably familiar with from your own insurance through work, can potentially save your loved one some money. However, don’t assume this until you have gotten good professional counsel, especially if your loved one doesn’t travel out of their local area at this point in time.
Good luck! And pat yourself on the back for being willing to guide your loved one through a process that they may find confusing. The National Council on Aging created MyMedicareMatters.org to help you evaluate the best plan for your loved one, and there are lots of other people and resources out there to help you.
In our next installments we’ll talk more about prescription drug coverage (Part D) and some of the situations when you’ll want to get outside help.