Helping a family member or friend choose a Medicare plan
Adult children can play a major role in helping a parent, other relative, or friend choose their Medicare coverage for the coming year.
The Annual Election Period (AEP) for Medicare plans is from October 15 to December 7 for coverage beginning January 1, 2018. People can only change or enroll in Medicare plans during the AEP or during specific lifetime events, such as when they turn 65.
Whether your loved one is just learning about Medicare or has had Medicare coverage for years and would like to make a change, you can be an invaluable resource in helping them choose the right coverage based on their health care needs and priorities.
Medicare is the federal health insurance program for people age 65 or older, certain younger people with disabilities, and people with end-stage renal disease. People older than 65 qualify if they have paid Medicare taxes for at least 10 years. They must also be citizens or permanent residents.
Some people may qualify for Medicare and Medicaid. These individuals can enroll year round in Dual Advantage plans.
There are two ways to sign up for Medicare health plans: directly through the federal government through “original Medicare,” or through a “Medicare Advantage” private company. Both cover hospital costs (called Part A) and medical costs (called Part B). Medicare Advantage is also called Medicare Part C.
Medicare Advantage plans work similar to the health insurance you may get from an employer. They often offer several plans with different costs and levels of coverage, and they sometimes offer benefits original Medicare doesn’t cover, such as routine vision and dental care, or prescription drug coverage. Original Medicare members can buy prescription drug coverage directly from the government in what is called Medicare Part D.
Keep these 4 key areas in mind when comparing Medicare plans:
The overall cost of a Medicare Advantage plan can vary, based on needs and income. Create a “health care budget” that outlines expected health needs, and compare overall costs. What is the plan’s monthly premium? Is there a deductible your loved one must meet first before coverage begins?
Are there copays for doctor or specialist visits?
Is there coinsurance (where the health plan pays for a certain percentage of a health service, and your loved one is responsible to pay the rest)?
Find out if the plan’s covered services will help lower the cost of managing your loved one’s health conditions, or if he or she will need to pay out of pocket for certain health care needs. Sometimes, the least expensive Medicare plan (or even the most expensive one!) may not necessarily be best. One way to see how Medicare plans set themselves apart is to research covered services that original Medicare plans may not always include. For instance, some plans will cover in-home care for members, help with the cost of medical devices such as hearing aids, or provide the expertise of a registered nurse who can help with managing medications or certain health conditions. Is there dental or vision coverage? Does the plan cover prescription drug costs (Part D)? Can members receive help managing their chronic conditions? Can members get help with their prescription medications? Are in-home services or care covered? A Medicare plan should ideally allow your loved ones to keep seeing the doctors they prefer. Many health plans require members to see doctors within a provider network. Other plans allow members to see any doctor, but these plans usually cost more. Are preferred doctors “in network”? If the primary care provider is in network but specialists are not, is it possible to still get specialist visits covered by referral? How close to home are the nearest innetwork doctors?
It's important to know which medications are covered. Make a list of your loved one's medications, then check the Medicare prescription drug formularies of the plans being considered. A formulary is a list of medications covered by a health plan.
Which prescriptions does your loved one need?
Will the Medicare plan cover these prescriptions, or will they cost more?
If any medications are not covered, is there an acceptable alternative in the formulary?
Will that alternative interact well with the other medications being taken?
Do you have questions or need more information? Fidelis Care's Licensed Sales Representatives are available to meet with you and your loved one in the comfort of their own home or at one of our many community offices. To schedule an appointment or for more information, please call 1-800860-8707 (TTY: 1-800-695-8544) or visit fideliscare.org/medicare.