By Steven Buttice, Founder and President, Living By Your Design, Inc.
Mom and Dad came to you with 3 inches of mailed information from their Medicare plan insurance company. In the past, they went through this process themselves, but it’s becoming too complicated. Knowing very little about Medicare, how can you help them? Where do you start? Medicare open enrollment started on Oct. 15 and continues to Dec. 7. Like ACA (Obamacare) open enrollment, people are allowed to make changes during this time period. Here are some questions that are often asked:
Question: Mom and Dad received notice that their MAPD has been canceled. What options do they have?
Answer: Your parents actually have many options. The cancellation creates a guaranteed enrollment special election period. They can move to a MADP in the same or different company or a Medicare Supplement with a MedicareRX plan. They have limited time to act and should not delay in talking with a broker and carefully reviewing the benefits, limitations, and exclusions of any plans considered.
Question: Mom and Dad have Medicare, a Medicare Supplement, and an RX Plan. Do they need to do anything?
Answer: No, most people will stay with the coverage they already have. However, it is prudent to review the Annual Notice of Change (ANOC) from the Medicare RX plan and make sure your drugs are covered, premiums are manageable, see if there are any new restrictions on your drugs, and see if your pharmacy is still in-network. People usually make changes when premiums rise substantially or their drugs or pharmacy change.
Question: Mom and Dad have a Medicare Advantage Plan (MA) and the premiums and out-of-pocket costs are rising. What can they do?
Answer: MA and MA with prescriptions (MAPD) plans should be reviewed yearly as above. In some cases, their company may have another plan that may better meet their needs; in other cases, look at a competing company. Be sure to get professional advice and review the benefits, limitations and exclusions carefully.
Question: I have a Medicare Supplement and my premiums are very expensive. I am in my 90s, and do not have many expenses and do not think I would be aggressive with future medical care. What can I do?
Answer: In cases like this, you may wish to look at a MAPD that includes your network of doctors. It will lower your premiums, but you will have co-pays. Again, be sure to get professional advice and review the benefits, limitations and exclusions carefully.
There is a common theme in all of these answers. Many mistakes have been made with both Medicare and ACA plans. These mistakes can be very costly now and in the future. They may result in a person not being able to see the network provider they wish to see. There are ACA certified, licensed insurance brokers in your community who can help you. They are trained in the ACA products, have experience with health insurance and look at the bigger picture of how your plan can work for you. Also, being a broker, they can find the best company for you. You do not pay any extra money for this service.
You can also use as resources: Medicare at www.medicare.gov and/or our website at www.MRMS-INC.com for various issues including information on Medicare and Medicare plans. Coordinating care for your children and parents simultaneously is not easy. What can you do to manage this? Three words of advice: plan, plan and plan. Legal, financial, residential, mental and physical health care elements must be addressed prior to a crisis. A sandwich generationer should guide their parent through these issues and the primary issue of safety, while being careful not to take all control away from a parent. Once again, it is important to start talking, making suggestions, and guiding early. Do not wait for a crisis.
For more information or a list of “Questions to Ask in Different Aspects of Care,” contact Living By Your Design, Inc. We focus on the issues of older Americans: legal, financial, free guidance for residential placement, and health care issues. Call 309-285-808 or visit our website: www.LivingByYourDesignInc.com. We are located at 809 W. Detweiller Dr., Peoria, IL 61615.