Unquestionably, one of the most complex parts of adulthood is watching our loved ones enter and progress into their elderly years. As Caregivers, we want to provide the elderly people in our lives with the support and security that they have shown us over the years. As such, their physical, mental, and emotional health especially needs to be looked after. Along with Life’s transitions, they still may suffer from feelings of anxiety or even depression.
It can be painful to the point of heartbreaking as we watch our loved ones struggle with the challenges that old age brings. Many of us do and will always see ourselves as still being in our late teens or early twenties, even when, in reality, those ages are doubled or tripled. After all, we’ve all heard the saying, “You’re only as old as you feel!” On one hand, it’s a great mindset because even as we get older, we can keep that youthful spark and zest for life we had in our twenties. The truth is, though, as we, and especially as our loved ones, get older, the rigors of life take their toll on our minds and bodies. Meanwhile, for many of us an image of our parents is somewhat frozen in time, our loved ones such as our parents have been such a big and integral part of our lives that it can be hard to see them age. Yet, as time marches on, things change, and the people we care about will continue to age. As caregivers, we’ll have to talk with our loved ones about their medical needs. Especially as those medical needs may evolve over time.
A big part of being able to have those conversations involves understanding Medicare and what it entails.
Since its inception, Medicare, the national program that subsidizes healthcare services for people 65 or older, younger people with disabilities, and patients with end-stage renal disease, has helped millions of Americans. However, for all the good it’s done and continues to do, Medicare can be a bit tricky to navigate. As a Caregiver, the Elderly Person in your life will need your help in making the best decisions for their future.
In this article, we’ll look at some resources to help your Elderly Person get the best coverage for their needs during Open Enrollment. We’ll also help you know what to look for to avoid being misled or otherwise taken advantage of.
A Quick Lesson on Open Enrollment
The open enrollment period happens annually from October 15th to December 7th. During that time, your loved ones can make changes to their Medicare Coverage to better suit their needs. When most seniors’ Medicare coverage begins, they start off with what’s known as “Original Medicare,” which is Medicare Part A and Medicare Part B.
During the Enrollment period, the Medicare recipient can add, change or drop coverage types like Medicare Part D and the Medicare Advantage plan. Once changes are made to the coverage, they start on January 1st of the following year. It’s important to remember that during the Open Enrollment Period, changing coverage types isn’t mandatory for the person in your care. If what they have works, they are free to keep it as is.
If you do change their coverage, remember that premiums they pay may fluctuate. It’s been estimated by fidelity investments that a person retiring in 2024 at the age of 65 $165,000 in healthcare and medical expenses throughout retirement.
There is No Grace Period, for the most part.
Something else to keep in mind regarding the December 7th deadline is that there is no grace period for the most part. If changes to coverage aren’t made before that date, then your loved one will have to wait a year to change their coverage. The only exemptions are:
- If they have moved back to the United States after living out of the country.
- If they move to an address outside of the move to an address that isn’t your current plan service area
- If they moved out of a live-in or recently moved out of a facility like a nursing home
- If they lose their coverage due to losing a job
- Their current plan changes its contract with Medicare.
According to Medicare’s official website, those situations would invoke a Special Enrollment Period, allowing them to change their coverage outside the annual Open Enrollment Period.
Understanding The Different Parts of Medicare
We’ve already mentioned Medicare Part A and Medicare Part B, the so-called “Original Medicare,” as those parts have been part of the program since it launched in 1965. As of 2023 it’s estimated that up to 66.4 Million Americans are covered by “Original Medicare”. However, we wanted to take a moment and dive a bit deeper into those and the other parts that make up Medicare in the hopes that you’ll gain a more well-rounded understanding of Medicare as a whole.
Medicare Part A – Hospital Insurance
As you are probably already aware, Part A covers things such as inpatient care in hospitals, skilled nursing facilities. Hospice care, and home healthcare. Thankfully, this aspect of Medicare can relieve a lot of the stress for those who find themselves needing medical attention.
Medicare Part B – Medical Insurance
Meanwhile, Medicare Part B covers treatment from doctors and other medical professionals, outpatient care, and home health care. An added benefit to Part B is that it also covers things like wheelchairs, walkers, hospital beds, and other medical equipment that may be needed. Services like those can add up if a person has to pay for them independently. This part of Medicare also covers preventative health measures such as screenings, shots, vaccines, and yearly checkups. Remember, staying on top of all those as we age is important! As an added benefit of “Original Medicare,” you are able to go to any doctor or hospital in the United States that takes Medicare. In addition, Medicare Part B can cover certain telehealth services after you meet the Part B deductible and pay 20% of the amount approved by Medicare for healthcare providers’ services.
Medicare Part C/Medicare Advantage
This one differs slightly from Original Medicare in that Medicare Part C is a Medicare-approved plan from a private insurance company that offers an alternative to Original Medicare for your health and drug coverage. Medicare Advantage comes with its own share of advantages and disadvantages. On the plus side, people with Medical Advantage typically pay lower premiums and deductibles than other plans. However, on the downside, those with this plan can only use doctors within the Medical Advantage network, which may limit some access. Patients also have to get prior authorization to receive care. Unfortunately, that can delay needed medical treatment.
Medicare Part D – Drug Coverage
Medication has become one of the most critical and expensive aspects of healthcare. As we get older, many of us rely on medication to help with chronic pain, mental health issues, or any number of other ailments. To that end, Medicare Part D helps to cover the cost of prescription drugs, including recommended shots or vaccines. It’s important to note that while you aren’t automatically enrolled in Medicare Part D like you are with Original Medicare, you can sign up for Medicare Part D in addition to Original Medicare. Otherwise, you are also able to get Medicare Part D by joining a Medicare Advantage plan.
What Medicare Doesn’t Cover
Something to remember about Medicare is that, unfortunately, it has limitations. As you may already know, there are a number of things that Medicare doesn’t cover. As such, unless you have Medicare Advantage or have other coverage, there are medical services you will still have to pay for out of your own pocket. While some or even none of these may apply to you at the moment, it’s important to keep in mind that Medicare does NOT cover:
- Massage Therapy
- Most Dental Care, such as Dentures, fillings and cleanings
- Cosmetic Surgery
- Medical care if you are out of the country
- Eye exams and eyeglasses.
- Hearing aids
- Concierge/Boutique Medicine
Thankfully, though, there are some exceptions to what is not covered. If you have Original Medicare, it may, in some cases, cover medical issues such as cancer-related treatments, organ transplants, and heart valve repair or replacement.
Understanding Your Medicare Options: Original Medicare vs. Medicare Advantage
We wanted to dive a bit deeper into Medicare Advantage and look at its key differences from “Original Medicare.” Since Advantage Medicare is often referred to as Part C, the waters can be a bit muddy. Medicare C is handled by private insurance companies.
If the older person in your life has Original Medicare:
- They can visit any Doctor or Hospital that accepts Medicare Patients
- They are covered by Medicare Parts A and B
- They do not need a primary doctor
- They do not need referrals to see a specialist
- They do pay a deductible along with premiums for Part B
- They are not automatically covered by Medicare Part D (though it can be added during Open Enrollment
If the older person in your care instead has Medicare Advantage:
- They can only use doctors, hospitals, or other healthcare providers in the Medical Advantage network.
- If they go to a doctor or healthcare provider outside of the network, they may have to pay a fee
- They will have coverage that compares to Medicare Part A and Part B
- They may need to have a primary care doctor
- They may need a referral to see a specialist.
- Most Medical Advantage plans do include Part D
As you can see, both options have advantages and disadvantages. Hopefully this will provide enough information for you and the older person in your care to make an informed decision about which coverage is best for them.
Staying Alert for Scams and Misleading Information
There is an incredibly frustrating fact that needs to be addressed. Specifically, the fact that there have always been people who prey on the older members of society in an attempt to decieve them. Even though legitimate Medicare Insurance Agents and Brokers can be very helpful, you and your loved ones should be very mindful in your dealings within this process. Unfortunately, this requires vigilance as some brokers may be illegitimate. Like moths to a flame, Open Enrollment may lead to an increase in those trying to mislead seniors. As such, we wanted to offer some tips on how to protect the older adults in your life from being taken advantage of.
Recognizing Medicare Enrollment Scams:
One of the first things to keep in mind, according to the NY State Wide Senior Action Council executive director, Maria Alvarez, (Forbes Health), “There are no Medicare representatives, and Medicare never cold calls.” So, in the event someone calls your loved ones claiming to be from Medicare, they either don’t answer or hang up the phone right away. Even if the call display says “Medicare”. The most essential thing to understand about scammers is that they lie. It’s the same if someone comes to the door claiming to be a representative of Medicare, do not believe them. Do not open the door; instead, ask them to leave the property”.
Best Ways To Protect Yourself and Your Loved Ones:
If you or the person in your care are looking to deal with a Broker or an Agent, there are additional steps that can be taken for protection. For starters, you and the person in your care should only deal with people you trust. Don’t share any personal information of the person in your care, and do your best to ensure the person in your care doesn’t either. If a company or person you/the person in your care doesn’t know receives an email from a total stranger regarding Medicare, ignore and delete it.
Say “No” to any gifts or freebies being offered. According to wedmd.com, Brokers are NOT allowed to give gifts of any kind, including, but not limited to, things like knee braces or even cash, as incentives to do business with them.
If you or the person in your care has encountered a scammer, please call 1-800-MEDICARE (1-800-633-4227) right away to report them.
Conclusion
As we’ve seen in this article, there are many factors to consider during the Open Enrollment Period. We really hope that the information presented helps seniors and caregivers alike navigate the road ahead. No doubt there will be bumps along the way, but remember, help is always available.
