3 steps to help family caregivers navigate Medicare open enrollment

It’s National Family Caregivers Month, an annual opportunity to recognize the important contributions of those making sacrifices to care for their families. ApexHealth knows that caregivers are working overtime scheduling appointments, balancing budgets and driving back and forth to the doctor, all while trying to take care of their own needs. 

To make things as easy as possible for those helping loved ones meet their health needs, we regularly publish tips for family caregivers. This month, as the sign-up deadline for Medicare approaches, we’re offering pointers for navigating open enrollment. Let’s dive into some steps to start the process:

Step 1: Identify your loved one’s needs

Navigating open enrollment starts with knowing where your loved one stands. Start by answering these questions:

  • Do they need care from multiple doctors and specialists?
  • Do they take multiple prescriptions?
  • Will they need ongoing vision, dental or hearing care?
  • Do they have any chronic conditions or the possible need for in-patient care?
  • Are they looking for additional financial, health and fitness benefits?

If you answered yes to any of these questions, a Medicare Advantage plan might be a good choice. Here’s some of what these plans may offer: 

  • a network of doctors and specialists who provide coordinated care;
  • an over-the-counter (OTC) allowance for drugs and supplies; 
  • coverage for routine vision, dental and hearing care not offered by Original Medicare; 
  • maximum out-of-pocket limit (MOOP); and 
  • extras that can improve overall health and wellness, such as free gym memberships, chiropractic care, acupuncture, therapeutic massage and Flex Cards.

Step 2: Know what the different types of Medicare plans cover

One thing that’s great about Medicare is that your loved one can choose the plan that suits their needs, from Original Medicare to Medicare Supplement plans to Medicare Advantage plans. Just remember that Original Medicare does leave some significant gaps in coverage. 

Let’s talk more about what each type covers.

Original Medicare (Parts A and B) – Part A covers hospital stays. Part B covers visits to doctors, specialists and urgent care centers. Original Medicare covers 80% of eligible doctor and hospital visits.

Medicare Advantage plans (Part C) –  Part C includes all the benefits of Original Medicare (Parts A and B), plus more comprehensive coverage and additional benefits, such as dental, hearing and vision. In addition, Medicare Advantage plans may provide extras like gym memberships and OTC allowances. Medicare Advantage plans are offered by private health insurance companies and may have a monthly premium.

Medicare Prescription Drug plans (Part D) –  Part D covers prescription drugs and is sometimes included in Medicare Advantage plans. It can also be purchased as stand-alone coverage. Like Medicare Advantage plans, Part D plans are offered by health insurance companies for a monthly premium.

Medicare Supplement plans – Also called Medigap plans, Medicare Supplement plans cover the gap left by Original Medicare. They are offered by private health insurance companies and have a monthly premium. Original Medicare pays for 80% of covered doctor and hospital bills, and Medicare Supplement plans cover the extra 20%, plus the deductible. Medicare Supplement plans include neither prescription drug coverage nor many of the extras offered by Medicare Advantage plans.

We’ve talked more about the basics of what each part of Medicare covers in a previous blog.

Step 3: Make the most of annual and open enrollment periods

There are specific times each year when your loved one can change their coverage and benefits to make sure they’re choosing the best plan for their current needs. 

Your family member can choose a plan when they first become eligible, as early as three months before they turn 65. During their birthday month, it’s time to sign up for Medicare, if they haven’t already. By three months after their birthday, your loved one is reaching the end of their initial enrollment period. Check out our previous blog post for more details on the Medicare Timeline.

From October 15 – December 7 each year, your family members can join, switch or drop a plan. This is called the Annual Enrollment Period (AEP). As long as they select a plan by the end of this period, coverage should begin on January 1. Check out our previous blog for tips on understanding the AEP.

Once enrolled in a Medicare Advantage plan, your family member can switch to a different Medicare Advantage plan or switch to Original Medicare (and join a separate Medicare drug plan) from January 1 – March 31 each year. 

Helping your loved one enroll in Medicare can be challenging, but we hope these steps can make things easier. For more information, get in touch with our ApexAssistants at (844) 279-0508 (TTY: 711). Our hours of operation are Monday through Friday 8 a.m. – 8 p.m. (local time) from Apr. 1 through Sept. 30 and seven days a week 8 a.m. – 8 p.m. (local time) from Oct. 1 through Mar. 31.

For more tips and reminders on how to make the best of the Medicare enrollment periods, take a look at our other blog posts  and follow us on social media –– FacebookInstagram and LinkedIn.


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