We know for sure that caregivers have a lot on their plate. One thing you may need to do is help your parent or loved one enroll in Medicare. A lot goes in to helping make sure they’re enrolled in Medicare coverage that best meets their needs and helps them live life boldly. Our advice? Understand the basics. Here’s some tips for helping your loved one enroll in Medicare.
First, remember to communicate
Choosing healthcare coverage is an important decision, and clear communication is definitely key. Gather information about your loved one’s medical history and current health situation. Also, find out what doctors they see or have seen, what medications they take or have taken and where they receive or have received care.
Second, find out when your loved one is planning to retire
Most of us become eligible for Medicare when we turn 65. Before your loved one’s 65th birthday, check to see if they’re still working or if they plan on retiring. If they’re still working, they can stay on their employer’s plan, add extra Medicare coverage, or leave their employer’s coverage for Medicare. A lot of this is based on the size of the company where they work. Encourage them to speak with their employer’s human resources (HR) department to find out more.
Third, know the different “parts” of Medicare
Medicare includes four parts. Each part focuses on a different chunk of medical coverage:
- Original Medicare (Parts A and B)
- Medicare Advantage (Part C)
- Medicare Prescription Drug plans (Part D)
- Medicare Supplement plans
Part A covers hospitalization services, and Part B covers doctor visits and other medical treatment. Medicare Supplement plans can be purchased to help offset costs of what Original Medicare does not cover. Original Medicare does not cover prescription drugs, so your loved one will need to enroll in a Part D plan. A Medicare Advantage plan covers the same things as Original Medicare with additional benefits to help your loved one live their best life. Most also include prescription drug coverage. (If you want more information, we put together a quick, comprehensive overview of Medicare in a previous blog post!)
Fourth, know the Medicare timeline
Your loved one can enroll in Medicare three months before they turn 65, the month they turn 65 and three months after they turn 65 a total of seven months. Ask them if they’re already receiving Social Security. If this is the case, then they’re automatically signed up for Original Medicare – Parts A and B. If they’re not, they’ll need to sign up.
Coverage begins on the first day of their birthday month if they complete enrollment before the month they turn 65. If they sign up during their birthday month or after their birthday, coverage will start the first day of the following month. It’s always a good idea to enroll ahead of time so they’re covered right away. During this seven-month period, known as their Initial Enrollment Period (IEP), your loved one can also enroll in a Part D plan (if needed) or enroll in a Medicare Advantage plan.
Fifth, know what happens during Medicare’s Annual Election Period (AEP)
Medicare’s AEP is a short time period – October 15 through December 7 – where your loved one can choose or update their Medicare coverage. During AEP, they can:
- Make changes to their Medicare coverage, including switching from Original Medicare to a Medicare Advantage plan
- Change from one Medicare Advantage plan to another
- Change from one Medicare Part D plan to another
Any decision on Medicare coverage during AEP goes into effect on January 1 of the following year.
Sixth, consider these factors when helping your loved one choose their Medicare coverage
One of the great things about Medicare are the many options your loved one has to choose from the type of coverage and available Medicare Advantage plans within your service area. Keep the following six things in mind when helping your loved one enroll in Medicare:
- Costs including coinsurance, copays, deductibles and premiums.
- Provider network including whether their doctors and specialists are part of a plan’s network. Also, check nearby facilities including hospitals and urgent care centers.
- Medications your family member or loved one currently takes or may need to take in the next year. Check a plan’s “drug list” or formulary to see what’s covered. Also, remember that Original Medicare does not cover prescription drugs, they will need to enroll in a separate Medicare Part D prescription drug plan or a Medicare Advantage plan with Part D coverage (MAPD).
- Supplemental benefits including dental, hearing or vision services. These are not covered by Original Medicare alone. Medicare Advantage plans may cover these items, and offerings vary by plan.
- Services including skilled nursing, facility-based care, and rehabilitation or therapy that your loved one might need.
- Extra benefits including gym memberships that can help your loved one stay active and healthy. Medicare Advantage plans offer extra benefits that Original Medicare does not. Offerings vary by plan.
If you are a caregiver or have any questions about helping your loved one enroll in Medicare, the ApexHealth team is happy to help! Give us a call 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.