Unraveling the array of Medicare options available during open enrollment isn’t easy. If you’ve recently signed on to help a senior loved one revisit their Medicare coverage, the opportunity to make decisions for 2018 ends on December 7, so the time to start evaluating options is, as the saying goes, “immediately, if not sooner.” (The exception to this deadline is for those who qualify for a special enrollment period (SEP).
Medicare Open Enrollment – Tips for Caregivers
It’s the period near the end of the calendar year when U.S. citizens (or permanent legal residents who have been in the U.S. for at least five years) age 65 and older have the opportunity to make changes to their Medicare or prescription drug plans.
Open enrollment lasts for seven weeks, and is different from “initial enrollment,” which allows new Medicare recipients a maximum of seven months to sort out their plans.
Read these tips for caregivers, if you’re navigating Medicare open enrollment with your parent or spouse this year:
1. If You’re Just Starting Out
Read through “Medicare Basics,” a publication primarily intended for caregivers, family and friends who are new to open enrollment or are navigating the Medicare system for the first time. It’s an excellent resource, but should not be considered a legal document. Refer to Medicare.gov or phone 1-800-MEDICARE for the most current information. Or consider visiting MyMedicare.gov. Here, beneficiaries can apply or set up an account that allows easy management of many aspects of the Medicare recipient’s health information online.
2. Obtain Authorization
It is okay to help someone apply online for Medicare without official authorization. The beneficiary will simply need to be able to sign the application or have it forwarded for a signature. If you and the beneficiary are together when placing a call to Medicare, he or she can verbally authorize you to act as their agent. However, if, going forward, you plan to help them with open enrollment annually or you’re acting in absentia, it’s best to legalize the arrangement:
- The beneficiary can complete and file an “Authorization to Disclose Personal Medical Information” form (CMS-10106).
- Having a durable power of attorney (POA) is usually the most expedient way to make medical and estate-planning decisions for someone else, particularly if he or she is receiving long-term care in an assisted living, memory care community or nursing home. (Each institution you deal with may require a notarized copy of the POA.)
- Alternately, your loved one may simply wish to appoint you the official agent for making their health care decisions, which requires a health care proxy and the Social Security Administration’s “Appointment of Representative” form (SSA-1696-U4).
- Should your loved one become incapacitated before authorizing you to communicate with Medicare on their behalf, you will need to go to court and petition for guardianship – often a costly, time-consuming procedure.
3. Original Medicare, What Can and Cannot Be Changed
Also called Original Medicare, Medicare Part A (for in-patient or hospital care) and Part B (for outpatient care) are public (government-provided) insurance and individuals cannot change them. They can simply opt in or opt out. Participants typically pay a monthly premium for part B only. Part A is covered by Medicare taxes deducted while the recipient or their spouse was working. Learn more about Medicare coverage here.
Often used to augment A and B, Medicare Supplement Insurance (Medigap) is a private plan that helps cover certain out-of-pocket costs, such as copays and deductibles. (In order to own a Medigap policy, the beneficiary must have parts A and B, and there is a “Medigap open enrollment period” unique to the individual and unrelated to fall open enrollment; policies can be changed, but timing is key.)
So what can be changed during open enrollment?
- Beneficiaries may opt out of Medicare A and B by selecting a Medicare Advantage plan, also referred to as Medicare Part C. (In 2018, more than a third of Medicare recipients are expected to be enrolled in Medicare Advantage, in which coverage is contracted through private insurance companies, mostly HMOs and PPOs. Ninety percent of these plans include prescription drug coverage and may also include vision and/or dental care. The number of Advantage plans available to choose from depends on where the beneficiary lives: there are rural parts of the U.S. where none are available.)
- They may elect to switch from one Medicare Advantage plan to another OR return to Original Medicare.
- They may change Medicare Part D (prescription drug plan).
When helping a senior examine options, always look beyond the price of the premiums. A plan that appears too costly up front may end up saving money in the long run. Make certain that any change will not result in a lapse in coverage.
Additionally, it’s possible he or she is happy with their coverage as-is (or you are both paralyzed into inaction at the thought of wading through new options), but be aware that the plan itself may not stay the same from year to year. Make sure you are both aware of any revisions before you decide to “let it ride.”
4. Seek Out Free Advice
The internet has a great deal of information when it comes to Medicare and open enrollment, but it can be hard to sift through all the data to find what you’re looking for. One of the most useful resources for caregivers is the State Health Insurance Assistance Program (SHIP), which provides one-on-one health insurance counseling at no cost. This and other helpful sites, including a link to contact your State Insurance Department, are listed here.
5. Consult a Professional
Contact a state-licensed insurance agent or broker who specializes in Medicare Part D and Medicare Advantage policies. Subject to rigorous oversight, these agents may lose licensure if they fail to comply with strict rules related to selling plans to Medicare beneficiaries, so most can be relied upon to provide sound advice.
6. Gather Important Information in Advance
One way to make things easier when you’re doing research and making choices on someone’s behalf is to have crucial information at your immediate disposal.
When contacting Medicare, have his or her:
- Date of birth (DOB)
- Social Security number (SSN)
- Medicare ID number or claim number and effective dates of Medicare parts A and B (found on Medicare card)
- Information about any additional health care coverage (policy, member, and group ID numbers)
You may also need:
- Any prescription drug names and relevant information about his or her health conditions
- Bank account and routing numbers to set up automatic payment of premiums via Medicare Easy Pay
- Any documents, such as bills, receipts, Medicare Summary Notices pertinent to a specific inquiry
- If applicable, include:
- Contact information for the beneficiary’s nursing home, assisted living community, or other long-term care facility
- Veterans Benefits and/or Railroad Retirement Board (RRB) Benefits information
- Medicaid/PACE information
How did you navigate Medicare options with your parent or senior loved one? What did you learn in the process? We’d like to hear your stories in the comments below.