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Medicare Made Clear: Helping Parents Navigate the World of Medicare
Life and Style Daily
July 13, 2021
5 min

Between budgeting for rent, food, gas, and other family expenses, our parents usually placed their retirement plans at the back of their minds. While some start reconsidering insurances as they approach the age of 65, others have little to no clue on what to do. They often end up enrolling in the easiest and cheapest health plan that doesn’t cover everything they may need.

Not only will this leave them paying for any future vital care out of their pocket, but some might even opt to go without the service to avoid the financial burden. As their child, it’s your duty to help your parents navigate the world of medicare. You need to guide them in making the right decisions so they could have a comfortable retirement. But to help your parents get started with their health plan, you must first understand Medicare.

What Is Medicare?

Medicare is a health insurance program funded by the US federal government. It provides medical coverage for those who are 65 and older and some younger people with disabilities. With healthcare costs becoming a growing issue over the years, your parents can certainly benefit from a health plan.

This program can help them save money by paying for health care services and items they may need as they age. Although it covers many essential medical needs such as doctor visits and hospital stays, this health insurance doesn’t pay for everything.

It is divided into four parts (Part A, B, C, and D), each serving different healthcare needs. So, if your parents only signed up for one Medicare part, you might need to help them deal with some of the coverage gaps. Knowing these Medicare parts will help you and your parents understand what their health insurance covers. Here are the following:

Part A: Hospital Coverage

Medicare Part A covers hospital stays and hospice care in case your parents suffer from an unexpected injury or sudden illness. It also includes home health care and skilled nursing care that they may need after being hospitalized for a knee replacement or stroke. However, this program doesn’t pay for custodial or long-term care, such as eating, bathing, moving around, using eye drops, and other basic activities of daily living.

Part B: Doctor and Outpatient Services

Let’s say it’s the flu season and you want to protect your 85-year old mom from this contagious disease. This part of Medicare pays for preventive services and other essential medical services and supplies. That includes doctor visits, diagnostic screenings, lab tests, durable medical equipment, and even flu shots. Some of your parent’s outpatient prescription drugs are also covered by this health plan. Moreover, Medicare Part B includes inpatient, outpatient, and partial hospitalization mental health care coverage.

Part C: Medicare Advantage

Medicare Part C or Medicare Advantage is a popular alternative to Medicare. Unlike the government-funded Part A and Part B, which is sometimes called Original Medicare, Part C is offered by private insurance companies. You can think of it as an all-in-one plan that combines various parts of Medicare. This provides some of the benefits you can find in Part A and Part B. Sometimes, this could also cover additional services and supplies such as prescription drugs, vision, dental, and hearing care.

Part D: Prescription Drugs

Medicare Part D covers some of your parent’s prescription costs. Like Medicare Advantage, Medicare drug plans are offered by private insurers. Most companies have their own list of what drugs are covered, but it usually has at least two drugs in the most commonly prescribed categories and classes. It includes generic brands and brand-name prescription drugs.

When Does One Get Medicare?

If your parents are currently under the age of 65 and are receiving Social Security benefits, they’re automatically enrolled in Medicare Part A and Part B when they reach 65.

Medicare Part A is free for those who worked and paid payroll taxes for many years. However, Part B isn’t free and will be deducted from your parents’ Social Security benefits. They can decline this when they’re first eligible but will have to pay a penalty fee if they change their mind and sign-up for Part B later.

If your parents are 65 or almost 65 and not getting Social Security, they have to sign up for Medicare. They can do this during the 7-month period of their 65th birthday. That means three months before their big day and three months after it.

  • You should also keep these in mind if your parents plan on getting different Medicare plans:
  • Your parents can sign-up for Part A and turn down Part B.
  • They can enroll in Part B without buying Part A.
  • To enroll in Part C, they need both Part A and Part B.
  • To get Part D, they need to be enrolled in either Part A or Part B.

Original Medicare Vs. Medicare Advantage

If your parents are having trouble navigating Medicare, the chances are that they’ll just pick whatever is cheap or easy to get. While health insurance can make a difference in their lives, what is cheaper may not always be the better when it comes to their health.

For example, your parents’ insurance may only cover hospitalization, so they’ll miss out on prescription drug savings. And if they require long-term preventive care after they’re discharged, you might have to become their full-time caregiver because their plan doesn’t cover it.

After reading all of these, you might think that Medicare Advantage would be a better choice. It combines several Medicare parts, which provides more coverage options in one convenient plan. And unlike Original Medicare, Medicare Advantage plans have annual out-of-pocket limits.

However, Medical Advantage doesn’t pay well for skilled nursing, home health, and long-term care. Unlike Original Medicare, your parents may be limited in the providers and doctors they can see. They will also be restricted to their plan’s service area. If they move, their Medical Advantage might be unavailable.

Helping Your Parents Navigate Medicare

Now that you know the different options and how it works, it’s time to help your parents navigate Medicare. Follow these next steps to get started:

  1. Ask them what they need. Do they need prescription drug coverage, dental care, vision care, or other wellness programs?
  2. Pick the right plan that they can afford and suits their needs.
  3. Contact an expert.
  4. Fill out an “Authorization to Disclose Personal Health Information” form.
  5. Gather and organize their documents. See what your parents owe and don’t owe. It will help track unexpected charges.
  6. If your parents have Medicare Part C or Part D, review the “Annual Notice of Change”.
  7. Notify pharmacies and doctors about the new coverage.

With different types of health coverage and parts, getting a Medicare plan can be daunting for our parents. But you can guide them through this big decision. You need to consider their needs and review what each option covers before choosing the right one. It’s best to read through each service and compare plans carefully. You can also visit their website or contact an expert to see if they cover your parents’ needs.

Need help with your anxiety? Read ”Hypnotherapy for Anxiety: What You Need to Know” to learn more.

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