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Medicare: What Might Surprise You - Aging Wisely

If you are a Medicare recipient or a caregiver who helps an aging parent with medical, financial or care needs, it is important that you understand Medicare coverage, options, restrictions, etc. We talk to many family members who care for aging parents and are surprised by needs that Medicare does not cover. To get a concise overview of the various parts of Medicare and what each covers, start with our Medicare Fact Sheet (with 2012 Medicare co-pays and deductible information). Contact us for printed copies of this information and Medicare educational materials or seminars, if you have a support group, community group, or clients with whom you’d like to share this information.

We are currently in one of Medicare’s annual open enrollment periods. This year, from October 15th to December 7th, Medicare recipients can switch Medicare drug plans (Part D) and switch to or from a Medicare Advantage plan. Each Medicare recipient or caregiver should review their current coverage during this period. Plans make changes and it is likely you or your loved one has had some health changes, which may cause a different plan to be more appropriate for you. The changes you make become effective on January 1st. Additionally, from January 1st-February 14th, those enrolled in a Medicare Advantage plan can disenroll and switch back to regular Medicare (this is the only change that can be made during that period).

Medicare Advantage Plans are an option for receiving various Medicare benefits via a private insurance company. Typically, these plans will have preferred providers or networks (or providers may not accept the coverage due to the reimbursement rates) and may require a primary care physician or have other restrictions. They may also include additional benefits such as eye or dental care or gym memberships, and the deductibles, co-pays, etc. are usually less expensive for the recipient. If a person is enrolled in a Medicare Advantage Plan and is not pleased with the plan’s coverage and choices, there are several special enrollment periods to make changes.

You may, for example, be caring for an aging parent who is enrolled in a Medicare Advantage plan and becomes hospitalized. After the hospital stay, he/she may need inpatient rehabilitation care at a Skilled Nursing Facility. However, the Medicare Advantage Plan may have limited skilled nursing facilities within the network and you may not be pleased with the options. In that situation, there is what is known as the OEPI (Open Enrollment Period for Institutionalized Individuals). Persons “institutionalized” (i.e. residing in or moving in and out of a skilled nursing facility and other eligible institutions) have a continual enrollment period. The person can disenroll from a Medicare Advantage plan while in the facility and return to regular Medicare (or a different MA if accepting enrollment) the beginning of the next month.

There are other special enrollment periods for those wishing to switch plans, including a “trial period” when you first sign up for a Medicare Advantage Plan of 12 months, in which you can disenroll and switch back to standard Medicare at any time during that period. If you are concerned about coverage under any plan or do not understand a plan’s coverage decision, it is important to learn about your Medicare rights, including the right to appeal. Medicare and health insurance can be complicated to navigate, so it is vital to be your loved one’s advocate as a caregiver and to seek outside help when you have questions or difficulties.

We will be covering a number of the key issues that surprise caregivers about Medicare coverage in upcoming blog posts so stay tuned, or sign up for the Aging Wisely blog feed to get updates.

On November 17th, we are offering a free educational seminar, The Ins and Outs of Medicare, in honor of National Family Caregivers Month. Come learn more about Medicare coverage, questions to ask and how to better understand your coverage. We navigate the healthcare system every day with our clients, so let our expertise benefit your family.

If you would like help analyzing your Medicare plan during this year’s open enrollment period, or you are preparing to retire and want a complete analysis of your options and what you need to do regarding Medicare coverage, call us today at 727-447-5845 or fill out our contact form to discuss our Medicare Analysis services.

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