Trying to figure out Medicare can be a frustrating experience for many seniors. Along with challenges understanding certain terms, older adults may feel anxious trying to predict their needs in order to sign up for the right plan. With so many similarities in the names of plans, but with vastly varying benefits, it is easy for anyone to get confused about plans.
As a caregiver, whether you are family, a friend or a professional, helping your senior wrap their head around Medicare options can set them up for healthy aging. But it’s important that you understand the basics before you try to explain this complex and complicated system.
Understanding Enrollment Periods
Seniors have three windows to sign up Medicare — open enrollment, their 65th birthday and a qualifying event. Talk to your loved one about Medicare in enough time for them to make a decision during an enrollment option that works best for them.
Open Enrollment: An annual window that occurs every year from October 15 to December 7, where anyone 65 or older can sign up for Original Medicare and Medicare Advantage.
Your 65th Birthday: For the three months before after your 65th birthday, older adults can enroll in the Medicare plan of their choice.
A qualifying event: Enrollment is open to seniors experiencing a major life change like moving to a different state or losing coverage from a retirement package.
It’s important to keep in mind that Medicare Advantage plans also have an enrollment window. You can sign up in the fall with Original Medicare or during a special open enrollment just for Advantage Plans that runs from January 1 – March 31 each year.
Medicare Parts A, B, C, D and Beyond
You’ve definitely heard the word Medicare, and it’s likely you’ve heard it followed by a variety of alphabet letters. What does it all mean? Knowing the differences will empower you to help an older adult put it all together.
Original Medicare: This is a government-sponsored health insurance plan available to seniors over 65 that covers portions of medical bills related to hospital stays and doctor’s visits. Original Medicare is often referred to as Parts A and B.
Medicare Advantage: These plans, also referred to as Part C, are offered by private insurance companies and include Original Medicare along with extra benefits like vision, dental, wellness and prescription drugs. These plans vary from state and by insurance provider, so it’s important to research the different benefits offered in your area. For example, in most states, Humana Medicare Advantage plans often cover the popular SilverSneakers fitness program. Part D is also usually covered by most Medicare Advantage plans.
Medigap: This supplemental insurance plan steps in to help cover additional costs associated with your medical care. Unlike Advantage plans, Medigap does not include Original Medicare, but you must have Original Medicare (Parts A and B) to apply. Medigap plans typically have a higher monthly premium, but often result in lower out-of-pocket expenses.
Remember, this is just a basic sketch of what these plans look like. The reality is much more nuanced than what you can glean from three bullet points. To help hone your research, it’s a good idea to talk to your senior about their budget and their needs and wants. It makes it easier going in knowing what kind of coverage they can afford.
Starting with these two areas of navigating Medicare might not seem that difficult, but in truth they are a strong foundation to support deeper research. It’s important you help explain to your older adult that planning and researching now can prevent unexpected gaps from popping up between care needed and care covered. That’s why understanding the basics is the key to communicating this complicated, complex healthcare system with anyone 65 and older.