Call waiting: Guide to helping parents with Medicare open enrollment

By Beth Orenstein Posted : 11/01/2011

senior couple discussing medicareIt's that time of year: fall is creeping into winter and the holiday season, which means it's open enrollment for Medicare. If you're an adult child helping your parents or older relatives through the process, you may have already felt guilty about screening your calls.

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To help, we've done the research for you and compiled it into a handy guide to everything you need to know about navigating Medicare open enrollment. With our primer as a resource, you can relax and enjoy Thanksgiving with your family instead of explaining what a formulary means and discussing health insurance.

The first thing you need to do is remind Mom and Dad (if they're 65 or over or disabled) that the open enrollment period for Medicare is earlier this year than in years past. Open enrollment ends Dec. 7--not at the end of the year as it has in prior years. It also started earlier this year, Oct. 15, so time is getting short.

Your parents should use the time to review their Medicare options and, if they want, to make any changes.

What can we do during Medicare open enrollment?

During this time, your parents can change from Original Medicare to a Medicare Advantage Plan, most of which are HMOs run by private companies. Or, they may switch from a Medicare Advantage Plan to Original Medicare. If they choose Original Medicare, they likely will need to buy supplemental insurance to pay their co-insurance and deductible costs. (Medicare only pays 20 percent of the doctor's approved fee.) If they choose Original Medicare, they also should decide now whether they want to keep or add drug coverage under Part D. Many Medicare Advantage Plans include drug coverage.

Your parents may be happy with the health insurance coverage they have as well as what it costs, says Fred Riccardi, director of programs and outreach for the Medicare Rights Center, a nonprofit counseling organization in New York. "They don't necessarily need to change anything," Riccardi says. "But they should at least review the options they've chosen to be certain it's what they want."

What should we ask? Where do we find answers?

Here's a list of questions your parents or relatives should ask when doing their review, and where they can find answers.

Q: Is the cost of the Medicare supplemental plan in which we're enrolled going to change?

A: By now, you should have received an annual notice of rate changes from the Medicare supplemental insurance or Medicare Advantage Plan in which you're enrolled. "It will describe what the plan costs are going to be for 2012 and if they are making any changes," Riccardi says. If you haven't received a notice, call your health insurance carrier and ask for one.

Q: What if we want to change our supplemental Medicare health insurance plan? Where can we learn about our options?

A: Here are three good places to start:

  • Your state department of insurance. You can go online or call and request a list of Medigap health insurance providers in your state, Riccardi says. Medicare users can buy a supplement health insurance plan, also called Medigap, to cover some of the costs that Original Medicare does not cover, such as co-payments, deductibles and co-insurance. Also, ask for the consumer satisfaction information on these providers. It's critical that you deal with a reputable company when buying Medigap or Medicare Advantage Plan health insurance, Riccardi says.
  • The insurance companies themselves. This time of year, many Medicare supplemental insurance providers take out full-page ads in the local newspapers and/or send you direct mail. They hold meetings locally that you can attend where you can ask questions and get answers. You can also call the company and ask to speak with a representative who can answer your questions. Are Dad's ostomy bags covered? What about Mom's visits to the podiatrist?
  • The Medicare Plan Finder on the official government website for Medicare. Here, you can do a general search with only your ZIP code or a personalized search using your Medicare number, last name and birth date.

Q. What do I need to know about a Medicare Advantage Plan?

A: Only about 25 percent of those eligible for Medicare choose a Medicare Advantage Plan, Riccardi says, although the numbers are expected to be slightly higher for 2012.

The biggest advantage to a Medicare Advantage Plan is that the cost is usually lower than for a Medigap plan. However, Medicare Advantage Plans often restrict your options in terms of the hospitals you can use for treatment and the doctors you can see.

If you choose a Medicare Advantage Plan, check to be sure the hospitals and doctors you go to regularly are part of its network. It's a good idea, Riccardi says, to ask your doctors for opinions about the plan and whether they believe it's a good fit for you, particularly if you have an ongoing medical condition.

Remember, price is not the only important consideration when choosing the plan that's right for you, Riccardi says. For example, if you travel a lot, you may not want a supplemental insurance plan that restricts your choice of doctors and hospitals.

Q: Do I need supplemental drug coverage?

A: There is a lot to think about when it comes to Medicare drug coverage, Riccardi says. As with choosing a plan, cost is just one consideration, but not the only factor that should be part of your decision.

Even if you're not taking a lot of prescription drugs now, consider joining a Medicare drug plan because you will pay a late enrollment penalty if you choose to join later, Riccardi says. You will pay this penalty as long as you have a Medicare drug plan.

When considering which drug plan is right for you, ask these questions of your pharmacist and plan provider:

  • Is the pharmacy I use in the plan? If not, are there other options that are equally convenient?
  • Must I use mail-order? Some drug plans require you to do so, while others do not.
  • What are the co-payments for generic and brand-name drugs? If you use a lot of generics, you might be interested in plans with tiers that charge you little or nothing for generic drugs.
  • What is the yearly deductible for drug coverage? Deductibles can vary--some drug plans have no deductibles but higher monthly premiums. You have to do the math.
  • What drugs are on your formulary? A formulary is the list of drugs that the Medicare drug plan covers, and it includes how much you pay for them. Each drug plan has its own formulary, so check that your drugs are covered. Of course, your health and prescriptions may change later, so it can be hard to know which plan is best for you, Riccardi says.

The government offers a good resource for making decisions about drug coverage: Medicare Prescription Drug Coverage: How to Join a Medicare Drug Plan.

Q: Where else can I find help with my Medicare questions?

A: Another good resource is your area agency on aging. Many area agencies on aging across the country provide free programs and counseling sessions for people who have questions about Medicare enrollment.

The National Area Agencies on Aging can help you find the local agency closest to where you live--there are 650 in the country.

2 Responses to "Call waiting: Guide to helping parents with Medicare open enrollment"
  1. Kimberly Taylor 18, Jun, 2013

    Just wanted to let everyone reading these commments that there is help out there to navigate through the Medicare system: In almost all counties in the US there is a Department of Aging and in those locations they have a State Health Insurance Program: The staff and volunteers in the SHIP are well trained and certified to counsel individuals and their families on their Medicare options: In your local SHIP office you can not only receive information you can also get assistance filing a claim with Medicare and many other Medicare related activities: These programs are out there people just sometimes do not know where to look!!!

      Reply»  
  2. anthem medicare 15, Apr, 2013

    I was denied by health care coverage because of health care issues.

      Reply»  

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