The 43 million caregivers in the US—people who provide unpaid care to family members or friends age 50 and older—are overworked and need help.
- 26 million of these caregivers hold down fulltime jobs and care of the older person in their spare time.
- 27 million of them also manage the older person’s finances, which includes helping them decipher their Medicare options.
With five parts to Medicare, 10 different Supplement plans, a multitude of Part C (Advantage) options from drug coverage to networks to out-of-pocket limits and increasing prescription drug costs, navigating the Medicare maze is a daunting task to an overburdened caregiver.
These Caregiver Medicare tips can help answer common questions and help caregivers with choosing a Medicare plan that meets both the health and financial needs of your loved one.
- Manage Timelines Effectively: Medicare eligibility begins for US citizens and legal residents when they turn 65. You have a 7-month "initial enrollment period" that begins 3 months before your birthday month and ends 3 months after. During this initial enrollment period, you can enroll in Original Medicare (Parts A&B), a prescription drug plan (Medicare Part D) or a Medicare Advantage plan. If you want to enroll in a Medigap (Medicare Supplement Insurance) policy, the open enrollment period starts the first month you’re both 65 and enrolled in Part B and lasts for 6 months. During that 6 month Medigap enrollment period you have a guaranteed right to buy any Medigap policy sold in your state.
- Avoid Late Enrollment: Those who enroll late in Original Medicare (Parts A & B) or a Medicare prescription drug plan (Part D) can incur permanent late penalties. Anyone who isn’t working, doesn’t have insurance from an employer or lives abroad should plan to enroll in Medicare at age 65. If you still work and receive benefits from an employer, you’ll need to enroll in Original Medicare within eight months of your retirement from work, even if you have COBRA benefits or if the employer provides retiree health benefits. People on Medicare who have a gap in their creditable prescription drug coverage for more than 63 continuous days will also have to pay a permanent late enrollment penalty for their prescription drug benefit (Medicare Part D) should they choose enroll in coverage at a later date.
- Don’t Expect a Notification: If the person you’re caring for began receiving their Social Security benefits before age 65, they don’t have to apply for Original Medicare when they turn 65. But nobody else should expect to receive a notice from Medicare when they turn 65. Medicare puts the responsibility on the individual senior to begin the enrollment process.
- Know Your Loved One’s Prescription Drugs: Compile a list of the future Medicare beneficiary’s current prescription drugs’ names, dosages and required frequency of use. Once you have that list, use the prescription drug plan comparison tool at PlanPrescriber.com to see if the drugs on your list are generic or available in generic form. If a generic drug is available, try to talk with the Medicare beneficiary’s primary doctor. The doctor can tell you if it makes sense to switch from a brand-name prescription drug to a lower cost generic alternative, if one is available. Once you have the final list of drugs your beneficiary is on, you can compare prescription drug plans on www.PlanPrescriber.com and help the beneficiary enroll online or over the phone.
- Obtain Consent: If you are a caregiver for your parents and are meeting with their doctor to discuss their health and treatment plan without them, make sure your parents sign a consent form so their doctor will be able to legally discuss their medical and coverage needs with you.
- Take Care of Yourself: Preserving your own health is just as important as caring for someone else’s. Take control of your own life by balancing caregiving with personal needs. Don’t be afraid to take some time out to nurture your interests and tend to your health.
- Beware of Fraud: Identify and report any Medicare fraud, abuse or scams. Carefully review the “Explanation of Benefits” statements received for all regular Medicare and Part D services. Review bills from all providers to make sure you are paying for only the services or equipment the Medicare beneficiary received. Be careful about giving out any personal information (your own or your loved one’s) to individuals or organizations. There is a helpful section on fraud and specific tips to avoid fraud at www.Medicare.go.
- Don’t Overlook Legal Matters: At a certain point, it may be advisable for your loved one to grant you or another family member a "durable power of attorney" that includes the ability to make decisions relating to your loved one’s healthcare. Discuss who will take on this important responsibility and if there are specific medical preferences or directives that your loved one has requested. You don’t want to make these types of decisions in the middle of a health crisis. Also, make sure your loved one has a Living Will or Advanced Healthcare Directive.
- See if You Qualify for Financial Assistance: If you provide unpaid care for a family member or friend, it might be possible for you to get a small but regular payment for your work. If the person you’re caring for is eligible for Medicaid, a program called "Cash and Counseling" might be available in your state. Call Medicaid or visit www.cms.gov/home/medicaid.asp to find out. The same holds true if the person you are caring for has long-term care insurance that includes home care coverage. Call the insurer to ask about this benefit and any possible restrictions.
You may be able to get Extra Help to pay for your prescription drug premiums and costs. For more information on Extra Help, you can contact PlanPrescriber.com at 800-404-6968 to be connected with a partner’s licensed representative who can discuss Extra Help eligibility rules or contact Medicare directly at 1-800-MEDICARE (1800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or Your Medicaid Office (only required for pieces referencing Part D benefits or cost-sharing). In general, beneficiaries must use network pharmacies to access their prescription drug benefit, except in non-routine circumstances, and quantity limitations and restrictions may apply. Note: The Centers for Medicare and Medicaid Services (CMS) has neither reviewed nor endorsed the information provided.
Ross Blair is president and CEO of Plan Prescriber, Inc., a leading provider of comparison tools and educational materials for Medicare-related insurance products. PlanPrescriber.com offers free and unbiased online advisor tools to help you find the optimal plan and save money.