Caregiver Tips in Helping with Medicare
By Ross Blair
The 43 million caregivers in the U.S. — people who provide unpaid care to family members or friends age 50 and older — are overworked and need help. Here’s why:
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.
The Caregiver Medicare tips below offer help. They were developed by Ross Blair, CEO of Plan Prescriber, a provider of comparison tools and educational materials for Medicare-related insurance products. These tips answer common questions and help caregivers choose the Medicare plan that meets both the health and financial needs of their loved one.
1. Manage Timelines Effectively: Medicare eligibility begins for U.S. citizens and legal residents when they turn 65. A person has a seven-month initial enrollment period that begins three months before their birthday month and ends three months after. During this initial enrollment period, a person 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 the person is both 65 and enrolled in Part B, and lasts for 6 months. During that 6-month medigap enrollment period, a person has a guaranteed right to buy any medigap policy sold in their state.
2. 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.
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 late-enrollment penalty for their prescription drug benefit (Medicare Part D).
3. 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.
4. 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. Then use the prescription drug plan comparison tool at PlanPrescriber.com to:
– Find out if the drugs on your list are generic or available in generic form. If a generic drug is available, ask the Medicare beneficiary’s primary doctor if it makes sense to switch from a to a lower-cost generic alternative.
5. 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.
6. 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. Take time to nurture your interests and tend to your health. Know the Caregiver’s bill of rights.
7. Beware of Fraud: Identify and report any Medicare fraud, abuse or scams. To be on the lookout, 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.gov.
8. 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.
9. 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 http://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 or your loved one’s prescription drug premiums and costs. For more information on Extra Help, you can contact:
– PlanPrescriber.com at 800-404-6968
– Medicare at 1-800-MEDICARE (1800-633-4227). TTY users should call 1-877-486-2048, 24-hours-a-day/ 7-days-a-week;
– Social Security at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call 1-800-325-0778;
– Your Medicaid Office
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.
The Centers for Medicare and Medicaid Services (CMS) has neither reviewed nor endorsed the information provided in this press release.