Whether you’re one of the 66 million Americans caring for an aging parent, grandparent or loved one, or just a son or daughter watching your mom and dad approach retirement, you know how important it is for your loved ones to have health insurance that fits their needs. And that means both understanding Medicare and talking to them about coverage; two things that are difficult.
Here is a basic overview of Medicare to help you get that conversation started.
What is Medicare?
Medicare is the federal health insurance program for people who are 65 or older (individuals are also eligible for Medicare at an earlier age if they have kidney disease or certain disabilities).
What’s the difference between Original Medicare and Medicare Advantage?
Original Medicare is our country’s health insurance program for those who are 65 and over or who have a medical disability. Original Medicare includes Part A and Part B coverage. Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care and some home health care. Part B covers certain doctors’ services, outpatient care, medical supplies and preventative services. Learn more about Part A and B here.
Medicare Advantage, formed in 1995 by the federal government, was created to give people more options. Medicare Advantage plans are sold by private health insurance companies, like Blue Cross Blue Shield of Michigan, and are regulated by the federal government. Medicare Advantage is referred to as Part C. Part C plans include Part A and Part B and additional benefits which may include dental, vision, hearing and prescription drug coverage. Part C plans have an out-of-pocket maximum each year.
Are individuals automatically enrolled in Medicare when they turn 65?
If the person is collecting Social Security or benefits from the Railroad Retirement Board, they’ll be automatically enrolled and receive a red, white and blue Medicare card in the mail three months before their 65th birthday or their 25th month of disability. They will need to sign up for Part A and Part B (Original Medicare) if they aren’t getting Social Security or RRB benefits (e.g., they’re still working).
Because Original Medicare doesn’t cover everything, they might choose to purchase a Medicare Advantage plan, a Medicare Supplement plan and/or a prescription drug plan (Part D). More about the enrollment process for those plans can be found here.
What if the individual wants more coverage than Original Medicare provides?
Then a Medicare Advantage plan may be the best fit. Learn about the benefits of going with a Medicare Advantage plan here.
Is Medicare the same nationwide?
Medicare plan options differ for each state, so it’s important to get state-specific advice and plan options before talking to loved ones about enrollment. If your loved ones travel out of state frequently, it’s also important to look at the availability of providers in the locations where they will be spending time. Some Medicare Advantage plans have nationwide provider networks so some costs for care received away from home may be covered.
Even if the person considering a new Medicare plan has had Medicare for a few years, it’s helpful to talk with them about their current medical needs and research new plans in case one could be a better fit. If they decide that a new plan is best for them, they can switch during the Annual Enrollment Period (Oct. 15 through Dec. 7).
Starting the conversation about Medicare early with your loved one will bring a sense of security to everyone involved in their care decisions. Also, taking the time to think through expenses ahead of time brings peace of mind. If you’d like to learn more about Medicare, these blogs will help you better understand the options currently available on the marketplace:
- Almost Eligible for Medicare? 4 Must-Knows Before you Enroll
- Your Most Pressing Medicare Annual Enrollment, Questions
- Medicare 101: Understanding Medicare Plans A-D
Medicare Plus BlueSM, Blue Cross® Medicare Private Fee for Service, BCN AdvantageSM and Prescription BlueSM are PPO, PFFS, HMO-POS, HMO and PDP plans with Medicare contracts. Enrollment in Medicare Plus Blue, Blue Cross Medicare Private Fee for Service, BCN Advantage and Prescription Blue depends on contract renewal. This information is not a complete description of benefits. Contact the plan for more information. Benefits, premiums and/or co-payments/coinsurance may change on January 1 of each year.
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Photo credit: David J Laporte