Are you caring for an aging parent or spouse? That can be overwhelming (especially today). And, if you’re making their health care decisions, navigating Medicare can seem like yet another chore. It helps to learn the basics of Medicare, so we’ve covered those below. It also helps to find out where support is available to shop for and choose the coverage that best fits your loved one’s needs.
Medicare Parts A and B
When Medicare was signed into law in 1965, it included two “parts” or kinds of coverage. Part A is hospital insurance and Part B is medical insurance. Together, Parts A and B are referred to as “Original Medicare.”
With Original Medicare, there are deductibles and coinsurance to pay. And it does not include important benefits like Part D prescription drug coverage and routine care, like vision and dental. That’s why many people choose to enhance their coverage.
Adding to Original Medicare coverage
If your parent or loved one needs more benefits than Original Medicare provides, they have options, including:
Medicare Advantage plans, also called Medicare Part C, are run by private insurance companies, like EmblemHealth. They include Part A and Part B benefits, plus most include additional benefits like routine care and wellness programs.
Another “advantage” of these plans is the limit on how much a Medicare beneficiary will have to spend each year for covered medical expenses. This is called the annual out-of-pocket maximum, and every Medicare Advantage plan has one.
Medicare Part D prescription drug coverage
Medicare Part D is not offered by Medicare itself. You can get Medicare Part D from a
Medicare Advantage plan. This is called a Medicare Advantage Prescription Drug plan, or MAPD. You can also choose to purchase a separate Part D plan run by a Medicare-approved, private insurance company. These usually come with a separate premium.
Medicare Supplement plans
Medicare Supplement plans, also known as “Medigap,” help cover some of the costs that Original Medicare does not, such as deductibles, coinsurance, and copayments. Medicare Supplement plans do not include prescription drug coverage. A separate Part D plan would need to be purchased.
Things to consider when choosing a Medicare plan
Take into account your loved one’s medical and prescription drug needs, financial resources, and the level of flexibility they want.
If they need more coverage than Original Medicare, here are two options to consider:
- A Medicare Advantage Prescription Drug plan can help simplify things and ease the financial burden, including many $0 premium plans, combined medical and prescription coverage, and extra health and wellness benefits. Some plans even include dental, too.
- A Medicare Supplement plan may be a good option if your parent or loved one doesn’t mind paying a higher monthly premium in exchange for fewer out-of-pocket costs for medical services. Remember, to get coverage for prescriptions, a separate Part D plan must be purchased.
Many Medicare Advantage plans include other benefits to help keep people well. Those may include (at no extra cost):
- Prescription home delivery.
- Exercise programs and gym memberships (such as SilverSneakers).
- Eyeglass and hearing aid discounts.
- Over-the-counter (OTC) medicine allowances.
Dental benefits may be included or available at an added monthly cost.
“Extra help” from Medicare is available
People with limited incomes may qualify for “extra help” to pay for their prescription drug costs. For qualified members, Medicare could pay up to 75% or more of drug costs, including monthly prescription drug premiums, annual deductibles, and coinsurance. Additionally, those who qualify will not have a coverage gap or late enrollment penalty.
Many people are eligible for these savings and don’t even know it. For more information, or to see if your loved one qualifies, contact:
- 1-800-Medicare (1-800-633-4227) (TTY:1-877-486-2048), 24 hours a day, 7 days a week,
- The state Medicaid office, or
- The Social Security Administration at 1-800-772-1213. TTY users should call 1-800-325-0778, between 7 a.m. and 7 p.m., Monday through Friday.
We’re here for you
Choosing a Medicare plan for your parent or loved one is a big decision. You don’t have to figure it out on your own. Medicare Annual Enrollment Period ends December 7. Enrollment for Individual and Family plans ends January 31. Explore our plans and enroll soon to make sure you have the coverage you need in 2021. Questions? Call us at 800-859-4880 (TTY:711).