Five Tips to Get Your Parents the Best Medicare Coverage
Have your parents asked you to help them figure out what Medicare coverage to get? There’s no one-size-fits-all Medicare coverage, but you might feel more confident helping them if you understand:
- The various Medicare coverage options available
- What type of Medicare coverage best suits your parents’ lifestyle
- Your parents’ health conditions and needs
- Your parents’ financial situation
- Whether your parents have a favorite doctor
Mom and Dad have always been there for me—during Hairy the Hamster’s funeral when I was 6 years old and during my divorce when I was 36. So when they asked me to help them make sense of their Medicare coverage, I agreed without hesitation. Now what? Here are five tips I’ve learned to help you find the best Medicare coverage for your parents’ needs.
Medicare coverage tip #1: Understand Medicare coverage options
At first, learning about Medicare can seem like playing Scrabble—all those lettered parts. Understanding the parts of Medicare coverage is your first step toward figuring out the best Medicare coverage for your parents.
Medicare Part A and Part B
Traditional Medicare, Part A and Part B, is what you typically get if you’re automatically enrolled when you qualify for Medicare coverage. Part A typically covers inpatient hospital stays, care in nursing facilities, hospice care, and some home health care. Medicare Part B generally covers certain doctors’ services, outpatient care, medical supplies, and preventive services. Your parents will pay a portion of the Medicare-approved amount as deductibles, coinsurance, and/or copayments.
Medicare Part A is premium-free if one of your parents has worked and paid Medicare taxes for at least 10 years. Medicare Part B has a monthly premium.
Traditional Medicare doesn’t cover all care. For example, it doesn’t cover prescription drugs except in certain situations, and it doesn’t cover routine dental care.
Medicare Advantage is an alternative way to get Original Medicare coverage. Private insurers contract with Medicare to offer Medicare Advantage plans. All Medicare Advantage plans provide at least the same level of coverage as Original Medicare, Part A and Part B.
Many Medicare Advantage plans offer extra benefits. These may include Part D prescription drug coverage, routine dental coverage, routine vision and hearing coverage, fitness programs, or other benefits. Newer Medicare Advantage benefits may include adult day care, transportation, and in-home support services – just to name a few examples.
Medicare Part D prescription drug coverage
The cost of prescription drugs can be a big part of health care expenses. Your parents will want to make sure they have Medicare drug coverage if they take medications to treat health problems.
Your parents can get this optional coverage by enrolling in a Medicare Advantage prescription drug plan, or a stand-alone Medicare Part D prescription drug plan. Both types of coverage are offered by Medicare-approved private insurers.
Each Medicare prescription drug plan has a formulary – that’s a list of covered prescriptions. You may want to make lists of your parents’ medications, so when you’re looking at plans, you can make sure the formulary covers your parents’ drugs. That will also tell what your parents’ cost will be. Your parents can’t share the same plan. They can both enroll separately in the same plan, but each parent will have his or her own coverage.
Medicare Supplement insurance
Medicare Supplement insurance can work alongside your Medicare Part A and Part B coverage to help cover Medicare out-of-pocket expenses. We’ll get into more details below.
Medicare coverage tip #2: Think about your parents’ lifestyle
There’s a lot to consider when trying to help your parents get the best Medicare coverage for their needs. Here are a few questions to think about:
- Do your parents spend most of their time near home? Medicare Advantage plans have regional service areas. These plans generally don’t cover your care outside the plan’s service area, except in emergencies.
- Would either parent use the extra benefits that some Medicare Advantage plans offer? For example, some plans include routine dental care. Some offer gym memberships through the SilverSneakers program. It’s a good idea to look at the benefits each plan is offering so you can help each parent find a suitable plan.
- Do your parents like to travel? Their best Medicare coverage option might be Medicare Part A and Part B along with a Medicare Supplement insurance plan. Your parents can use their basic Medicare and Medicare Supplement plan anywhere in the U.S. Some Medicare Supplement plans offer some coverage for emergency care abroad.
Medicare coverage tip #3: Consider your parents’ health
Despite having Medicare coverage, your parents might face health care costs. Does your Dad have a lot of doctor visits – or even some hospital stays lately? Or maybe Mom has just been diagnosed with a health condition that’ll mean treatment with prescription drugs. Her doctor might need to order tests for her, and she may also have a lot of doctor visits.
Many doctor visits, and hospital stays, come with out-of-pocket costs. As a result, a Medicare Part A or Part B deductible may apply.
Did you know that Medicare Supplement insurance plans may help cover these Medicare out-of-pocket costs? Your Medicare Part A and Part B deductibles* and coinsurance/copayments may be covered when you buy Medicare Supplement insurance. In fact, all standardized Medicare Supplement insurance plans generally cover Part A costs for a full year (365 days) after your Medicare coverage runs out.
On the other hand, there may be situations where a Medicare Advantage plan may suit a parent’s needs better. For example, there’s a type of Medicare Advantage plan called a Special Needs Plan (SNP). SNPs often have special programs to support members with conditions such as diabetes, cancer, and congestive heart failure – just to name a few conditions.
Your parent has to meet certain conditions to qualify for an SNP. Besides health conditions, another way your parent might qualify is by living in a nursing home or other institution, or qualifying for both Medicare and Medicaid. Read more about Medicare Advantage Special Needs Plans.
Does your parent take prescription drugs? He or she may need Medicare prescription drug coverage under Medicare Part D. Medicare Part A and Part B don’t cover most medications you take at home. You can get this coverage through a Medicare Advantage prescription drug plan or a stand-alone Medicare Part D prescription drug plan.
- *Medicare Supplement Plans C and F might not be available. These plans typically cover the Medicare Part B deductible. If your parents first qualify for Medicare on or after January 1, 2020, they won’t be able to buy these particular plans.
- Medicare Supplement insurance plans don’t work with Medicare Advantage plans.
Medicare coverage tip #4: Consider your parents’ financial security
To make sure your parents get Medicare coverage they can afford, you might want to take out your calculator. Add up their annual medical expenses for the past year or so. Then, compare that figure to monthly premium costs and estimated other plan costs. For example, say Mom’s Medicare health plan deductible last year was $300. Suppose she visited doctors several times over the year, and her coinsurance totaled $220. If you can find Medicare coverage that will cost less than that for about as many visits per year, you may be able to save your parents some money.
Keep in mind that Medicare plans have different premiums and different benefits. It’s a good idea to compare costs and coverage among the plans available where your parents live.
Medicare coverage tip #5: Ask your parents if they have a favorite doctor
Are your parents happy with their doctors? Are they willing to get care from someone else, if necessary? Many Medicare Advantage plans have provider networks. Your parents might have to use in-network doctors, or in some cases might pay more to get care from an out-of-network doctor. Rules vary among plans, so make sure your parents understand which doctors they can visit.
Most Medicare Supplement insurance plans let you visit any doctor who takes Medicare payments (assignment).
Compare Medicare coverage options available where your parents live
Are you ready to start checking out your parents’ Medicare coverage options? Enter their zip code in the box on this page, and click the tab that matches the type of coverage you’re looking at (like Medicare Advantage plans). You can show your parents what’s available in their area. The comparison tool even lets you enter prescription drugs.
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