It’s also the perfect time to have a broader conversation about their overall care needs.
There are a multitude of options when it comes to Medicare Advantage plans, allowing individuals the flexibility to choose the one that best fits their personal health and wellness needs. If you’re a caregiver, or an adult child helping with an aging parent, the choices can feel complex and overwhelming. Luckily, there are plenty of resources and experts that can help you navigate this critical healthcare decision with your loved one. You’ll just want to make sure you do the research ahead of time — the Medicare Advantage and Prescription Drug Annual Election Period (AEP) runs from October 15 through December 7.
And if you’re a caregiver or handling care from a distance, it’s always smart to use this time to ask your loved one about their overall care needs, explains Catherine Field, Humana’s senior vice president and Medicare division leader. “Even if your loved one is talking or moving a little slower as they age, they absolutely have a view and an opinion about what kind of care they need and if they’re not getting what they need,” says Field.
So, while you’re helping them pick out their Medicare coverage, use this time to find out how you can support them in other ways besides getting them on the right healthcare plan. “You may find there are needs outside of just changing their healthcare plan. Maybe they need more help driving, help around the house, or stability bars in their home because it’s a struggle to get in and out of the shower,” says Field. “Slowing down and taking the time to listen is probably one of the values that a caregiver or an adult child can really offer when you’re having this healthcare discussion,” says Field.
To help clear up some of the confusion around Medicare Advantage plans and AEP, we asked Field to tell us where caregivers should start, what resources are available to narrow down the search, and other ways to make an impact on someone else’s healthcare plan. Below, read her expert tips and explanations for some of the most frequently asked questions around the topic.
KCM: Where should caregivers start when they’re trying to figure out what Medicare plan is best for their loved one?
Catherine Field: I always recommend folks start with a personal needs assessment of the person you’re trying to help choose a plan.
- Current coverage: What health, prescription, dental and vision coverage do they have? How much does each cost? What do they like most about their plans? What are their favorite benefits, doctors, hospitals or other plan features?
- Future coverage: What would they add or change to their current plan to like it ever more? What do they hope to gain by selecting a new Medicare plan? Do they travel often or live elsewhere part-time?
- Spending: What was their healthcare spend this last year, and where do you think it will be this upcoming year?
- Medications: Do they have a chronic illness or need to take certain specific medications?
- Surgeries: Did they have a surgery this year but they won’t need one next year? Or will they have an upcoming surgery this year?
Taking an assessment of where they spend their healthcare dollars this year and next year is crucial.
What should the next consideration be for caregivers trying to navigate the process?
The second thing I tell people to do is to focus on who their doctors are. Ask yourself:
- Is there a specialist they have to see?
- Is there a hospital that’s near their home that you want to make sure they go to?
If so, you want to make sure that those providers and the healthcare community that supports you are in-network for the plan you’re choosing.
And finally, you should look at Medicare Advantage plans as compared to Original Medicare. There are a lot of extras that may come along depending on the plans available in your area — dental, vision, hearing, over-the-counter benefits, transportation, no-cost premiums, and flexible allowances — and which of those things may be more or less important to your loved one.
If prescription drug benefits are a priority, how do you figure out which plan to enroll in?
Many Medicare Advantage plans include a prescription drug benefit, so you want to figure out if your loved one’s medications are on the drug list for that plan. Logging your loved ones prescriptions in to an online pricing tool is going to help you decide what their needs are and help you choose a plan that matches those.
Do any Medicare Advantage plans offer financial assistance?
There are a few pieces on the plan that can help with financial assistance, such as:
- Some plans have a “Part B Give Back.” That’s where part of the Medicare Part B (or outpatient and preventive services) premium is reduced so that less is deducted from the beneficiary’s Social Security check.
- Some have an allowance for certain qualifying members to assist with groceries, rent, non-medical transport and even pest control and pet care supplies.
- Other plans have an over-the-counter benefit that can be used for things like vitamins, a blood pressure cuff, or a thermometer. It’s used for things that help manage health and wellbeing.
What happens if you miss the enrollment period?
AEP is from Oct. 15 through Dec. 7. If you miss it, you will likely stay on the same plan that you were on before.
There are a few exceptions, or Special Enrollment Periods, when you can change outside of AEP, but they are limited. The special periods may be an option if you move to a new address and your current plan will no longer cover you or if you lost coverage because of an employment change or other circumstance. Also, if a 5-star Medicare Advantage plan is available in your area, you are allowed to switch to it one time per year; a 5-star rating is the highest possible rating from the Centers for Medicare and Medicaid Services (CMS).
It’s important to start planning early. You can make appointments with a licensed sales agent today, and start doing that needs assessment, so you end up on the right plan.
Are there other resources caregivers should use to help guide this decision?
I recommend three places:
- Medicare.gov is an excellent resource. They have physician, drug, and plan finder tools and a lot of resources to help weed out plans.
- You can do the same on humana.com or other insurance carrier websites where there are similar kinds of tools.
- You can also sign up to have either a virtual or in-person appointment with a licensed Medicare Advantage sales agent. I think they’re worth their weight in gold because they can work through everything with you. If you’re an adult child living in another city, you can get on the phone with them, and your parent can FaceTime in with you to have a three-way conversation.
Can you switch plans if you end up choosing one that’s not right for your loved one?
Every year, between January and March, the Medicare Advantage Open Enrollment Period takes place. This is when, if you’ve selected a Medicare Advantage plan you’re unhappy with, you’ll have an opportunity to make a one-time change. If you already had a Medicare Advantage plan then you can go back to the plan you were on, or you can always go back to original Medicare.
Are there other meaningful ways to figure out if your loved one is getting proper care during this time?
During this time when you’re talking about finding the right plan, I always encourage people to also talk about whether their loved ones’ doctors are meeting their needs. Oftentimes, we age with our doctors — like them, their doctor might be about to retire too. But there are many skilled doctors who are focusing and specializing in senior care.
I really encourage having a conversation with your loved one around: Are you getting enough time with your doctor? Are you getting your questions answered? Is your chronic condition being adequately or superiorly managed? Things like having blood sugar just even slightly out of whack or not having congestive heart failure managed can affect not only their longevity but their quality of life. I always say their doctor matters as much as their plan. Those two things really go hand in hand.
Humana is a Medicare Advantage HMO, HMO SNP, PPO, PPO SNP, and PFFS organization with a Medicare contract. Enrollment in any Humana plan depends on contract renewal. ID: Y0040_GCHLSM6EN_M.
