Medicare Open Enrollment Time Again! Helping Seniors Navigate the Options

Time again to think about your senior loved one’s healthcare options for the coming year. We know you look forward to this fun each fall!

Open enrollment for Medicare began October 15 and runs until December 7.

That means it’s time again when seniors make important healthcare selections for the coming year – – and when family caregivers of seniors should get all the information possible about loved ones’ healthcare needs,  determine the choices available to them and understand how the Affordable Care Act (ACA) affects their options and decisions.

Considerations in Meeting Seniors’ Healthcare Needs

In order to determine which coverage is best for your senior loved one, it is best to know what medical needs they have now and will potentially have in the upcoming year. No, we don’t have a crystal ball we can lend you, but an educated guess about medical needs will help you decide on the best course of action when selecting coverage.

  • Are your senior’s drugs still covered or have they been dropped from the list?
  • Does your senior have new medical conditions or supply needs?

Some seniors have numerous prescription and over-the-counter medications that need to be purchased while others may have only a few medications prescribed. Some may need medical supplies such as diabetic testing or oxygen. They might need to have routine blood work or no lab testing.

Is your senior one of those in a state of health that requires only annual physical check-ups and preventive screenings with recommended immunizations?

Unfortunately, others may have several chronic diseases that need close monitoring from the healthcare team in addition to preventive screenings.

Original Medicare covers Part A (acute care/hospital insurance) and Part B (supplies/medical insurance) while an Advantage Plan covers Part C (including A, B and usually a prescription drug plan). If you opt for original Medicare you will need to select a Part D prescription drug plan as well.

Seniors can add a supplemental plan to original Medicare to cover their out of pocket expenses. Advantage plans are generally more inclusive and therefore you can’t be sold any additional supplement/Medigap with one of these plans. Remember, these are sold through private insurance companies so be sure to compare benefits and costs to your senior when helping them make a choice.

If your senior already has long term care insurance, you should compare what that plan specifically covers as a supplement to Medicare costs to be sure you are not duplicating services with their annual election.

Affordable Care Act Changes for Seniors

If your senior is covered by Medicare and Medicaid, they do not need to consider the Insurance Marketplace set up through the Affordable Care Act since this information is specific for those people who currently have no insurance coverage and is therefore not applicable for your senior.

The ACA:

  1. Gives you a 50% discount on covered prescription drugs when you hit the “donut hole” until 2020 when the donut hole closes.
  2. Cover numerous preventive tests and screenings primarily at no cost to the beneficiary (mammograms, colonoscopies, diabetes,etc.)
  3. Includes annual wellness exam (not as extensive as a physical, you may still need that)
  4. Still have deductible costs, premium costs and 25% of drug cost until you reach the donut hole

To help you get more information and compare plans, you can review plans using at Plan Finder.

Open Enrollment Time

Open enrollment is the time to select a different insurance coverage that better meets your senior’s needs or decide that the coverage and plan they have already are exactly what they need.

It is important to investigate costs and benefits for just the right coverage instead of incurring many out-of-pocket expenses that will burden your family. This is one place where taking extra time to understand and evaluate the options can help avoid expensive mistakes and ensure our senior loved ones are getting the healthcare coverage they need.

Knowledge is power and in this case could be money too!

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