Resources for Family Caregivers of Older Adults
Medicare Open Enrollment – Health & Prescription Coverage for Seniors

Medicare Open Enrollment – Health & Prescription Coverage for Seniors

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Every year in the fall it is time to take a good look at your senior’s healthcare coverage as part of Medicare open enrollment.

If they are on Medicare, it is time to examine whether their prescription drug plan is meeting their current needs or if they should get or change their supplemental coverage.

Open enrollment runs from October 15 to December 7.  This allows you and your senior enough time to review your current plan and where gaps may be happening that could be filled. This is especially true with regard to prescription drug plans under Part D.

Any changes you make now in your senior’s coverage will go into effect on January 1.

Open Enrollment Considerations

It is very important to get as much information as you can about your senior’s current plan and any options that could improve their benefits for the upcoming year.

Your senior may have received information in the mail about their current plan. The Annual Notice of Change (ANOC) will give you and your senior a look at what is coming in the next year.

  • Will their plan fees increase?
  • Is the copayment changing?
  • Are there higher or new out-of-pocket charges?
  • Will there be new rules placed on the plan that may change how they get reimbursement or need to file claims?

This notice will help you and your senior decide if they need to make a change.

If the fees are increasing or new rules are not acceptable, it is time to look for a plan that will better meet your senior’s needs. Perhaps things have changed in your senior’s health this year that requires them to seek out another plan that works better, covers more of what they need or reduces their own spending.

Check Healthcare Providers

Check to see if your senior’s healthcare providers are still in the network. More and more healthcare providers have changed the way they practice and may or may not continue to treat Medicare patients (sad to say but true).

Will your senior’s current Advantage plan or supplement include their trusted providers or will a different plan get them their own doctor or specialist?

Perhaps you and your senior are very happy with the coverage that they currently have. Even so, you should all look over the options to see if there might be something slightly more beneficial or at least to ensure you that your loved ones are in the best plan for the coming year. If so, keep the plan they have and spend the year assessing if all their needs continue to be met so you will be ready for the following enrollment period to re-evaluate the coverage.

Too much knowledge isn’t a bad thing.

Prescription Drug Plans

Looking into other prescription drug plans should top the list of activities with which you assist your senior loved one during open enrollment. Research has shown that many seniors can lower their plan fees and expenses by investigating other plans.

Did you know that different pharmacies charge different co-pays? It will benefit your senior to look into the nearby drugstores. Check to see if their favorite pharmacy is the preferred provider under their prescription drug plan.

For many seniors, the list of prescription medications, use of generics, dosages or frequency of medications has changed at some point over the current benefit year.

The drug coverage plan should be geared toward the types of medications your senior takes. When these medications change, the drug coverage may not be sufficient. If they can’t pay for what isn’t covered, seniors will often just not take the prescribed drugs, which could have severe consequences.

Are there limitations or rules that your senior currently has in their plan, such as getting a three month supply at a time that easily gets changed right after they re-order leaving them holding the bag (and spending the money) on drugs that they can’t use or are they limited to which pharmacy they can use? There are numerous considerations when looking for the most appropriate plan.

It will take a little investigative work so prepare to step up to the challenge!

Help to Search the Possibilities

If you want to learn more about the available prescription plans in which your senior might benefit including pharmacies and drug costs based on your senior’s medication list but feel overwhelmed with the leg work that might be required to find out about the options, you can visit the Medicare.gov website and use the locator to help you in your search. It will use your locale to help you search for the best options for your senior loved one.

You can contact Medicare directly by calling 1-800-Medicare to learn about the available advantage plans that could help gain the best possible and affordable health care for your senior. They can give you a list of plans and information about them. From there, you can contact the advantage plan provider and get the specific details. When you have compared a few choices, it will be easier to make an informed decision or guide your senior’s choice.

You should be sure the plans cover their doctors and local hospitals or clinics so that they can continue to receive the care they have come to trust.

If your and your senior loved one are dissatisfied with any of the choices you make or the changes to the Medicare Advantage plan you thought would be an improvement, there is a period of time between January 1 and February 14, known as the Medicare Advantage Disenrollment Period, when you can make changes as desired.

If your senior is a beneficiary of Medicare, they do not need to use the Health Insurance Marketplace for any health coverage. That is designed for those people without health insurance and not those covered by Medicare.

Dental Plans

You may already know that Medicare does not cover dental expenses so you and your senior may wish to investigate whether a dental plan would be a worthwhile expense for them. Open enrollment is a good time to think about this insurance option too.

There are dental plans available for seniors, including one through AARP and the Delta Dental Insurance Company. Plans include fixed premiums, three cleaning per calendar year, guaranteed acceptance and a large network of local dentists.

Many seniors decide to forego dental plans and limit dental care due to financial issues seeking mouth care only in emergencies. Dental problems can severely impact overall health in seniors and lead to poor nutrition.

Some seniors opt to pay cash for each dental visit and can work out a discounted rate from a dental group in their community. However you and your senior choose to finance the care for their teeth, dentures or mouth, be sure that this is on the list for regular healthcare for your senior.

We know that sometimes one more task to accomplish as a family caregiver could be one too many, but learning all you can and helping your senior make wise financial, healthcare choices will alleviate headaches (and other health problems!) in the coming year for you both!

We'd love to hear your thoughts!





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