The transition to Medicare can be daunting to some. However, if they have someone to guide them, the process becomes much smoother. You can be that perfect guide to help older relatives plan for Medicare in 2021.
There are several steps involved when transitioning to Medicare. Once you’ve learned who those are, you’ll be ready to help any Medicare-eligible person in your family.
Figuring out their Initial Enrollment Period
The Initial Enrollment Period (IEP) is the first Medicare enrollment period your older relatives will experience. Their IEP is a seven-month window that starts three months before their 65th birthday month and ends three months after.
For example, if your mom’s 65th birthday is in July, her IEP will begin April 1st and ends October 31st. However, if her birthday falls on the 1st of the month, her IEP is moved up one month. So, instead, it will start on March 1st and ends on September 30th.
During the IEP, your older relatives can apply for Medicare Parts A and B. If they apply during the first three months of their IEP, their Part A and Part B will start on the 1st of their 65th birthday month (or on the 1st of the month before their 65th birthday month if they have a birthday that falls on the 1st).
You can help your older relatives during their IEPs by assisting them with the online application, getting together important forms and documents when needed, or helping them decide if they need both Medicare parts, just one, or neither at that time. If they’re covered by a large employer, they may be able to delay Medicare past their IEP.
Comparing their Medicare plan options with them
Once enrolled in Medicare Parts A and B, your relatives will have the option of enrolling in a Medigap or Medicare Advantage plan. The purpose of these plans is to limit their out-of-pocket spending on medical services. They can only enroll in one or the other, so you can help them compare each option so they can decide which type of plan is likely the best fit for them.
Medigap plans pay secondary to Original Medicare Parts A and B. They cover things such as the Part A and B coinsurance as well as the Part A deductible. For example, Medigap plan G covers these Original Medicare cost-sharing expenses and all others except the Part B deductible. If they decide a Medigap plan is right for them, they will have six months from their Part B effective date to enroll in a Medigap plan without underwriting.
Medicare Advantage plans pay instead of Original Medicare. When enrolled in one of these plans, your relative will receive coverage for their medical care through a private insurance carrier. With a Medicare Advantage plan, they will still have cost-sharing expenses. However, they will be protected by a maximum out-of-pocket limit.
If they decide a Medicare Advantage plan is the right fit, they will have three months before their Part A effective date, the month of, and three months after, to enroll in a Medicare Advantage plan.
Comparing Part D plans with them
Medicare Part D provides prescription drug coverage. Most Medicare beneficiaries will need Part D when they are first eligible, so they don’t receive a late enrollment penalty. However, if your relative enrolls in a Medicare Advantage plan, odds are the Advantage plan already includes a Part D plan.
If they have a Medigap plan or no Medicare plan, they will need to enroll in a Part D plan when first eligible. The period to enroll in a Part D plan is the same period they would use to enroll in a Medicare Advantage plan.
There are several Medicare Part D plans, each covering a different set of medications at different costs. This is the part of Medicare that your older relatives could use the most help with as Part D can be a very confusing program. Help them come up with a list of their prescription drugs, the dosing, and their preferred pharmacies. Then, use the Medicare Plan Finder Tool with them to compare the Part D plans in their area to find which plan is most cost-effective for their specific medications.
Medicare is a maze. Having someone as a guide or even just an extra set of eyes and ears to retain all the information could be just what your older relatives need. They’ll thank you for it later.