Learning Center > How to Prepare For Your Aging Parents' Future

How to Prepare For Your Aging Parents' Future

Retirement is one of life’s biggest milestones. But with the celebration comes challenging decisions to make before and during retirement: finances, living situations, healthcare, and insurance, to name a few.

And if you’re helping your parents with their retirement planning, you might already be making calls or doing online research to support them with these decisions that impact their futures as retirees.

The planning can be overwhelming, so try breaking it down into 4 buckets: financial planning, healthcare, living arrangements and health insurance.

With these buckets in mind, you'll need to ask yourself things like:

  • What will my parents' monthly income and budget look like?
  • Is the money sufficient to maintain a comfortable standard of living?
  • Are there current or impending health concerns to plan for?
  • Are there plans for relocation after retirement?
  • Will long-term care or home health care be needed?

Plan ahead with these 4 tips

1. Face the facts with financial planning

Though many baby boomers made sound financial retirement plans, nearly 50% did not. And still, the economic crash of 2008 challenged people's savings accounts - even those who planned ahead.

Those who wisely chose conservative retirement portfolios feel a pinch because many will outlive their investments. So inevitably: People are working longer than expected. In fact, nearly 11 million people over the age of 65 will continue in the workforce because they simply cannot afford to retire.

But aside from working longer, your parents may want to improve their financial situation in the following ways:

  • Downsize their home. A smaller home gives your parents more money back in their pockets. A smaller home is also easier to navigate and keep clean.

  • Make lifestyle changes. Eliminating a second car or relocating to an area where the cost-of-living is lower are some things retirees are doing to improve their financial situation. Some also find that volunteering helps fill time that would otherwise consume income.

  • Move in with their children. This generally happens only after they have no alternative. But know that this decision takes careful planning and patience.

  • Sign up for Medicaid. If seniors have a very low retirement income, they may qualify for both Medicare and Medicaid. This will be especially helpful if they face costly medical care and potential long term care.

  • Shop for Medicare Advantage and Medicare Supplement plans. Both Medicare Advantage and Medicare Supplement plans have their benefits, depending on your parents' healthcare needs. But Medicare beneficiaries can only enroll in one or the other. That said, your parents can make individual choices so that one might have Medicare Advantage, while the other has a Medigap policy. These plans can help seniors to better manage healthcare costs.

2. Talk to your parents about their health

Most people have a pretty good idea of the health concerns they'll face as they age. As examples, it's likely that life-long smokers know they have a higher-than-average risk of developing lung disease, cancer, or heart conditions. Someone who is overweight and inactive knows their risk of diabetes is higher. And people with a family history of certain cancers know their personal risk is higher.

Know that it's OK to discuss potential and existing health concerns with your parents now before they become unmanageable later in life. While the conversation might be uncomfortable, it's a necessary step in the planning process.

3. Discuss living arrangements

When the time is right, you may want to talk with your parents about long-term care, home health care, or other living arrangements, depending on their situation.

Long-term care

The first thing to know: Medicare does not cover long-term care. But some services associated with long-term care may be covered.

Long-term care is for those who are disabled or have chronic conditions, which prevent them from managing many of their daily needs including:

  • Preparing meals
  • Bathing/showering
  • Getting dressed
  • Housekeeping
  • Transportation

Though Medicare doesn’t cover long-term care, Medicaid does. There are also separate long-term care insurance plans available for purchase. But know that the right time to get this coverage is before it's needed.

Home health care

Home health care includes medical and non-medical assistance in your own home. For instance, bathing assistance and performing simple chores around the home like washing dishes may be provided by home health care providers. Just don't ask them to repair your ceiling fan.

For good reason, home health care is an option that's on the rise and is expected to keep growing. Thanks to the Chronic Care Act of 2017, the Centers for Medicare & Medicaid Services (CMS) has authorized expanding some home health care coverage via Medicare Advantage plans - a good step if you or your parents will need these services.

One word of caution: Medicare Advantage plans can change from year to year, so be sure to pay attention to these important changes.

Relocation

If your parents are in good health, you may still want to give them food for thought if they plan to relocate to a warmer, sunnier state. For instance, Original Medicare and Medigap coverage will be unaffected as those are not tied to specific service areas. On the other hand, Medicare Advantage and Prescription Drug Plans (Medicare Part D) are mostly tied to specific service areas so a plan change may be necessary.

That said, relocation may be beneficial, just be sure to talk to a licensed insurance agent about Medicare options for your parents first.

Ask your parents to move in

Though it can be a sensitive situation, you may opt to have your parents live with you during their retirement. But be sure to think of things like ways to help them with mobility, especially as they age.

For example, you might need to install wheelchair ramps, safety rails in shower stalls, or other safety precautions. Some of these features may be covered by Medicare, so consider these options when comparing Medicare Advantage policies for your parents.

4. Understand Medicaid vs. Medicare

Insurance is all about protection and peace of mind. And although no one can predict the future, having a sound insurance policy in place can protect your aging parents (and you) from potential financial distress. The simple fact is that Original Medicare does not cover everything seniors may need. That's why Part C (Medicare Advantage), Part D and Medigap plans were developed.

But some Medicare beneficiaries may qualify for dual enrollment in Medicare and Medicaid. That's because Medicare is federally administered, while Medicaid is provided through the state.

If a person or couple fall within certain federally-mandated poverty guidelines, they may qualify for both. This will provide them with 100% coverage at no to very low cost.

To see if your parents qualify for dual-enrollment, visit Medicaid's Seniors & Medicare and Medicaid Enrollees page. You'll find charts that show income levels for qualifying by region.

Get Help With Medicare

If your helping your parents to explore their Medicare options, you'll want to first look at their current Medicare plans to see if they're cost-effective and fit with their specific health needs. You will also want to list all sources of income. But if your parents don't have one, you can help them create a budget so that you know what they can afford and where they may need to make changes.

Whether your parents are aging into Medicare or getting ready for retirement, our licensed insurance agents are available to help you and your parents explore Medicare plans in your area.

The sooner you help your parents plan for the future, the better. After all, your parents don't have to be alone when it comes to managing healthcare expenses and finding the right Medicare plans for their needs.

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And Medicare vaccine coverage gives those ages 65 and up the support needed to get access to crucial vaccines. After all, preventing infection is much easier than treating certain illnesses, especially those that affect the respiratory system like COVID-19, flu, and pneumonia. Through Medicare Part B of Original Medicare and Medicare Part D drug plans, you can be sure that necessary vaccines will be covered at the optimal doses and frequency. But just because a vaccine is recommended for most people and covered by Medicare doesn’t mean that you should run out and get it. Some vaccines may not be suited to you based on your individual health status and history. For this reason, it’s critical that you speak with your doctor about the vaccines you should and shouldn’t receive. You can also learn more about Medicare coverage for vaccines on the benefits provided by your Medicare insurance plan. Just remember: Part D plans change their formularies every year, so the costs of Medicare Part D vaccines may change. Always review your coverage during the Medicare Open Enrollment Period, and consider switching to a plan that better suits your needs if necessary. If you’d like to get help finding a Medicare plan, call 800-620-4519 to speak with one of our licensed insurance agents, or click to try our Medicare plan comparison tool to find Medicare Advantage or Prescription Drug Plans near you. The above information does not constitute medical advice. Always consult with a medical professional regarding your health needs. If you are experiencing a health emergency, contact your local emergency health services immediately or visit the nearest emergency room or urgent care.
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Retirement should be a time of joy and freedom, but too often these years can unfortunately be tainted by battles with chronic illnesses. And one of the most common is cardiovascular disease (CVD), often called heart disease. In fact, heart disease is the leading cause of death in the United States. That’s why February marks American Heart Month - a way to bring awareness to heart disease and help spread tips on heart disease prevention. And to help celebrate American Heart Month, we’ll review some of the facts about cardiovascular disease, along with tips to combat it. Then we’ll dive into how your Medicare coverage can help you prevent, treat or manage cardiovascular diseases. What Is Heart Disease? Heart disease, also known as cardiovascular disease CVD is a broad term for several different medical conditions. But generally speaking, heart disease is an illness that affects the heart or circulatory system. The illnesses that fall under the heart disease category include: Coronary artery disease (CAD) Heart rhythm problems Congenital heart disease Infections of the heart tissue Heart valve disease Cardiovascular Disease Risk Factors Many of the biggest risk factors of cardiovascular disease are lifestyle related. And while there’s a general assumption that these factors are the sole cause, many people are actually born with heart disease. It can be congenital and hereditary. But those with lifestyle risk factors have control over heart disease prevention. The main risk factors and causes of heart disease include: Obesity High cholesterol Diabetes Smoking High blood pressure And these causes of heart disease can be directly tied to such behaviors as: Poor diet Poor physical activity Too much alcohol Tobacco use Genetics or heredity Simply put, the lifestyle habits (good or bad) that we form are what lead to the major risk factors for cardiovascular disease. Genetics and heredity may then play a role in whether or not we actually develop heart disease. 4 Tips To Prevent Cardiovascular Disease CVD As we mentioned above, the fact that so many of the risk factors for CVD are lifestyle related can be a silver lining, meaning we can make smart choices and avoid unhealthy behaviors to protect our hearts. Now let’s walk through some healthy habits to maintain good heart health. #1. Stop Smoking Quitting smoking is almost universally hailed as the biggest step to reduce your risk of heart disease. Smoking is considered the most easily avoidable lifestyle factor that leads to cardiovascular disease. So if you currently smoke, make an attempt to stop now. Quitting smoking will also save you money, making this heart disease prevention tip a no-brainer. #2. Eat Healthy Diet also plays a big role in the health of your heart. A poor diet multiplies and compounds risk factors, but a smart, healthy diet can reduce your risks and get your heart in great shape. You should always speak with your doctor about nutrition and heart healthy diet options. But generally speaking a heart healthy diet may include: Fruits and vegetables Whole grains Low-fat dairy products Skinless poultry and fish Nuts and legumes In addition to eating these nutritious foods, another suggested tip is to limit your saturated fat, sodium, and sugar intake. This type of diet fits into the DASH (Dietary Approaches to Stop Hypertension) eating plan. #3. Stay Active There’s no getting around the fact that an active lifestyle is a healthy one. But you don’t have to jump right in and overdo it. In fact, gentle but steady exercises can be great way to help prevent heart disease, including: Walking 30 minutes per day Cycling Swimming The main point is to pick an activity that you enjoy. So if you have a scenic path, beach, or lake nearby, consider talking walks or riding your bike there. You should also have a backup plan for poor weather or to keep safe and healthy during COVID-19. Research home workout apps or programs on platforms like YouTube or you Smart TV. But just remember: If you over-commit to exercise and activity, you may fall off the wagon completely. Instead, start small, and add time and distance gradually. If you make it a firm part of your routine, you’ll stick to it. Again, always be sure to consult your doctor before developing an exercise or activity regimen for heart health. #4. Stay Informed About Your Cardiovascular Disease CVD Risks One of the most important heart disease prevention tips is to stay proactive and empowered about your own personal health. This is especially true if you have a family history or genetic predisposition. Here are some key strategies: Don’t miss or delay your doctor’s appointments. If recommended, make sure you get cardiovascular screenings and tests. If you’re on heart disease medications, be sure to consistently take them and follow your treatment plan. Ask questions and be proactive when it comes to your health and wellbeing. How Does Medicare Cover Cardiovascular Disease CVD? If you’re on Medicare or aging into Medicare,and cardiovascular disease prevention and treatment is important to you, you’re in luck. All aspects of the Medicare program cover heart disease related measures. This includes Medicare cardiovascular screening, treatment, and healthy lifestyle tools. Heart disease prevention and treatments are covered by: Original Medicare Part A Original Medicare Part B Medicare Part D drug plans Medicare Advantage plans (Part C) Medicare Supplement Insurance (Medigap plans) In the most basic sense, Medicare will cover all the stages of cardiovascular disease, including: Annual screenings (covered by Part B) Doctor’s visits, both primary and specialists (covered by Part B) Heart condition medications (covered by Part D) Cardiovascular tests and procedures (covered by Part B) Hospitalizations (when admitted as an in-patient, covered by Part A) When you use Medicare Part B under Original Medicare, you can expect to pay: Part B deductible ($203 for 2021) Part B coinsurance (20% of the Medicare-approved charges) Part B excess charges (up to 15% of the Medicare-approved charges if you use providers who don’t agree to Medicare’s prices) When you use Part A coverage under Original Medicare, your costs may include: Part A deductible ($1,484 per benefit period) Part A coinsurance of $0 per day (after you pay the deductible) for hospital stays of up to 60 days Part A coinsurance of $371 per day for hospital stays over 60 days Medicare Cardiovascular Screenings Medicare covers cardiovascular screenings, which involves a blood test once every five years. But if your doctor orders more frequent cardiovascular screenings and tests, Medicare will cover them. However, you’ll pay your share of costs as we outlined above. Medicare Cardiac Rehabilitation Programs Medicare Part B will cover part of the costs for cardiovascular disease rehabilitation programs. These covered programs include exercise, education, and counselling designed to maintain your heart health. Note: Medicare Part B will cover these cardiac rehabilitation programs, only if any of these scenarios apply to you: You’ve had a heart attack in the last 12 months. You’ve had heart bypass surgery. You’re experiencing stable angina or chronic heart failure. You’ve had a heart of lung transplant. You’ve had a valve or artery repair or replacement. Once again, you’ll pay your standard 20% coinsurance if you use these cardiac rehab programs under Medicare Part B. Cardiac Tests Covered By Medicare Beyond standard cardiovascular disease screenings and rehabilitation programs, Medicare will cover medically necessary cardiac tests ordered by your doctors. These types of heart tests may include: Blood tests Echocardiograms (ECG) Exercise stress tests - MRI or x-rays Just as with the other services, you’ll pay 20% cost-sharing under Part B of Original Medicare. Cardiovascular Medications Most prescription drugs are not covered by Original Medicare. But you may be able to get heart and cardiovascular prescription drug coverage through a Medicare Part D plan. The 2 types of Medicare plans that offer Part D: Standalone Prescription Drug Plans (PDP) and Medicare Advantage plans that include Prescription Drugs (MAPD) It’s important to note that not all drugs are covered by all Medicare Part D drug plans. However, all Part D plans must cover at least two drugs in every therapeutic category, including heart disease or cardiovascular disease. Tip: You can use our prescription lookup tool to see if your drugs are covered under Medicare Part D. Medicare Chronic Condition / Disease Management Programs If you have more than one chronic condition, you can qualify for special disease management programs. These are also covered by Original Medicare, but you’ll still be responsible for your standard cost sharing. You may also have to pay a monthly fee to participate in these chronic care management services. Under these management programs, you’ll work with your healthcare professionals to craft a comprehensive health plan tailored to your heart condition. A chronic care management plan may include: Goal setting and health evaluations Working with all of your specialists Managing your medications Cardiovascular Disease And Private Medicare Plans So far, we’ve reviewed your coverage and costs under Original Medicare. But if you choose a private plan option like Medicare Advantage or Medigap, these plans will cover your cardiovascular health as well. If you enroll in a Medicare Supplement plan, your plan will pay part of the costs you’d normally pay out of pocket. If you enroll in a Medicare Advantage plan, you’ll likely pay small copayments - similar to what you’d pay under Original Medicare. But with Medicare Advantage, you’ll have out-of-pocket spending protection, since these plans put a cap on your annual health spending. Most Medicare Advantage plans and some Medigap plans also offer access to non-Medicare health and wellness benefits. These can include gym memberships, SilverSneakers or other health programs that can help you lower your risks of cardiovascular disease. Conclusion: Medicare & Cardiovascular Disease Coverage With lifestyle and healthy habits, you can control many of the factors that may lead to cardiovascular disease. And if you currently have heart disease, you can manage your condition with a healthy lifestyle and tests, specialists, and medications covered by Medicare. To make the most of your private Medicare coverage (Part C or Part D): Check to ensure your medications are covered by the plan you’re considering. Make sure you’ll remain in-network with your doctors and specialists. And if you want help choosing a Medicare plan, you can work with a licensed insurance agent who can help you find Medicare plans and give you free Medicare quotes (with no obligation to enroll in a plan). Just call 1-800-620-4519 to speak with one of our licensed insurance agents, or use our Medicare plan comparison tool to find Medicare plans in your area. Note: This article is for general education purposes and does not replace the advice of a medical professional. Always seek the guidance of your physician or a medical professional for medical advice, diagnosis, and treatment.
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What Is Medicare Advantage And How Does It Work? The popularity of Medicare Advantage plans is growing at a rapid pace. In 2020, more than 36% of all Medicare beneficiaries were enrolled in Medicare Advantage health care plans. Whether you’re already in a Medicare Advantage plan, you’re curious about them, or you’ve never heard of them, this Medicare Advantage guide is for you. In this in-depth Medicare Advantage guide, we’ll provide a Medicare Advantage overview that will answer your frequently asked Medicare questions and cover the following topics: What is Medicare Advantage and who qualifies for it The different types of Medicare Advantage plans and how they work The difference between Original Medicare and Medicare Advantage What Medicare Advantage plans cover Who should consider getting Medicare Advantage How much Medicare Advantage costs Medicare Advantage and special scenarios Medicare Advantage plan ratings When to enroll in Medicare Advantage How to enroll in Medicare Advantage What Is Medicare Advantage? Medicare Advantage, also known as Medicare Part C, is an alternative to Original Medicare. The Medicare Advantage program is a way for beneficiaries to access their benefits and rights under Original Medicare, but through a private insurance company instead of the Federal Government. A Medicare Advantage plan is a contract between a private insurance company and the Medicare program. By law, every Medicare Advantage plan must cover everything covered by Original Medicare (Medicare Part A and Medicare Part B). This means that if you choose to enroll in a Medicare Advantage plan, you can be confident that you’ll receive all the benefits you’re entitled to under Original Medicare. Who Qualifies For Medicare Advantage? To qualify for Medicare Advantage, you must be enrolled in Original Medicare Parts A and B. You also must continue to pay your Part B premium in order to keep your Medicare Advantage coverage. There are no age restrictions for Medicare Advantage plans. If you’re enrolled in Part A and B before age 65 due to a disability or chronic condition, you’re still eligible for Medicare Advantage coverage. How Do Medicare Advantage Plans Work? Medicare Advantage health care plans work like the employer-sponsored health insurance plans you may be used to from your previous or current job. Medicare Advantage plans provide comprehensive coverage, and you usually need to stay in-network to receive care. You’ll typically have some out-of-pocket expenses when you receive services and procedures under your Medicare Advantage policy. These costs typically come in the form of copayments or coinsurance that you’ll pay to your provider when you receive care. An important point to remember is that all Medicare Advantage plans have an annual out-of-pocket (OOP) maximum that limits the total amount you can spend in any year. But you do not have an OOP with Original Medicare. What Types Of Medicare Advantage Plans Are Available? There are 6 types of Medicare Advantage plans, including: Medicare Advantage HMOs (Health Maintenance Organizations) Medicare Advantage PPOs (Preferred Provider Organizations) Medicare Advantage PFFS (Private Fee-For-Service Plans) Medicare Advantage SNP (Special Needs Plans) Medicare Advantage HMO-POS (HMO Point-Of-Service Plans) Medicare Medical Savings Plans (MSPs) In this Medicare Advantage guide, we’ll focus on Medicare Advantage PPO plans and Medicare Advantage HMO since they’re the most common types of MA plans. The Difference Between Original Medicare and Medicare Advantage The primary difference between these programs is that Medicare Advantage is an alternative to Original Medicare. When you join a Medicare Part C plan, you no longer receive your Medicare benefits through Original Medicare. Medicare Advantage plans are offered and administered by private insurance companies. But these private insurance companies must comply with many rules and regulations set by the Medicare program. Pros And Cons Of Medicare Advantage Plans vs. Original Medicare Medicare Part C plans have many advantages when compared to Original Medicare. The 3 biggest pros of Medicare Advantage plans are: Annual Out-of-Pocket Maximum spending cap Availability of prescription drug coverage* Extra benefits for things not covered by Original Medicare *Note: Some MA plans are available without prescription drugs. These additional benefits from Part C make Medicare Advantage a more complete coverage option than Original Medicare. MA plans can have their drawbacks in comparison to Original Medicare, depending on your healthcare needs. The 3 biggest pros of Original Medicare are: #1. You can see any doctor or go to any facility anywhere in the country, as long as they accept Medicare. #2. There are no networks. Most Medicare Advantage plans have some kind of network restrictions. #3. You don’t need referrals to see specialists. With some Medicare Advantage health care plans, such as HMOs and Special Needs Plans, you usually need referrals from your primary care physician to visit a specialist. What Does Medicare Advantage Cover? Medicare Advantage plans provide coverage that matches Original Medicare Parts A and B. Generally speaking, your Medicare Advantage plan will cover the same service or procedure as Original Medicare. But there is one exception to this rule, which we’ll cover below. Medicare Advantage plans cover the following services. Medicare Part A Services Medicare Part A covers services that take place in healthcare facilities or institutions like: Inpatient hospital stays Skilled nursing services (not room and board) Hospice care In-home care Note: Hospice care is usually not covered by Medicare Advantage plans. Instead, hospice care is covered under Original Medicare, even if you’re enrolled in a Medicare Advantage plan. However, a new test program in 2021 will explore Medicare Advantage plans providing hospice benefits. Medicare Part B Services Medicare Part B services and procedures are considered more routine and non-emergency in nature than Part A. Common Medicare Part B services include: Doctor’s visits, including specialists Physical and occupational therapy Lab and diagnostic testing services like blood work and x-rays Durable medical equipment Mental health services Ambulance services Some cancer treatments, including chemotherapy As mentioned, Medicare Advantage plans cover all of these services with the exception of hospice care. Medicare Advantage And Prescription Drugs Most Medicare Advantage plans offer prescription drug coverage. These plans are also known as Medicare Advantage Prescription Drug Plans (MAPDs), and they include Medicare Part D. Medicare Advantage Extra Benefits When considering Medicare Advantage pros and cons, it’s essential to take extra benefits that Medicare Advantage could offer to you. Many of these benefits are not provided through Original Medicare. Medicare Advantage benefits may include: Fitness programs: SilverSneakers, gym memberships, and fitness trackers. Vision care: Eye exams, contact lenses, and sometimes eyeglass frames. Hearing care: Exams and often discounted hearing aids. Dental coverage: Some plans have basic dental benefits built in, others offer dental coverage for an extra premium. Transportation: Rides to and from medical appointments. Meal Deliveries: For qualified people returning home from the hospital or skilled nursing facility Telemedicine services and virtual healthcare. Note: Medicare Part C plans have the ability to choose which, if any, extra benefits to offer. These insurance companies may also make changes to their Medicare benefits and offerings each year. Who Is Medicare Advantage Good For? You should consider enrolling in Medicare Advantage if: You want to put a cap on your total out-of-pocket spending under Original Medicare. You want prescription drug coverage without paying for a separate Part D drug plan. You need some of the extra benefits (vision, hearing, private home aides) that come with many Medicare Part C plans. You don’t want to pay for Medicare Supplement (Medigap) plans. You don’t mind using a network of doctors and facilities. You don’t mind needing referrals to see specialists. You don’t mind paying small copays each time you see a doctor. How Much Does Medicare Advantage Cost? Medicare Advantage plans have several costs associated with them. Before we dive into each cost, it’s important to remember that you always have to pay your Part B premium in order to have Medicare Advantage. Now, some Medicare Advantage plans offer a benefit that covers part, or all, of your Part B premium. But check the plan benefits closely to see if this is offered by a specific Medicare Advantage plan. Beyond this Part B premium, you might face the following Medicare Advantage plan costs: Monthly premium Annual deductible Copayment Coinsurance You might have a monthly premium for your Medicare Advantage plan, but these premiums tend to be low. For example, the average Medicare Advantage premium was $23.63 per month in 2020. However, many Medicare Advantage plans do not have a monthly premium. In 2020, 60% of people enrolled in Medicare Advantage didn’t pay a monthly premium. Some Medicare Part C plans have an annual deductible, but again, many do not. If your plan does have an annual deductible, this means you’ll have to pay a certain amount before the plan begins paying benefits. Note that there may be separate deductibles for drug coverage and medical benefits. Beyond premiums and deductibles, the most common expenses you’ll have with Medicare Advantage plans are copayments and coinsurance. These two terms are referred to as “cost-sharing.” This is what you’ll pay out of pocket when you receive covered services. All the amounts you pay during the year count towards your annual out-of-pocket cap. Examples Of Medicare Advantage Costs Let’s look at 3 examples of how these Medicare Advantage costs work in a Medicare Advantage HMO plan. (Note: These costs are not the actual costs for any specific plan, but rather, in the range of costs for plans that you may have access to.) Scenario 1: Medicare Part B Services You injure yourself shoveling snow on your property, and you go to the doctor for an examination. You’ll pay a copay of $20 to see your primary care physician who then refers you to an orthopedic specialist. Your orthopedic specialist charges you a $35 copay for the office visit and wants you to get x-rays. You pay a $50 copay for the x-rays. Fortunately, nothing is broken or torn, so your specialist refers you to physical therapy. You pay a copay of $40 for four physical therapy sessions. Your total out-of-pocket spending for this injury is $265, spread out over a month-long period. All of these costs count towards your Medicare Advantage out-of-pocket maximum. Scenario 2: Medicare Part A & B Services You experience the symptoms of an irregular heartbeat, so you’re admitted to the hospital as an inpatient. You spend two nights in the hospital. You pay a copay of $300 per day, which amounts to a total of $600. After you’re released from the hospital, you continue to see a cardiologist, and you pay a $35 copay to see this specialist each time you visit. Scenario 3: Cancer You’re diagnosed with a treatable cancer, and you’re given chemotherapy. The copay for this treatment is 20% of the Medicare-approved cost. Although 20% amounts to more than $20,000, you hit your annual out-of-pocket maximum, so your costs are capped at $5,900 for the year. When Can You Enroll In Medicare Advantage? You can normally enroll in or change your Medicare Advantage coverage during 3 periods of time: Your Initial Enrollment Period (IEP) when you’re first eligible for Medicare. The Medicare Annual Enrollment Period (AEP), which runs from October 15 to December 7 each year. The Medicare Advantage Open Enrollment Period from January 1 to March 31 each year - however, this MA open enrollment is only for those already in a Medicare Advantage plan. Enrolling In Medicare Advantage For The First Time If you’re turning 65, you can enroll in Medicare Advantage during your Initial Enrollment Period (IEP). Your IEP lasts for 7 months, which begins 3 months before your 65th birthday, includes that birthday month, and ends 3 months after you turn 65. If you’re under 65, your first chance to enroll in Medicare Advantage starts: After your 24th month of receiving Social Security disability benefits, or At any age if you have Amyotrophic Lateral Sclerosis (ALS), also called Lou Gherig’s Disease, or if you have End-Stage Renal Disease (ESRD). Changing Your Medicare Coverage During AEP The Medicare Open Enrollment Period, also called the Medicare Annual Enrollment Period or Annual Election Period, is a good time to decide whether Medicare Advantage or Original Medicare is right for you. Also keep in mind that Medicare Advantage plan benefits can change annually. So if you have a MA plan, you should check to make sure the plan still meets your needs. Here are the actions you can take during AEP: Change from Original Medicare to a Medicare Advantage plan. Change from one Medicare Advantage plan to another. Disenroll from your Medicare Advantage plan and go back to Original Medicare. Change from one prescription drug plan (Medicare Part D) to another. Enroll in a prescription drug plan. Cancel your prescription drug coverage. If you enroll in, or switch your Medicare Advantage insurance during AEP, your new coverage will be effective on January 1st of the following year. You may also be able to enroll in a Medicare Supplement plan if you drop your Medicare Advantage coverage during AEP. The Medicare Advantage Open Enrollment Period If you’re enrolled in a Medicare Advantage plan, you have access to another enrollment period beyond AEP: The Medicare Advantage Open Enrollment Period (MA-OEP). MA-OEP runs from January 1 to March 31 of each year. During the MA-OEP, you can: Change from one Medicare Advantage plan to another. Drop Medicare Advantage, and return to Original Medicare. Add a Prescription Drug Plan if you return to Original Medicare. It’s important to keep in mind that the MA-OEP is only for people who already have a Medicare Advantage plan. If you change plans during the MA-OEP, your new coverage will be effective on the first day of the month after you enroll. Medicare Advantage & ESRD Coverage For all years before 2021, there was an exclusion for people with permanent kidney failure, known as End-Stage Renal Disease (ESRD). ESRD patients could not get new Medicare Advantage coverage. However, beginning January 1, 2021, ESRD patients will be able to enroll in or switch Medicare Advantage plans. Now the eligibility for Medicare Advantage and Original Medicare will be perfectly aligned. Medicare Advantage And Other Special Scenarios We mentioned earlier that Special Needs Plans (SNPs) are a type of Medicare Advantage insurance. Let’s take a look at some common types of SNPs, and how Medicare Advantage health plans are also helping people to get access to care and benefits during the coronavirus pandemic. Medicare Advantage And Chronic Conditions There are Medicare Advantage plan options for people with chronic conditions like diabetes and heart disease. These plans are known as Chronic Special Needs Plans (Medicare C-SNPs), and the benefits are tailored to help you treat and manage your chronic condition. These health plans often provide you with a care coordinator to make sure your needs are being met. These Special Needs Plans have Special Enrollment Periods (often called SEPs), so if you qualify for a C-SNP, you can enroll in it at any time. You won’t have to wait for an annual enrollment window. Medicare Advantage And Medicaid Another kind of Special Needs Plan exists for “Dual Eligibles” – people who are eligible for both Medicare and Medicaid. These plans, called Dual Eligible Special Needs Plans (D-SNPs), have cost-sharing that conforms to the Medicaid program, which means that most costs are $0. D-SNPs incorporate various prescription drug discount programs, depending on your income level - so you’ll save money on your prescriptions if you qualify. D-SNP plans also have more favorable enrollment windows, which allow you to access the benefits once you become eligible for Medicaid or extra help and at certain times during the year without waiting for an annual enrollment window. Medicare Advantage And COVID-19 Medicare provides Coronavirus coverage to help people combat the virus, which includes: No-cost lab testing. Antibody testing. All medically-necessary services and procedures, including hospitalizations and doctor’s visits. Coronavirus vaccine coverage, when one becomes available. Many Medicare Advantage health plans are waiving cost-sharing for these services. In this case, you wouldn’t pay a copayment or coinsurance for seeing a doctor or going to the hospital if you have COVID-19. Medicare has also approved an expanded role for telehealth and virtual doctor’s visits. And many Medicare Advantage health care plans offer these no-contact services with no out-of-pocket cost to you. Medicare Advantage Plan Ratings Every established Medicare Advantage plan is given a Medicare Start Rating by the Centers for Medicare & Medicaid Services (CMS). Star ratings range from 1 to 5, with 5 stars being the highest. Here’s a breakdown of what each rating means: 5-star rating: Excellent 4-star rating: Above Average 3-star rating: Average 2-star rating: Below Average 1-star rating: Poor Medicare Advantage plans are rated on several different metrics and are given an overall rating. This Medicare star ratings system is designed to help you get a feel for the level of quality and satisfaction a MA plan offers. Star ratings also give you an idea of how well a plan treats its members. Plans are rated on how quickly it responds to appeals and complaints and how they cover health screenings and preventative services. Plans are also rated for both medical benefits and prescription drug benefits, if the plan has drug coverage. How To Enroll In A Medicare Advantage Plan If you want to enroll in a Medicare Advantage plan, you’ll want to consider 3 things before joining: Make sure you find a plan that’s available in your area. Most Medicare Advantage plans are restricted to specific counties or states. Make sure your current doctors and medications are covered. This is especially important if you’re looking at a Medicare Advantage HMO plan. You’ll have to use the doctors that are in-network, and you’ll only get coverage for medications that are on the plan formulary. So make sure you investigate these before enrolling. Pay attention to star ratings. This can help you compare the overall quality among different plans. But keep in mind that new plans are not given star ratings until enough data has been collected for CMS to calculate a rating. Once you’ve found a plan, you have a few options to enroll, including: Online, by phone, or paper enrollment directly with the insurance company. Working with a licensed health insurance agent who can help you find, compare, and enroll in a Medicare Advantage plan of your choice. Medicare Advantage Guide Conclusion Medicare Advantage plans can be a great way to manage your out-of-pocket spending while enjoying extra benefits we covered, if you qualify. And they can offer some compelling advantages over Original Medicare, depending on your healthcare needs. So if you'd like to learn more about Medicare Advantage plans in your area, call 800-620-4519 to reach a licensed insurance agent who may be able to guide you to the right plan for your needs. You can also try online Medicare plan comparison tool.
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