“This morning my mom, who’s turning 65 soon, asked me to help her figure out her options around Medicare, and I realized I have no idea how to help her. She currently has Kaiser and is super on top of things and trying to plan ahead thoughtfully, but finds the whole process overwhelming. Even people with Ph.D.s can’t figure this out and folks with a lot less education and resources are supposed to do it too! Any tips you might have would be much appreciated.” – J.J., Oakland
A: Medicare — great program, yes. Overwhelming? You don’t know from overwhelming. And unless your mom has a Ph.D. in Medicare Studies, I am not surprised that she needs some help. To make it more complicated, the outcome of the November election might mean more changes in Medicare and more confusion. So, hold on to your seats — it’s going to be a bumpy ride!
So I am guessing that your mom has been asking you questions such as:
What does Medicare cover?
When should I enroll?
What about enrolling if I am still working?
Should I give up Kaiser if I enroll?
First, the easy part. What is Medicare and what does it cover? Medicare is a federal health insurance program that has four parts. Part A, hospital insurance, covers things like hospital stays, skilled nursing, hospice and home health care. Part B, medical insurance, pays for things like clinical research, ambulance services, durable medical equipment, mental health, outpatient, partial hospitalization, getting a second opinion before surgery, and limited outpatient prescription drugs. Part C, Medicare Advantage, is Medicare through private health insurance plans; and Part D, prescription drug coverage, pays the cost of prescription drugs. (While many people know that Medicare is open to people ages 65 and older, they may not know it is also open to some people who are younger and have certain disabilities.)
One of the questions we get asked a lot on our Senior Information & Referral Line is whether Medicare pays for long-term care. The short answer is no. Medicare will cover up to 100 days in a skilled nursing facility (commonly known as a SNF) if it’s medically necessary, but beyond that you are on your own. Long-term care, in a nursing home or at home, is not covered by Medicare.
So, now that you have a basic understanding of what Medicare covers, when should your mom enroll? Now it gets a little more complicated.
If your mom is already getting Social Security benefits, she will be enrolled automatically in Medicare Parts A and B effective the first day of the month of her 65th birthday. She should be on the lookout for her Medicare card in the mail about three months before her 65th birthday.
If your mom is not yet receiving Social Security benefits, and wants to receive them, then she can apply for both Medicare and Social Security at the same time. It is best to apply three months before your 65th birthday to ensure that your coverage start date will not be delayed. To start the process, your mom can call Social Security at (800) 772-1213. Some people are able to apply online at www.social
security.gov if they meet certain listed requirements.
If your mom wants to apply only for Medicare, it is pretty much the same process as described above — you can apply three months before your 65th birthday and still go through the Social Security office at (800) 772-1213. At this time, it is not possible to apply online for Medicare alone.
So pick up your smart phone and put a Medicare application reminder in your calendar three months before your mom’s birthday. Waiting to apply has consequences and there is no automatic notification that it is time to apply (unless she is already receiving Social Security).
OK, easy enough, you say. But my mom is still working and has health insurance through her job. Should she still apply for Medicare? The short answer is yes. But, this being Medicare, it’s complicated. Which parts of Medicare will be applicable to her now depends on the number of employees at her company and the type of drug coverage her employer offers. So she should touch base with her employer to see how her coverage interacts with Medicare, or contact one of the resources listed below.
For Kaiser members, the situation is a little different. If your mom wants to stay on Kaiser and enroll in Medicare, she must sign up with Kaiser’s Senior Advantage Program, which means that Kaiser takes over all her care. That can be good because everything is centralized, but it can also limit some services. For example, at JFCS/East Bay we accept Medicare for seniors who want counseling, but cannot accept seniors who have their Medicare through Kaiser unless they want to pay out of pocket. You can find more information at http://bit.ly/oox82G.
With so many details and things to think about, there is clearly no way for me to answer all your questions here, but don’t despair. One of the best ways to get your specific questions answered is through the Health Insurance Counseling and Advocacy Program, commonly known as HICAP. HICAP is a nonprofit organization that provides free, objective information and counseling about Medicare. Its website (www.cahealthadvocates.org/HICAP), has great information, or you can call (800) 434-0222 to speak with a counselor.
HICAP has offices in most counties across the state and sponsors ongoing workshops that can give you a good basic understanding of Medicare. You can find workshops by county on the HICAP website.
AARP also has a good Medicare starter kit (www.aarp.org) and an excellent “Ask Ms. Medicare” column with lots of very specific questions and answers. And then there is, of course, the Medicare website itself (www.medicare.gov), which has good information, but I think it is best to start with HICAP. 2-
If you are feeling particularly overwhelmed you will find yourself in good company! Jane Gross, a New York Times columnist who has been writing about aging issues for years, chronicled her struggle to understand Medicare Part D (the drug plan) in an informative article “D is for Dazed” (http://newoldage.
blogs.nytimes.com/author/jane-gross). Even with her expertise in the field of aging, she still found herself in a position similar to yours and your mom’s.
Despite the difficulties of getting through the Medicare application process, it remains, in my opinion, a great and valuable program. My hope is that one day, Medicare benefits will be expanded to include much-needed services such as nursing homes, in-home support and care management. It will certainly be interesting to see how things change as the next wave of baby boomer seniors, like your mom, test the limits of Medicare as we now know it, and what pressures they will bring on the program to better respond to the needs of our aging population. n
Rob Tufel, MSW, MPH, is director of Adult Services at Jewish Family and Children’s Services of the East Bay. His columns appear regularly in j.’s Seniors supplements. Have any questions about your aging parents? Email firstname.lastname@example.org or call (510) 558-7800 ext. 352.
Prescription drug plan rates are rising
Seven of the top 10 prescription Medicare prescription drug plans are raising their premiums by 11 percent to 23 percent next year, according to a report by Avalere Health.
“The average senior is going to benefit by carefully scrutinizing their situation, because every year the market changes,” Avalere President Dan Mendelson said last week. Avalere crunched the numbers based on bid documents that the plans submitted to Medicare.
The report found premium increases for all top 10 prescription drug plans, known as PDPs. However, the most popular plan — AARP MedicareRx Preferred — is only going up 57 cents per month nationally, to $40.42 from the current $39.85.
The price hikes appear to be driven by market dynamics, and some insurers are introducing new low-premium options to gain a competitive advantage on plans that are raising their prices.
The seven plans with double-digit premium increases were: the Humana Walmart-Preferred Rx Plan (23 percent); First Health Part D Premier (18 percent); First Health Part D Value Plus (17 percent); Cigna Medicare Rx Plan One (15 percent); Express Scripts Medicare-Value (13 percent); the HealthSpring Prescription Drug Plan (12 percent); and Humana Enhanced (11 percent).
Two plans in the top 10 had single-digit increases: SilverScript Basic (8 percent) and WellCare Classic (3 percent).
On the plus side for consumers, a major new low-cost plan entered the market. Premiums for the AARP MedicareRx Saver Plus Plan will average $15 a month nationally, although it won’t be available everywhere. That’s $3.50 less than the current low-cost leader, the Humana Walmart plan, whose premiums are rising to $18.50. — ap