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Health Insurance Basics

Medicare and Your Loved One

November 14, 2020

If you are a caregiver for a family member or loved one, you have a lot on your plate. Managing appointments, medicine, and living adjustments for another individual can be challenging.

Signing up your parents or other loved ones for Medicare often requires extra work to research and select a plan. Understanding the basics of the process and options will make it easier on you and your loved one. 

Talking About Medicare to Parents or Loved Ones

Communication is key if you help make decisions and plans for someone else's health care. If your loved one is eligible for Medicare, having a chat with them about their medical care and coverage can benefit both of you.

Gather as much information about your loved one's medical history and current situation as possible. Find out what doctors they have seen, where they have received care, and what medications they take.

Tips for starting the conversation:

  • If possible, talk about medical coverage when your loved one’s health is stable.
  • Ask what they would like help with in relation to their health.
  • Find out what decisions and actions are important to them.
  • Ask who they want involved in their health care and decisions. Pick a personal representative and have them registered with the health insurance provider. This will help with gathering medical history and making discussions.

Signing Up for Medicare — a Timeline

Before turning 65: Discuss options.

Most Americans become eligible for Medicare when they are 65. If your loved one is reaching their 65th birthday soon, find out if they have completed their enrollment yet.

If your loved one is still working, they have additional options and decisions as they approach age 65. They can stay on their employer’s plan, add extra Medicare coverage, or leave their employer’s coverage for Medicare. Some of these options change based on the size of the company where they work. Learn more about those options on Empire’s website.

Three months before their 65th birthday: Enrollment.

If they have not already enrolled, the Initial Enrollment Period lasts for seven months during the year they turn 65:

  • The three months before they turn 65,
  • The month they turn 65,
  • And the three months after they turn 65.

If they are already receiving Social Security, they are automatically signed up for Original Medicare. This includes Parts A and B. Part A covers hospitalization services, and Part B covers doctor visits and other medical treatment — with some exceptions. They can also sign up for a Medicare Part D drug plan, if they need it. They will receive a packet from Medicare that outlines steps they need to take, as well as any potential deadlines for those steps.

If they are not receiving Social Security benefits, they will need to fill out an application to enroll. They do this through the Social Security Administration.

65th birthday: Coverage begins.

If they complete enrollment before they turn 65, coverage will start the first day of their birthday month. If they sign up during that month or after their birthday, coverage will start the first day of the following month.

October 15 to December 7: Open Enrollment.

In all years after their 65th birthday, they will need to decide on a plan for the coming year during the Annual Enrollment Period, which is October 15 through December 7. 

Medicare Plan Options

Once your loved one enrolls in Medicare, they will select a plan. They can:

  • Stick with Original Medicare coverage;
  • Add a Medigap supplement plan to go with Original Medicare;
  • Or pick a Medicare Advantage Plan.

You can help your loved one enroll in a plan through Medicare.gov or a private insurer. You can learn more about this process and plan options through an Empire webinar.

The right Medicare plan can make a major difference in what they pay and how easily they can find care. Factors to consider include:

  • All healthcare-related costs, including premiums, deductibles, copays, and coinsurance.
  • Whether their doctors and specialists accept a particular plan's payment. You might also check nearby facilities such as urgent care and hospitals.
  • Services your loved one may need, such as skilled nursing, facility-based care, and rehabilitation or therapy.
  • Medications your family member is currently taking or may need to take in the coming year. Plans cover different drugs, often at different prices.
  • Services that may not be covered. For example, Medicare alone does not cover vision and dental services, or prescription drugs. Medicare Advantage plans often cover all of those items.
  • Any extra benefits that can help. There are Medicare Advantage plans with discounts and services, such as gym memberships and meal delivery.