We know just how busy the fall can be for you and your loved ones. We are rapidly approaching the holiday season. While fun, this time of year can lead to a bit more stress, jam-packed schedules, and increased responsibilities. Added on to everything already going on in October, November, and December, if you are an Older American or caring for an Older American, there is the added responsibility of making sure that you are ready for Medicare Open Enrollment.
Medicare Open Enrollment takes place annually from October 15th through December 7th. As The Centers for Medicare and Medicaid Services shares, the main reason for this Open Enrollment Period is that “Medicare health and drug plans can make changes each year—things like cost, coverage, and what providers and pharmacies are in their networks… (this is the time) when all people with Medicare can change their Medicare health plans and prescription drug coverage for the following year to better meet their needs.”
Medicare Open Enrollment is a critical time. It is the time when you can change your plan without penalty and therefore warrants careful analysis to choose the right plan for you.
While choosing a plan may seem simple at first, it is not. There are several different plans within Medicare that we have seen firsthand cause additional stress to our senior clients and their loved ones. To begin to prepare on how things may have changed in your plan, you can review the mailing sent to you by the Medicare office. Depending on your plan type at this time, you will receive either an “Evidence of Coverage” (EOC) or an “Annual Notice of Change” (ANOC) statement.
To give you a bit of the lay of the land when it comes to Medicare, especially if you are helping a senior loved one handle this for the first time, we want to share more information on each plan directly from Medicare itself:
Medicare A – According to Medicare “Medicare Part A covers your hospital expenses. This includes hospital stays, skilled nursing care (as long as custodial care isn’t the only care you need), hospice, and home health-care services. Part A services may require you to pay various deductibles, coinsurance, and copayments.”
Medicare B – According to Medicare “Medicare Part B is your health insurance coverage. It covers two types of services, including medically necessary services to treat illnesses or conditions, such as doctor’s office visits, lab work, x-rays, and outpatient surgeries, and preventive services to keep you healthy, like cancer screenings and flu shots. Part B also covers medically necessary durable medical equipment such as wheelchairs and walkers to treat a disease or condition. Costs for Part B services vary, but frequently, you will pay a deductible and then 20% of the Medicare-approved amount, as long as you use providers who accept Medicare assignment.”
Medicare Advantage Plans – The Medicare Advantage program is run by private insurance companies approved by Medicare. In other words, insurance companies can offer specific services and care to seniors although they must offer the same coverage as original Medicare. A specific example would be that many of these plans also offer the Medicare Part D prescription drug coverage.
Medicare Part D – This is Medicare’s prescription drug coverage plan. It may be offered as a standalone plan or as a combination of coverage with a Medicare Advantage Plan.
The additional complication for seniors and their loved ones is that none of the Medicare Plans will completely pay for the cost of long-term care. Should you or a loved one need in home care or long-term care in an assisted living facility or a skilled nursing facility, this will not be covered for the long-term by Medicare. Medicare is an acute payor system and, as such, is not set up to pay for the duration of a custodial need for care.
Many seniors and families whose loved ones need long-term care are faced with the chilling reality of being forced to pay out of pocket for these very high costs when they are needed. We often meet with new clients who were under the mistaken impression that Medicare would be able to provide this assistance and did not take the time to plan early.
Unfortunately, in many of these instances, the senior and their family members must “spend down” their assets in order to be able to qualify for government benefit programs that can help with long-term care costs such as Medicaid.
But with some good planning to prepare, it does not have to be that way.
We know that you may have many questions when it comes to Medicare Open Enrollment and in regard to long-term care planning. We encourage you to get the information you need as soon as possible this fall when it comes to finding ways to protect and care for yourself and your loved ones for their health care needs and beyond.
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Kevin Snyder is a husband, father, and an attorney at Snyder Law, PC in Irvine, California. He’s all about family and passionate about estate planning, elder law, veterans and teaching others how to protect what matters most: family, dignity, and legacy. Snyder Law helps parents from Orange County, Los Angeles County, and the greater surrounding Southern California area.