Medicare—And You Thought The IRS Was Complicated!
Navigating the murky waters of Healthcare Insurance, Medicare, supplemental Medicare policies, Med-i-gap policies, prescription policies and Long Term Care Insurance is complicated. My former job was clarifying coverage to clients and physicians and I can’t begin to adequately explain it. Many websites cover the topic but I often find them confusing. There are even businesses whose business consists of helping seniors decide which plans to use.
An interesting aside…most health education materials are written at a fifth grade reading level so they are easily understandable. Parts of the Medicare guide are written for above a twelfth grade reading level (30%), the rest is between fifth grade and twelfth grade reading level. No wonder people get confused!
Honestly, seniors who don’t have an advocate helping them figure this out get very frustrated or buy a plan they are unhappy with later.
Stay with me here. I will try to keep it simple and direct you to useful resources.
Let me share a few of our experiences with you. My father-in-law has passed away, but he thought you could never have too much insurance. As a result he had four or five supplemental Medicare policies. He didn’t understand that Medicare basically pays 80% and the insured pays 20% for most things. A supplemental policy also pays 80/20. So all of his other policies paid nothing. They don’t pay on top of the 80%, only the same 80% Medicare already pays. What my father-in-law wanted and thought he was buying was a “med-i-gap” policy. It pays, as the name implies, for some of the “gaps” in Medicare coverage. There are more med-i-gap polices available as awareness grows. Some are referred to as supplements. Read the policy or insist they explain what is covered before you sign up. Ask a company representative to explain terms you don’t understand. Bear in mind the company representatives are selling a product.
Medicare plans are an alphabet soup. Basic hospital care is Part A, outpatient care such as doctor’s visits are Part B. Most people sign up for A ad B as we did. There are also “managed Medicare” plans, called Advantage Plans or Part C. In essence you sign your Medicare benefits over to the company and they manage it for you. These plans are like Medicare H.M.O.s. Some seniors love these plans. You have less decision-making but also less choice about providers and hospitals. They tend to provide robust wellness programs.
Medicare does not pay for prescriptions. Many prescription insurance policies now exist. They are Part D in the alphabet soup of choices. These policies are in addition to a “medi-gap” policy.
Which policy is best for your elder depends on how many and what prescriptions they take. Shop around for what fits your elder’s needs The government explanation is below:
Are you a visual learner like I am? This chart will help.
*Blue Goose of Maine produced the chart. I have no affiliation with them nor am I recommending their product. I’m impressed with their clear presentation, though.
If you help your elder through this process you do them a great service. If you have the rare elder who enjoys being on hold, haggling with sales reps and repeating their vital information over and over, then repeating once more so the insurer can record it, let them go for it. For my parents, they hated the process. They couldn’t hear the people over the phone, didn’t understand the products offered nor how they would affect their access to care. They were grateful to delegate it.
What has been your experience helping an elder with insurance companies and Medicare?
Best wishes in your care-giving journey!