Five Things to Consider when Helping Senior Parents Find Health Insurance

If your senior parent, relative, or friend asks you for help when choosing their NC health insurance coverage, you can take steps to support them.

Health Plans of NC, Kelly Quinn
Portrait of an attractive senior woman with a confident smile on her face.

In 2020, stats showed that almost 25% of the North Carolina population were over the age of 60 and over 10% of people aged over 65 lived alone. If you’re asked for help by a senior family member or friend, there are several things to consider to help them find the right level of Medicare or health insurance so they’re adequately covered. The first step is uncovering their needs. This means talking about sensitive topics like finances and personal health. While it may be uncomfortable, you need to understand their situation to help them make the best choice. It will also take time to research and select the best plan. 

Other areas to consider when finding the right North Carolina health insurance plan for your loved one include:

Understand what Medicare covers

Knowing what Medicare covers is important to help determine if it will be enough for your family member or friend. Original Medicare Parts A and B cover hospital and physician visits. Original Medicare covers about 80% of this cost and doesn’t include prescription drug coverage.

Determine what type of insurance your parent, relative, or friend is eligible to receive

At 65, your parent, relative, or friend will be eligible for Medicare if they’ve been a permanent US resident or citizen for five years and paid 10 years of social security taxes. At the time of enrollment, it’s essential to find insurance coverage to help fill in the gaps that Medicare doesn’t cover. This additional coverage can come from a Medicare Supplement (Medigap) plan, a Part D prescription drug plan, or a Medicare Advantage plan. If your parent or their spouse is still working after they turn 65, they may be entitled to a retiree benefit or a special enrollment period for Medicare. There is a coordination of benefits rule that determines which plan pays first if your parent has more than one plan. Encourage your parent, friend, or family member to discuss this with their HR Department to make sure they understand their benefit options. It’s also essential they don’t miss any critical deadlines.

Find out the costs

Medicare and private insurance plans, including Medicare Advantage and Medigap, come with out-of-pocket expenses. Therefore, when comparing Medicare plans North Carolina, it’s a good idea to gather all the costs to help you assess each plan.

  • Premiums – monthly payments for Medicare and private insurance

  • Deductibles – the amount of money spent before the plan kicks in

  • Copayments – flat fees for services

  • Coinsurance – a percentage of the cost of health services; usually after the deductible is met

  • Prescriptions – check the formulary to find out the Tier of the drug

  • Out of Pocket Maximum – once reached, the insurance plan picks up the rest of covered medical expenses

Work out what providers your parent/friend/family member can access

By choosing Original Medicare with a Medigap policy, your parent or loved one can see any participating Medicare provider. However, suppose they leave Original Medicare and opt into a Medicare Advantage plan. In that case, they will be subject to limitations based on a Health Maintenance Organization (HMO) or a Medicare Preferred Provider Organization (PPO). When considering their options, it’s good to make sure their doctors accept Medicare and are in the appropriate network if subject to one. Medicare Advantage plans should have a provider lookup feature on their website to help you. In addition, you should be able to search by area, for example, Charlotte, North Carolina.

Complete a checklist 

Creating a checklist for researching health insurance options can help ensure you’ve covered everything. Here’s a list of things to consider when helping your family member:

  • Do some research to educate yourself on the different Medicare coverage options.

  • Ask your parent, relative, or friend for a list of their doctors and prescription medicines.

  • Ask them about their health conditions and their approximate annual healthcare expenses.

  • If they plan to work past age 65, get an idea of how long they’d like to continue working. Advise them how important it is to talk with their HR team. Follow up on that conversation. Will they be eligible for retiree benefits? Will they qualify for a special enrollment period later? Knowing this will help prevent them from missing essential coverage deadlines.

  • Help them request quotes directly from reputable licensed brokers and insurance companies.

  • Compare plan out-of-pocket expenses, network restrictions, and prescription formularies.

  • Remind them to take advantage of preventive and screening services covered by Medicare once enrolled.

If you have any questions, it’s always helpful to seek professional help to go over the details and ensure you’re getting the best plan for their needs. Our Medicare agents specialize in helping with health insurance in North Carolina. They can help you find the best health insurance in NC for your parent, friend, or family member. Compare Plans Now or chat to one of our experienced North Carolina health insurance agents by calling 1-800-797-0327

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