Helping A Senior Relative Or Friend Find Health Insurance

Health Plans of NC Staff
Older woman and younger woman sitting on a park bench looking at a phone

If your senior parent, relative or friend asks for your help in choosing health insurance coverage, there are several things you can do to support them.

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How can I help a senior parent, relative or friend find health coverage?

Whether Medicare or other coverage, there are things to consider when trying to help your senior parent, relative or friend find health insurance. It’s not an easy subject to discuss, and it involves talking about sensitive topics like personal health and finances. It will take time and research to select the best plan. Here are four things to consider.

What does Medicare Cover?

Original Medicare Parts A and B cover hospital and physician visits. Original Medicare covers about 80% of this cost and does not include prescription drug coverage.

What type of insurance is my parent, relative or friend eligible for?

At age 65, if your parent, relative or friend has been a permanent US resident or citizen for 5 years and paid 10 years of social security taxes, they are eligible for Medicare. At the time of enrollment, it is important to find coverage to fill in the gaps that Medicare does not 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 communication with their Human Resources Department to make sure they understand their benefit options and don’t miss any important deadlines.

How much will coverage cost?

Medicare and private insurance plans, including Medicare Advantage and Medigap, come with out-of-pocket expenses. Gather the costs of the following when comparing plans and options.

  • 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

Who is in Network?

By choosing Original Medicare with a Medigap policy, your parent can see any participating Medicare provider. If they leave Original Medicare and opt into a Medicare Advantage plan, they will be subject to limitations based on whether it is an HMO or a PPO. 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.

Checklist of things you can do to help:

  • 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 of the importance of communication with their HR contact. Follow up on that conversation. Will they be eligible for retiree benefits? Will they be eligible for a special enrollment period later? Knowing this will help prevent them from missing important 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.

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