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What Caregivers Need to Know to Navigate Medicare

As a caregiver, it’s important to know how to navigate the healthcare and insurance coverage of those you care for. If you are a caregiver for someone who has Medicare and is enrolled in a Medicare Insurance plan, here’s what you need to know.

Original Medicare is made up of Parts A & B and covers 80% of medical costs. Medicare Part D helps with the cost of prescription drugs.

In addition to having original Medicare, a person may also have an insurance plan provided by independent insurance companies and help to cover the cost that Original Medicare doesn’t cover.

The person you’re caring for may have:

1. A Medicare Advantage Plan (sometimes called an MAPD). This type of plan combines Medicare Parts A, B, and D.

2. A Medicare Supplement Plan (sometimes called a Medi-gap plan).

3. A stand-alone Prescription Drug Plan.

Finding out details about the cost of a Medicare member’s insurance plan, the cost of their medications, and what specifically the plan covers is called a “Summary of Benefits.” If your loved one can’t remember where they placed this information, you can get it from the insurance company or speak with a local Medicare insurance agent.

Before you call an insurance company or a doctor on behalf of your loved one, you need to be listed as someone who is allowed to speak on their behalf. In order to do this: ask your loved one if the two of you can call their insurance provider together so they can give permission for you to call on their behalf in the future. This may only require verbal permission given over the phone, or your loved one may have to fill out paperwork to have you added as someone the insurance provider is allowed to speak with.

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If your loved one wants to change his/her Medicare insurance plan, there are a couple of ways they can do this.

1. Every year between October 15 and December 7 is Medicare’s Annual Enrollment Period (AEP). During this time, a Medicare beneficiary can change his/her Medicare Advantage Plan or Prescription Drug Plan.

2. Between January 1 and March 31, Medicare has an Open Enrollment Period, which allows those on Medicare Advantage Plans to change.

3. There are also Special Enrollment Periods (SEPs) that allow a Medicare member to change his or her plan during other times of this year. An example of this would be moving to another county or state. A Medicare Insurance agent will be able to tell you if there are other SEPs that your loved one may qualify for.

If a change needs to be made to your loved one’s plan, we recommend talking to an agent to find out what options are available.

Who can you contact to find out more information about Medicare?

  • Your loved one’s insurance company. (You’ll find the member service phone number on the back of their insurance card.)
  • A local insurance agent.

Caress Insurance Agency, Inc has local agents who know the Medicare Insurance plans in your area; we work with Scripps Affiliated Medical Groups to help answer your Medicare questions.

We’ve created an online tool to easily compare plans and get a custom quote tailored to your loved one’s individual needs: click here to get a quote in just minutes!

Man using online tool to get medicare quote


CATEGORIES: MedicareParentingSeniors & Caregivers


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