Dealing with Aging Parents - Medicare - Part 2

I cannot possibly cover Medicare completely if I blogged for a year about it. I will throw out some suggestions for you that I think can help you and your parents with it.

Make sure your parents sign up for online access to their Medicare info This lets them see when claims are processed and you can see any issues (and try to thwart them) before you would get information by mail. It is preferable to see if your parents will let you have access as well.

When your parents get ready to sign up for Part D (Prescription), have them go to medicare.gov to price polices. They can put in the prescriptions they use and where they get their medicines and this tool will present you with the best options (considering cost and location) for their Part D policy

Have your parents speak with Medicare and allow you access via phone to be able to discuss Medicare issues with Medicare representatives if need be. All they have to do is call the Medicare toll free number and answer a few questions to do this. It can be very helpful to have the ability to do this especially if they are ill or simply cannot understand the complexities of Medicare. You will need their Medicare number - they should have a card with this info on it.

   

Finally, I’ll throw out some specific situations we had issues with in case these might be helpful

My parents had primary insurance with mom’s employer (Lourdes) til the day she died with Medicare as the secondary. We didn’t know that we had to let them know that dad’s primary was now Medicare with no secondary once mom passed away. We figured it out when claims started being rejected for no apparent reason. Turns out you have to call a different group under Medicare to change that. The permission dad had given them to have me talk to them concerning his issues didn’t apply and I had to send them a copy of his Power of Attorney. Then there was a delay because the office was in New York City, and I tried to contact them during the week of Hurricane Sandy. It still took repeated phone calls and finally Lourdes Benefits sending them a letter saying that he no longer was covered by them to get the situation straight.

My dad was on oxygen. This is called DME (durable medical equipment) and covered under Part B. We found out the bizarre way they cover this when dad moved to Nashville to stay with my sister and nobody there would agree to provide his oxygen. Turns out Medicare pays for three years of oxygen supplies then the company covers the next two (not billing during those two years). Dad was near the end of his three years so of course no company wanted to pick up those two free years since they hadn’t gotten the paid three years. I talked with dad’s oxygen provider (Legacy Oxygen who was really good to work with). They explained the above to me and said they would work out a way to get tanks to dad. They couldn’t explain the Medicare logic to me though.

We would see claims that were regularly rejected for no apparent reason. In these situations, you should start with the provider (not Medicare). They can often tell you why and then refile. I was told multiple times – “Oh it’s Medicare, we are used to that”.

Expect to be on hold 10-30 minutes when you call. Also expect to get different answers to the same question. Always take down the time you called and who you talked to.

Hopefully this will be of some help to you.  

Dealing with Aging Parents - Medicare - Part 1

Medicare is something that anyone 65 and over has to deal with. I can tell you it’s very confusing. I consider myself a relatively intelligent person and it’s confusing to me. I know my parents had a difficult time understanding it. Therefore, I do think that if you have older parents on Medicare, you can be very helpful in this situation. I will only speak to issues I directly dealt with. Volumes are written about how to do this but hopefully this will help you

First, I want to clear up a couple of fallacies about Medicare.

• Medicare is free – It most certainly is not. For your entire earning life, you pay for it. 1.45% of your earned taxable income goes to pay for it. Your employer kicks in 1.45% as well. If you are self-employed, you pay 2.9% (both parts). There is no cap (unlike Social Security taxes) so no matter how much you earn, you pay Medicare tax on it. Once you are using Medicare, you pay a monthly amount (that comes out of your Social Security normally) for Part B (I’ll discuss that in a minute). For 2013, it’s 104.90 a month for most people.
  
  
• Medicare pays for everything – No, it doesn’t. For a hospital stay up to 60 days, you pay a deductible of 1184.00 and for anything after that, you pay about 300 a day up to 90 days and then it gets into “lifetime use days” which I don’t even really understand. Your Doctor visits, lab tests, durable medical equipment (oxygen tanks and generator for example), you pay 20%. There is no stop-loss as is common with regular insurance policies so no matter how many of these type expenses you end up paying, you never hit a maximum. Finally, for prescriptions, you have a 300 deductible. Then, you pay 30% of “approved drugs” until you hit the “doughnut hole” (2970) when you pay 100% until you hit 4750.00.
  

Confused yet? 

Let’s talk about the parts of Medicare. Part A is hospital and strictly hospital. It’s not doctors, even ones that come and see you at the hospital. That’s Part B – Doctors, lab work, durable medical equipment. Part D is prescription coverage. Seniors generally apply for Part A and B when they turn 65. Part D you handle getting on your own. What’s Part C? Medicare Advantage (which I know nothing about).

I think that’s enough for one day. I’ll continue with some of our experiences and some recommendations in my next post.