The Sandwich Generation: Piecing Together The Medicare Plan Puzzle (Part 2)

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Helping Mom and Dad with their Medicare Questions

It seems like every other commercial on TV is about Medicare. Then on a visit to mom and dad’s you see a stack of Medicare papers on their kitchen table. Dad says all of the insurance information is very confusing and he would like your help. Life today is active, especially for women aged 45 – 56 who care for both their parents and children. These people are caught in the “sandwich generation” and these columns are focused on issues affecting you.

The Medicare Plan choices can be confusing, especially during the Annual Enrollment Period from 10/15 – 12/7; yearly when people can change plans. It is important to know this (AEP) is when insurance companies announce the changes in their plans for the following year. Drugs covered this year may not be on next year’s formulary. Doctors and other providers may have changed networks and not be included in your plan’s network next year. The plan’s co-insurance amount can also change; meaning more out of pocket expense for your parents. This applies mostly to Medicare Advantage Plans (MAs) and/or Medicare Prescription Plans (PDP).

The other major type of plan available is Original Medicare (OM) where most people also buy a Medicare Supplement. Medicare Supplements will adjust their benefits to cover the yearly increased Medicare co-pays. They usually also increase their premium at this time.

Both OM and MAs have their advantages, but in 2013, two interesting niche MA plans will be available in Central Illinois. The background is that Medicare is monitoring hospitals for quality and re-admissions with 30 days from discharge. In the near future someone hospitalized with a heart condition (congestive heart failure – CHF), COPD, or diabetes may receive a phone call from the hospital checking to see if the patient is managing their condition, or if they have questions or need additional help (to keep from being re-admitted).

To mirror this Medicare monitoring, at least one MA is offering a chronic disease plan. Personnel from this plan will monitor clients with CHF, COPD and diabetes by phone and may also send a physicians assist or doctor to see these people as needed. The concept is to manage these conditions better, provide better quality of life and less hospital stays.

Another interesting type of plan is for people who have both Medicare and Medicaid. These plans may offer benefits for hearing, vision and dental services not covered by OM. In certain situations, these plans work well in providing additional benefits that help people with a limited budget after their Medicaid spend-down.

More information can be found at www.medicare.gov or www.MRMS-INC.com. Talk with qualified insurance agents. Their help can be invaluable and you will you pay the same premium if you enroll on-line, but you have the agent’s future help.

Helping mom and dad and caring for your children simultaneously is not easy. It is very helpful to discuss and plan for reasonable future events, and a sandwich generationer should guide their parent through these issues including the primary issue of safety, while being careful not to take all control away from a parent. Once again, it is important to start talking, making suggestions and guiding early, do not wait for a crisis. If you would like a list of “questions to ask in different aspects of care” see our website and look under the “Patient Advocacy Division”.

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Steven A. Buttice is the president of Medical Reimbursement & Management Services, Inc., a firm specializing in issues affecting seniors, including seminars and consultation on Medicare Plans, Long Term Care and other types of insurance, claims issues, and sales/service of insurance products since 1984.

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