Questions about the Medicare Advantage Plan

Last fall, in more pain, mom had more x-rays of her hip and the doctors say it’s time for a replacement. She has asked me to review her Medicare health insurance plan and see how it works and explore the options she has. Tonight, our daughter has basketball game and this review seems like a complicated and time consuming project. 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.

Mom has a Medicare Advantage Plan (MA) which has co-pays for most services, such as: office visits, days in the hospital, surgery and rehab. These co-pays are lower if she can stay in her provider network. While she pays a lower premium than the alternative, a Medicare Supplement, she could easily exceed her total overall yearly medical/insurance costs because of the co-pays. Also, to my surprise cancer treatments all had co-pays that would make a Medicare Supplements more advantageous in that situation.

It is strongly recommended to understand your Medicare coverage and your options. Everyone’s situation is unique and health plans should fit your situation. Know your premium and your maximum out of pocket exposure. Look realistically at your budget. See if a lower premium and more medical cost exposure works. If not does a higher steady monthly insurance budget with no co-pays make more sense?

Now, the interesting idea in this case: What if mom changed to a Medicare Supplement, paid a bit more in premium, but had all of her current co-pays covered by insurance? Mom can stabilize her monthly budget and lower her overall out of pocket medical costs. From 1/1 to 2/14 every year, Medicare has an “Annual Disenrollment Period”. During this time period a person covered by an MA, may change to a Medicare Supplement and eliminate their out of pocket co-pays.

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 and the primary issue of safety, while being careful not to take all control away from a parent. 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”,

We wish you and yours a New Year of good health and great memories.