How to help a loved one sign up for Medicare

• The enrollment period for Medicare is Oct. 15 through Dec. 7
• 7 companies are offering nearly two dozen Medicare Advantage options for Rochester-area seniors.
• Lifespan, which provides non-medical advice to seniors and their caregivers, is offering free Medicare 101 seminars

Shirley Emery is too young for Medicare, but for the past few years she has been immersed in the process as she helps her mother.

“Every year I worry, did I find the best plan for her?” she said. “Not the cheapest, but what is the best coverage for the most reasonable price.”

The Fairport woman reports that so far, she has succeeded in matching a Medicare Advantage plan to the needs to her mother, now 88 and residing in an assisted-living facility.

Each fall brings the same anxiety, a feeling shared by other adult children who help a parent, grandparent or other loved one in the Oct. 15-Dec. 7 enrollment period for Medicare.

“We often get children calling on behalf of parents,” said Ron Brandwein, coordinator of the Health Insurance Information, Counseling and Assistance Program, a state program that locally is run from Lifespan. “The parents don’t understand because they’re elderly, have language barriers or whatever the issues are.”

The array of choices — traditional Medicare or Medicare Advantage — can turn enrollment into a daunting task.

For 2016, seven companies are offering nearly two dozen Medicare Advantage options for Rochester-area seniors.

“This is the most complicated I’ve ever seen it in 10 years,” Brandwein said. “This is mind-boggling, even for me.”

Brandwein said a decision should be based on several factors, such as the senior's overall health, travel habits, medications and which plans include their doctors.

It's likely everyone signing up for a plan will have questions specific to their situation or their choices. Brandwein talked through some of the common ones that he and his crew of volunteers get from younger people helping their loved ones:

How do we get started in the process?

Each October, Medicare sends every eligible person a handbook that lays out what will be covered in the coming year.

Medicare is for people 65 and older and for people with certain disabilities. For our purposes, we’ll focus on the 65-and-older group. So, ask your loved one if they have a Medicare card. You’ll need the Medicare number when you enroll for coverage.

If a person is collecting Social Security when they turn 65, they automatically will be issued a Medicare card.

What if they are delaying collecting Social Security when they turn 65?

If the person wasn’t receiving health insurance coverage through active employment, in order to start Medicare and not be subject to penalties later on, he or she will need to contact the Social Security Administration within their initial enrollment period. That initial enrollment period is three months before they turn 65, the month they turn 65, and three months after.

What if they worked past age 65 and had insurance from their job?

If your loved one had coverage from their employer, he or she will need to contact the Social Security Administration within eight months of that coverage ending to initiate Medicare without being subject to delays or penalties.

What are the choices for Medicare coverage?

There are two broad choices. One is traditional Medicare, which covers hospitalization (Part A) and outpatient services such as visits to the doctor (Part B). Traditional Medicare does not include prescription drug coverage, so you’ll have to buy a separate drug plan. We’ll get to why that’s important.

However, you can add a Medigap supplement to traditional Medicare to reduce the cost of co-pays and deductibles for Medicare-covered expenses.

The other is Medicare Advantage, which is offered by private insurance companies that are approved by Medicare. These plans have Parts A and B, and include drug coverage. Medicare Advantage also may include extras, such as allowances for health clubs or wellness programs.

Is traditional Medicare free?  

Part A coverage (hospitalization) typically is free for anyone who has paid into Social Security for 10 or more years.

Part B has a monthly premium. If you are collecting Social Security, the premium is automatically withdrawn. Even people who have a Medicare Advantage Plan pay that premium. Plus, with traditional Medicare, you’ll need to help your loved one select a drug plan, which has an additional cost.

My parents have had the same Medicare plan for years. Why do we need to go over the choices?

Once they sign up, they’ll be automatically re-enrolled during the next year’s sign-up process. But plans don’t stay the same, and neither do your parents. Because premiums increase and benefits change, your parents may be paying more than necessary or not getting the types of services they need or want.

My parents are moving to Rochester from outside this area. Do I need to know anything special?

Someone eligible for Medicare has to buy the insurance in the area of their primary residence. So if that person is moving here, they’ll have to change their insurance. If that’s not happening now, the person can use a special enrollment period that lasts for two months around the time of the move.

So, what do I have to be thinking of to help them choose a plan?

You may be asking your parents or grandparents things that aren’t always talked about in families. But it’s important to know those things, in order to make the best selection.

• Start with their overall health. If you don’t live with them, you may not know how often are they hospitalized or see a doctor. Just like with your own insurance, there are charges for services. Plans that charge higher premiums have lower copayments, and plans with low (or no) premiums have higher copayments. It’s a tradeoff. If your person doesn’t use many health care services, it may make sense to go for a lower premium and pay more on the few occasions when you need care.
• Do they travel? Does that involve only day trips, or are they snowbirds? All plans offer emergency or urgent care for vacations or road trips. Some plans have a benefit for people who spend time out of the area, but that benefit varies by company.
• What’s on their prescriptions list? Even if they don’t take any medication now, it pays to sign up for drug coverage (called Medicare Part D). If they don’t sign up when they enroll in Medicare and eventually want medication coverage, they’ll pay a penalty that can add hundreds of dollars a year, every year.
• If they’re not using any, or many medications now, they may want to consider a Medicare Advantage plan with a zero-dollar premium. That way, they are not spending extra on drug coverage and they’re protecting themselves from the penalty in the future. If they are taking a lot of medications, know that drugs are classified in tiers that range from generics in tier 1 to very specialized (and expensive) drugs in tier 5. The insurer classifies the drugs into tiers, and the tier determines how much your loved one pays. So check how different companies classify the drugs your loved one uses.
• If they have trouble paying for their medication, sign them up for the New York state Elderly Pharmaceutical Insurance Coverage, The plan helps with copayments and can pay the Part D premium for low-income seniors.
• Make sure your loved one’s doctors are in the plan you’re looking at. Double-check with the doctors (hospitals and other services the person uses) and with the insurer. If your loved one sees a provider who is not part of the plan, he or she could be responsible for the entire bill.

What do we do when we’ve chosen a plan?

If your loved one currently is enrolled in a plan and wants to switch, do not contact that current insurer to cancel. Have the individual contact the new plan of choice, either via phone or online, and sign up for that plan. Once that sign-up is processed, Medicare will be notified of the change and will then notify the previous plan of the change and the previous plan will eventually issue a notice of cancellation. This is to make sure there is no period in which the individual has no coverage at all.

PSINGER@Gannett.com

For more information

The Medicare enrollment period is Oct. 15 through Dec. 7. 

Lifespan, which provides non-medical advice to seniors and their caregivers, is offering free Medicare 101 seminars. Reservations are required. Go to www.lifespanrochester.org and click on the Events/Workshop tab or call (585) 244-8400, ext. 401.

• 1:30-3:30 p.m., Nov. 2,  St. John's Meadows at Brickstone Wintergarden, 1325 Elmwood Ave. 
• 1:30-3:30 p.m., Nov. 6, The Summit at Brighton,  2000 Summit Drive, Brighton.
• 1-3 p.m., Nov. 12, The Hurlbut Nursing Home, 1177 East. Henrietta Road, Brighton.
• 1-3 p.m., Nov. 13, Lifespan, 1900 S. Clinton Ave., Brighton.
• 1-3 p.m., Nov. 16, Westside YMCA 920 Elmgrove Road, Gates.
• 2-4 p.m., Nov. 17, Valley Manor, 1570 East Ave. 
• 3-5 p.m., Nov. 24, Lifespan. 

Medicare publishes a guide for families and friends. Go to www.medicare.gov/Pubs/pdf/11034.pdf.

For information about how to enroll in Medicare, go to www.medicare.gov.

For information about the Health Insurance Information, Counseling and Assistance Program, go to www.aging.ny.gov/healthbenefits/.