How To Help Loved Ones Navigate Medicare Open Enrollment Successfully

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Health care coverage can be confusing even at the best of times. And when Medicare’s annual open enrollment period rolls around, trying to make smart plan choices for medical and prescription drug coverage can feel like an overwhelming task.

But there’s no need for Medicare enrollees to face it alone. “People can help their loved ones navigate this process and make informed decisions about their health care,” says Jason Resendez, president and CEO of the National Alliance for Caregiving (NAC).

According to data from the NAC and AARP, over half of family caregivers in the U.S. advocate for their loved ones with the Centers for Medicare and Medicaid Services, insurance companies, health care organizations and other services. This advocacy is most common among Black (62%) and rural Americans (60%). In recent years, secondary caregivers are getting more involved as well (50% in 2020 compared to 42% in 2015).

Whether you’re already giving your loved ones a hand with the Medicare open enrollment process or just getting started, here are five ways you can make it less burdensome and more successful for the people you care about.

1. Be Prepared

Helping manage the process is easier with a little preparation ahead of time.

Do your homework if you’re not familiar with Medicare or the open enrollment rules. The “Medicare & You” handbook from the Centers for Medicare and Medicaid Services (CMS) is a great place to start.

Learn the most common mistakes people make so you can avoid errors that may affect your loved one’s coverage and access to care.

Additionally, use their Medicare card to log into their account. From there, you can learn about their current coverage, identify their eligibility for additional programs and compare their plan options, including Medicare Advantage and Medicare Supplement plans. If your loved one hasn’t set up an account yet, help them do so. If they’ve misplaced their card, contact CMS for a replacement.

2. Approach the Task With Patience and Understanding

If Medicare open enrollment has your loved one feeling frustrated or overwhelmed, it’s important to be patient with them, notes Resendez. “Be understanding of their feelings and try to help them manage their stress,” he says. “Listen and validate their feelings. It’s crucial to understand their perspective and acknowledge their concerns.” Maintaining a respectful approach shows that you care about their well-being and autonomy.

3. Understand Their Needs

Choosing the right Medicare coverage starts with understanding your loved one’s health conditions and care requirements. To help narrow down the options and identify the best plan, start by asking your friend or relative a few important questions, such as:

  • Do they want to keep their current health care provider?
  • Is that provider in their preferred plan’s network?
  • Do they need specialty care?
  • What prescriptions do they take?
  • What’s their preferred pharmacy?

“This [information] is needed to effectively compare plans and ensure that all medications, [providers] and pharmacies are covered by prospective plans,” says Sam Carleton, director of Vermont’s Statewide Health Insurance Program (SHIP) and a supervisor of the local advocacy organization Age Well.

4. Ask for Help

Sometimes helpers need help, too. “If family caregivers are feeling overwhelmed, there are plenty of resources available to help them and their loved ones navigate the process,” says Resendez.

The federal government’s Administration for Community Living funds State Health Insurance Assistance Programs to provide free, unbiased counseling about the enrollment process and coverage options, equipping beneficiaries to handle open enrollment themselves in the future.

Additional support is available at your local Area Agency on Aging, a public or private non-profit agency designated by your state to connect older adults to services including Medicare and Medicaid, as well as living arrangements.

A trusted financial advisor can also help guide you. One who completed the certification program for retirement income certified professionals is specially trained to help with Medicare and other financial issues.

5. Look Out for Fraud

Scammers are always eyeing opportunities to take advantage of vulnerable populations, and they often ramp up their activities during the open enrollment period. You can guard yourself and your loved one from bad actors by keeping an eye out for common Medicare scams.

For instance, Medicare never asks for a Social Security number, bank account information or a Medicare card number over the phone or email. In fact, Medicare doesn’t call you unless you request a call back. “If someone calls and says they’re from Medicare, hang up,” warns Resendez.

As for mail, only pay attention to letters from the beneficiary’s existing plan, from the Medicare office and—if they receive public assistance to pay for their plan and medications—from the federal or state government.

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