Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
Welcome to Medicare three sixty, where the world of Medicare
is simplified and you are empowered to make informed healthcare choices.
With over two decades of experience and insurance and financial
solutions with hosts licensed insurance agents Jennifer Lee, you are
guided through the ins and outs of Medicare. Whether you
(00:22):
are nearing retirement, navigating your options, or just curious about
what's available. Everything you need to know is covered. Tune
in for knowledgeable insights, tips and answers to your Medicare
questions so you can take charge of your health and
your future. And Now Medicare three sixty.
Speaker 2 (00:44):
Welcome everyone to another episode of Medicare three sixty, where
we break down the complexities of Medicare so you and
your family can make confident, informed decisions. I'm your host,
Jennifer Alfonso Lee with premier insurance and financial solutions. Today's
topic is one that hits home for so many families,
(01:06):
whether you're a senior yourself, an adult child helping your
parents navigate Medicare, or someone preparing for future caregiver responsibilities.
So today's episode caring for aging parents. What adults must
know about Medicare? This episode consistently becomes one of the
most shared topics because families realize just how many mistakes
(01:31):
and emergencies could have been avoided if they have this information. Sooner,
we're going to cover everything about power of attorney, enrollment mistakes,
dangerous coverage gaps, drug plan surprises, how children can help
reg flugs to watch for in the subtle warning science
parents won't tell you, so settle in. This is going
to be an important and emotional episode. So let's start
(01:56):
why this conversation is so critical. Medicare today is not
the same Medicare grandparents signed up for. There are more
planned types, more rules, more authorizations, more marketing, and honestly,
more traps. Here's what really happening behind the scenes. Many
seniors won't admit they're confused. Many feel embarrassed to ask
(02:20):
for help. Some don't want to burden their children, Others
are dealing with small cognitive declines that they're hiding, and
some simply assume Medicare covers everything which it doesn't. Adult
children often stepped in only after a crisis. A surgery
(02:42):
gets denied, a skilled nursing state isn't covered. A prescription
jumps to three hundred dollars. A parent switch is to
a new plan and didn't understand it. A bill goes
to collections or the hospital asks who is the decision maker.
By that point, they're in a reactive mode. And that's
(03:04):
why we're having this conversation to ship families into a
proactive mode. So power of attorney the lifeline. Families typically overlook.
This is one of the most misunderstood areas. A power
of attorney is not about taking control from your parents.
It's about protecting their wishes. There are three documents every
(03:28):
family should have, which is the durable power of attorney.
It allows you to help with financial matters, including Medicare calls.
Medical power of attorney allows you to make health care
decisions if they aren't able. HIPPA authorization allows doctors to
speak with you even if your parent is still fully capable.
(03:49):
Here's what people don't realize. Medicare will not talk to
you without proper authorization. Doctors will not explain medical details
without HIPPA approval. Banks insurance company will block you without
a POWA. That's power of attorney, banks and insurance. So
if something happens suddenly a stroke, fall, confusion, you have
(04:12):
zero authority to help without these documents, this is not
something to wait on. Many families find out late. Real
example had a client whose mother was hospitalized with pneumonia.
The hospital needed urgent decisions about medications, but none of
the kids had POWA. They spent two days scrambling while
their mother was sedated. So the action step here is
(04:36):
if your parents don't have documents, set up an appointment
with an estate planning attorney or a legal clinic within
the next thirty days. So let's talk about avoidable enrollment
mistakes that cost families thousands. So mistake number one is
delaying Part B for too long. Parents stay on employer
(04:58):
plans cobra or retire or retire unexpectedly. If they get
it wrong, they do face lifetime penalties. So that there
is a form that needs to be completed by the
human resources company or the department of that employer to
(05:21):
make sure that they've had credible coverage ever since they
were sixty five. Mistake number two not understanding Part B
start delays. People think Medicare works like employer insurance and
it doesn't. Enrollments can have a one to three month delay,
especially just with the government shut downs. And things like that.
(05:44):
You do want to be more proactive just in case
there are delays. Mistake three missing the Part D drug plan.
Parents say, I don't take meds, but giving Part D
leads to permanent penalties. So just because someone doesn't have
any drug medications, does it mean that you don't have
to get a drug plan. There are some plans that
(06:04):
are actually as low as zero dollars, so why not
just take that? The penalty is one percent for every
single month that you needed a drug plan that you
weren't on it. And so when you look at your
Part A and Part B Medicare Health insurance card, there's
no D on there, which is drug, but know that
(06:25):
it's invisible and then you do need one. Mistake number
four choosing plans based on premium not needs. Adult children
often look at lowest cost, biggest brand, or what their
coworkers' parents have. But the real question should be does
your parents have chronic conditions? Do they seem multiple specialists?
(06:48):
Do they want predictable predictable costs? Do they travel between states?
Are they comfortable with prior authorizations? So those are the
biggest things. Sometimes I see caregivers or adult children trying
to change their parents' plans. And so if your parents
(07:11):
are used to their plan and if it's not broken,
then maybe it's not worth fixing. Just just a fruit
for thought on that. Okay, some mistake number five parents
get enrolled without realizing it. Some enrollment. Some enroll because
they click something online, click something online. Someone gives you
(07:33):
a call, and sometimes it's even as far as they
pretend that you're there, that you're their agent, or that
you have that plan with them, and they just verify
your social and your Medicare ID number. So I've just
I've seen a lot of that. Okay, someone knocked on
(07:53):
their door, so do not if you didn't have an appointment.
Someone knocking on your door is unsolicited and actually not compliant.
They misunderstead of postcards. So yes, there are postcards where
it looks official like it's from the government, it's from Medicare,
and it really isn't. It's a marketing ployt for that
(08:16):
company to allow them to call you to help you, right,
but you got to be careful with that. But it
is marketing and they may be selling your information as well.
A call center agent enrolled them fast over the phone.
I do see this a lot when clients say, Jennifer,
I made a mistake. I entertained an agent. They were
(08:39):
so nice to me. You're nice too, but you know
they were a fast talker, they were smooth, and basically
have them change everything, and then what happens They can't
see their doctors and just these agents are not nowhere
to be found and they can't be reached. So be
care flown them too. So a doun't children need to
(09:02):
check the plan every single year just to help out,
I would say. So, Now let's talk about hidden coverage
gaps that blind side families. Let's talk about gaps that
cause real financial harm. Gap number one dental that is
a major problem. Medicare does not cover implants, dentures, deep cleanings, crowns,
(09:23):
oral surgery. Usually families are shocked when their parents suddenly
need ten thousand dollars in implants. Right, So having great
dental coverage, some I see like they keep some individual ones.
Some plans do have dental included. But you just need
(09:43):
to know the ins and outs because some dental is HMO,
some are dental PPO, and most dentists do like the
PPO version as well, So keep that in mind when
it comes to picking the right plan for clients. I
had one in particular where they did upgrade today because
(10:08):
their plan offered a dental PPO and their dentists is
actually a network, which is always better to go in
network if you can, because you'll save money. So Gap
number two is vision. Medicare covers medical eye issues, but
not routine exams for glasses, so if you're trying to
do laser those aren't included, so keep that in mind.
(10:31):
Of course, if you are on a Medicare advantage, there
are some plans with vision exam glasses that are frames
that are covered, so really no, and look at your
evidence of coverage hearing aids. So hearing aids could be
very costly. Some plans offer copay, some plans offer a
(10:54):
set amount of coverage, but I mean sometimes you're paying
three to six thousand out pocket without any additional coverage,
so keep that in mind. Gap number four skilled nursing.
This is a major trap. Medicare only covers it if
there is a three day impatient hospital stay, not observation
(11:14):
status and they meets strict rehab criteria, so families are
stunned to learn mom has to go with no help.
So This is a big thing. This was a rule
that changed a few years back that there has to
be a three day impatient hospital stay to get into
skilled nursing. So gap number five. Home health isn't caregiving.
(11:36):
Home health provides loan care, therapy, and clinical services. They
do not offer bathing, feeding, cleaning, daily support. So families
are confused about home health with long term care, and
that misunderstanding leads to emergencies. So remember, home health is
not like caregiving or extended or long term care support.
(11:57):
That are additional insurance policies for them at that you
could get. So now let's move to drug plant surprises
that hit suddenly. So prescription coverage is the number one
place where seniors lose money without realizing it. Surprise number one.
Yearly drug list changes, so a medication covered at ten
(12:19):
dollars one year might be eighty dollars are not covered
the next year. So definitely formulas do change year by year,
so make sure that you look at that. Premiums do
change as well, meaning what could be zero dollars this
year could be two hundred dollars next year. So that's
why it's always to review. Surprise number two the donut hole.
(12:44):
So really, actually, that's not a surprise. There is no
more donut hole right now, the donut hole. The max
was sixty eight thousand. Now the cap is twenty one
hundred for twenty twenty six. So just keep in mind
there is no don't anymore. Surprise number three. Pharmacies charge
different prices, so CBS, Walgreens, Walmart all may charge different amounts,
(13:08):
sometimes five to ten times more. So if you're really savvy,
you want to look at the prices. Surprise number four.
Tier changes, a drug moves from tier two to tier
three and the cost sky rocket. So let's just say
you had a Tier two drug that was zero dollars.
This year, the formulae changes, it becomes a Tier three
and now you're caught with a deductible and like a
(13:30):
percentage or a codepay, So watching out for that. Surprise
number five. Prior authorizations advantage plans can deny injectibles, inhalers, diabete, meds,
high cost generics, so definitely, and sometimes a senior could
get a letter that says, you know, it needs to
(13:50):
be approved, and sometimes they think that's a denial and
they don't move forward. But what really needs to happen
is contacting the insurance company to make sure that they
contact the doctor to get that approval. Depending where it
falls through the cracks, you need to follow up with
your doctor to make sure that they send that approval.
(14:11):
So children can help navigate appeals on alternatives, and of
course using a independent, licensed insurance agent like myself would
definitely help. So how about adult children? How are they?
How could they help? Right? So this is where families
make the big difference. Step one is to create a
(14:32):
Medicare binder. Include your Medicare card, the id cars, the druggalists,
specialist list, the power of attorney in the hippaforms, copy
of their plan benefits and pharmacy information. Two ten yearly
plan reviews. Even a twenty minute zoom could prevent a disaster.
And I know some just want to go on medicare
(14:54):
dot gov and review that. But working with a licensed,
independent age makes all the difference, especially if their experience
and their local just because they know the ins and
outs well, the good ones know the ins and outs
of the plans. They know what's going on with their
local marketplace and what plans are strong and what plans
(15:15):
are unstable. So definitely. While you can read a lot
of information, you definitely want help from a licensed independent broker.
So step three is to organize medication, update the lists
every time something changes, and then step four help with appeals.
Most families don't know that they could appeal any denial
(15:38):
and they could even appeal it two, three, four how
many times, so sex rates are very high when documented.
Step five watch mail for changes, so parents often throw
away important letters, plan changes, authorization notices, denial letters, hospital
status notices. So it is who have you to check
(16:01):
your mail, check your phone, your voicemails, messages, just because
there might be important updates from the health insurance company
as well as your medical group or your doctor. So
step six set up email alerts, turn on not okay
patients for new claims, prior authorization decisions and pharmacy charge changes.
(16:25):
It's also like for the claims, you definitely don't want
something on there that was fraudulent or incorrect pharmacy. Sometimes
even labs. The insurance company or the medical group wants
you to change a different lab, so that's something also
to consider every once a year. Just attending doctor business
(16:47):
could help you understand their healthcare trajectory as well, so
red flags that signal your parents need help. There are
signs adult children often ignore confusion about medications, complaints about
high drug costs, difficulty explaining which plan they have, getting
(17:07):
multiple bills labeled denied notices that they were switched to
a new plan, trouble remembering doctor appointments, increased hospital or
urgent care visits, repeating questions about coverage, and quite frankly,
like I've even had that today where clients have asked
(17:29):
so several times. But I know sometimes it's just for
understanding being overwhelmed by mail or paperwork, so that definitely
is something that they might also be overwhelmed with that
suddenly relying on neighbors or friends for advice. So when
you see these signs, it's time to step in gently,
(17:49):
respectfully and supportively. So emotional realities of caring for Asian parents,
we also need to acknowledge the emotion outside. Adult children
often carry guilt. I know you are probably the Sandwich
generation taking care of elderly and taking care of also
(18:14):
your your sons and daughters, right, so that could be
in a guilt. Parents fear losing independence, so that's a
big one. Most seniors do not want to lose their independence.
They want to be independent and have that freedom, and
some some are willing to accept it and some aren't. Right,
(18:35):
I was talking to a daughter of a client and
she's actually one hundred four years old and she's like,
my mom just barely let me get her like a cane, right,
So things like that, these these topics are definitely touchy.
I would say role shifts, right. They used to take
(19:01):
care of you, They used to be your provider and
just do everything for you. Now like girles have reversed,
so conversations do become difficult. So to make it not difficult,
I would start early, easier way into things like that.
Don't wait till they're much older to talk about these things.
(19:21):
But here's the truth. Getting involved is not taking away independence,
it's protecting it. Medicare is definitely complex and no seniors
should have to navigate it alone, even for my case
right now. Unfortunately, I do have my mother in law
who has dementia. Ever since they retired, they've lived with
(19:46):
me and my husband, and so her husband he died
I don't know, maybe was it seven years ago now,
and she was really his care giver right. I mean,
he had also Alzheimer's, So when he passed I feel
(20:06):
like there was a lot of emotions because she was
with him for a very long time and she was
his caregiver, so to just lose that importance as well.
And then now even in her case, unfortunately, she had
a knee surgery replacement and it didn't quite go well.
(20:27):
I mean, the knees fine, but her mind just kind
of went out and she just has never been the same, unfortunately.
And so that's what me and my husband is having
to work with to figure out all this as we
come along. My parents are a little bit younger, right
(20:49):
in their late sixties early seventies, and now I think
I should They've always been set and we have talked
about things like this, so it's not going to be
like a big surprise, but I am definitely seeing that
as the years go by, I definitely need to have
(21:09):
more rampant conversations with them, including my brother that also
is nearby, and like roles and responsibilities that we could take,
because it is definitely tough, right with siblings. If your
siblings are close, everyone could work together, but if you
have siblings at a different state, it is tough, and
(21:31):
then for you as a caregiver, you do need to
take care of yourself and also take a break sometimes
on that. So I'd say today's episode we covered a lot.
This is just not a lot of the knowledge that
I usually part and taken, but just there is definitely
(21:55):
the logical aspect of making sure everything is set for
your parents when the time comes. My parents fortunately has
everything planned from what's going to happen when things do
happen to them, and so it is time to plan
(22:17):
and start really talking and thinking it over your parents
and your siblings to see, you know's what's going to
happen in the future, right even though it's five, ten, fifteen,
twenty five, even thirty years down the line. We just
never know. But every part matters. So there is that
(22:37):
logical part the planning. They're just taking action and getting
everything done. And there's also the part where it's the
emotional aspect that's not visible, that's not logical, that you
definitely what should talk to your parents about. So caring
for aging parents is one of the most meaningful roles
will ever take on. Right. Definitely, your parents took care
(23:02):
of you and now paying a forward and taking care
of them, I'm sure really means a lot. So Medicare
shouldn't add stress, it should offer support. If you'd like
help organizing your family's Medicare documents, we do have some
free software on that that could help you, at least
(23:25):
with the will and the Advanced Directive portion that you
have it in one portal and that's free for you.
Could help you with that, reviewing your coverage or preparing
for twenty twenty six plan changes. My team at Premiere
three six CE Insurance and Financial Solutions is here for you.
And so this was a very touchy episode. I hope
(23:49):
you learned a lot or just something to be reminded
of of what you want to start implementing. You know,
we usually always want to implement things, but definitely taking
action and just getting it done is very important. So
thank you for spending time with me today. Share this
(24:11):
episode with a friend. It may save a family from
a crisis. So once again, my name is Jennifer ALFONZOI
with the Medicare three sixty show. I look forward to
the next episode. Thank you and have a wonderful day.
Speaker 1 (24:32):
Thank you for joining the program Medicare at three sixty.
Hope you found today's episode insightful and empowering. Remember understanding
your Medicare options is key to making the right choices
for your health and financial well being. If you have
questions or topics you would like cover it in future
episodes of Medicare three sixty, don't hesitate to reach out
(24:54):
and speak with our licensed insurance agent until next time,
Stay informed and take shre charge of your healthcare journey.
This has been Medicare three point sixty, your trusted source
for all things Medicare. Take care
Welcome to Medicare three sixty, where the world of Medicare
is simplified and you are empowered to make informed healthcare choices.
With over two decades of experience and insurance and financial
solutions with hosts licensed insurance agents Jennifer Lee, you are
guided through the ins and outs of Medicare. Whether you
(00:22):
are nearing retirement, navigating your options, or just curious about
what's available. Everything you need to know is covered. Tune
in for knowledgeable insights, tips and answers to your Medicare
questions so you can take charge of your health and
your future. And Now Medicare three sixty.
Speaker 2 (00:44):
Welcome everyone to another episode of Medicare three sixty, where
we break down the complexities of Medicare so you and
your family can make confident, informed decisions. I'm your host,
Jennifer Alfonso Lee with premier insurance and financial solutions. Today's
topic is one that hits home for so many families,
(01:06):
whether you're a senior yourself, an adult child helping your
parents navigate Medicare, or someone preparing for future caregiver responsibilities.
So today's episode caring for aging parents. What adults must
know about Medicare? This episode consistently becomes one of the
most shared topics because families realize just how many mistakes
(01:31):
and emergencies could have been avoided if they have this information. Sooner,
we're going to cover everything about power of attorney, enrollment mistakes,
dangerous coverage gaps, drug plan surprises, how children can help
reg flugs to watch for in the subtle warning science
parents won't tell you, so settle in. This is going
to be an important and emotional episode. So let's start
(01:56):
why this conversation is so critical. Medicare today is not
the same Medicare grandparents signed up for. There are more
planned types, more rules, more authorizations, more marketing, and honestly,
more traps. Here's what really happening behind the scenes. Many
seniors won't admit they're confused. Many feel embarrassed to ask
(02:20):
for help. Some don't want to burden their children, Others
are dealing with small cognitive declines that they're hiding, and
some simply assume Medicare covers everything which it doesn't. Adult
children often stepped in only after a crisis. A surgery
(02:42):
gets denied, a skilled nursing state isn't covered. A prescription
jumps to three hundred dollars. A parent switch is to
a new plan and didn't understand it. A bill goes
to collections or the hospital asks who is the decision maker.
By that point, they're in a reactive mode. And that's
(03:04):
why we're having this conversation to ship families into a
proactive mode. So power of attorney the lifeline. Families typically overlook.
This is one of the most misunderstood areas. A power
of attorney is not about taking control from your parents.
It's about protecting their wishes. There are three documents every
(03:28):
family should have, which is the durable power of attorney.
It allows you to help with financial matters, including Medicare calls.
Medical power of attorney allows you to make health care
decisions if they aren't able. HIPPA authorization allows doctors to
speak with you even if your parent is still fully capable.
(03:49):
Here's what people don't realize. Medicare will not talk to
you without proper authorization. Doctors will not explain medical details
without HIPPA approval. Banks insurance company will block you without
a POWA. That's power of attorney, banks and insurance. So
if something happens suddenly a stroke, fall, confusion, you have
(04:12):
zero authority to help without these documents, this is not
something to wait on. Many families find out late. Real
example had a client whose mother was hospitalized with pneumonia.
The hospital needed urgent decisions about medications, but none of
the kids had POWA. They spent two days scrambling while
their mother was sedated. So the action step here is
(04:36):
if your parents don't have documents, set up an appointment
with an estate planning attorney or a legal clinic within
the next thirty days. So let's talk about avoidable enrollment
mistakes that cost families thousands. So mistake number one is
delaying Part B for too long. Parents stay on employer
(04:58):
plans cobra or retire or retire unexpectedly. If they get
it wrong, they do face lifetime penalties. So that there
is a form that needs to be completed by the
human resources company or the department of that employer to
(05:21):
make sure that they've had credible coverage ever since they
were sixty five. Mistake number two not understanding Part B
start delays. People think Medicare works like employer insurance and
it doesn't. Enrollments can have a one to three month delay,
especially just with the government shut downs. And things like that.
(05:44):
You do want to be more proactive just in case
there are delays. Mistake three missing the Part D drug plan.
Parents say, I don't take meds, but giving Part D
leads to permanent penalties. So just because someone doesn't have
any drug medications, does it mean that you don't have
to get a drug plan. There are some plans that
(06:04):
are actually as low as zero dollars, so why not
just take that? The penalty is one percent for every
single month that you needed a drug plan that you
weren't on it. And so when you look at your
Part A and Part B Medicare Health insurance card, there's
no D on there, which is drug, but know that
(06:25):
it's invisible and then you do need one. Mistake number
four choosing plans based on premium not needs. Adult children
often look at lowest cost, biggest brand, or what their
coworkers' parents have. But the real question should be does
your parents have chronic conditions? Do they seem multiple specialists?
(06:48):
Do they want predictable predictable costs? Do they travel between states?
Are they comfortable with prior authorizations? So those are the
biggest things. Sometimes I see caregivers or adult children trying
to change their parents' plans. And so if your parents
(07:11):
are used to their plan and if it's not broken,
then maybe it's not worth fixing. Just just a fruit
for thought on that. Okay, some mistake number five parents
get enrolled without realizing it. Some enrollment. Some enroll because
they click something online, click something online. Someone gives you
(07:33):
a call, and sometimes it's even as far as they
pretend that you're there, that you're their agent, or that
you have that plan with them, and they just verify
your social and your Medicare ID number. So I've just
I've seen a lot of that. Okay, someone knocked on
(07:53):
their door, so do not if you didn't have an appointment.
Someone knocking on your door is unsolicited and actually not compliant.
They misunderstead of postcards. So yes, there are postcards where
it looks official like it's from the government, it's from Medicare,
and it really isn't. It's a marketing ployt for that
(08:16):
company to allow them to call you to help you, right,
but you got to be careful with that. But it
is marketing and they may be selling your information as well.
A call center agent enrolled them fast over the phone.
I do see this a lot when clients say, Jennifer,
I made a mistake. I entertained an agent. They were
(08:39):
so nice to me. You're nice too, but you know
they were a fast talker, they were smooth, and basically
have them change everything, and then what happens They can't
see their doctors and just these agents are not nowhere
to be found and they can't be reached. So be
care flown them too. So a doun't children need to
(09:02):
check the plan every single year just to help out,
I would say. So, Now let's talk about hidden coverage
gaps that blind side families. Let's talk about gaps that
cause real financial harm. Gap number one dental that is
a major problem. Medicare does not cover implants, dentures, deep cleanings, crowns,
(09:23):
oral surgery. Usually families are shocked when their parents suddenly
need ten thousand dollars in implants. Right, So having great
dental coverage, some I see like they keep some individual ones.
Some plans do have dental included. But you just need
(09:43):
to know the ins and outs because some dental is HMO,
some are dental PPO, and most dentists do like the
PPO version as well, So keep that in mind when
it comes to picking the right plan for clients. I
had one in particular where they did upgrade today because
(10:08):
their plan offered a dental PPO and their dentists is
actually a network, which is always better to go in
network if you can, because you'll save money. So Gap
number two is vision. Medicare covers medical eye issues, but
not routine exams for glasses, so if you're trying to
do laser those aren't included, so keep that in mind.
(10:31):
Of course, if you are on a Medicare advantage, there
are some plans with vision exam glasses that are frames
that are covered, so really no, and look at your
evidence of coverage hearing aids. So hearing aids could be
very costly. Some plans offer copay, some plans offer a
(10:54):
set amount of coverage, but I mean sometimes you're paying
three to six thousand out pocket without any additional coverage,
so keep that in mind. Gap number four skilled nursing.
This is a major trap. Medicare only covers it if
there is a three day impatient hospital stay, not observation
(11:14):
status and they meets strict rehab criteria, so families are
stunned to learn mom has to go with no help.
So This is a big thing. This was a rule
that changed a few years back that there has to
be a three day impatient hospital stay to get into
skilled nursing. So gap number five. Home health isn't caregiving.
(11:36):
Home health provides loan care, therapy, and clinical services. They
do not offer bathing, feeding, cleaning, daily support. So families
are confused about home health with long term care, and
that misunderstanding leads to emergencies. So remember, home health is
not like caregiving or extended or long term care support.
(11:57):
That are additional insurance policies for them at that you
could get. So now let's move to drug plant surprises
that hit suddenly. So prescription coverage is the number one
place where seniors lose money without realizing it. Surprise number one.
Yearly drug list changes, so a medication covered at ten
(12:19):
dollars one year might be eighty dollars are not covered
the next year. So definitely formulas do change year by year,
so make sure that you look at that. Premiums do
change as well, meaning what could be zero dollars this
year could be two hundred dollars next year. So that's
why it's always to review. Surprise number two the donut hole.
(12:44):
So really, actually, that's not a surprise. There is no
more donut hole right now, the donut hole. The max
was sixty eight thousand. Now the cap is twenty one
hundred for twenty twenty six. So just keep in mind
there is no don't anymore. Surprise number three. Pharmacies charge
different prices, so CBS, Walgreens, Walmart all may charge different amounts,
(13:08):
sometimes five to ten times more. So if you're really savvy,
you want to look at the prices. Surprise number four.
Tier changes, a drug moves from tier two to tier
three and the cost sky rocket. So let's just say
you had a Tier two drug that was zero dollars.
This year, the formulae changes, it becomes a Tier three
and now you're caught with a deductible and like a
(13:30):
percentage or a codepay, So watching out for that. Surprise
number five. Prior authorizations advantage plans can deny injectibles, inhalers, diabete, meds,
high cost generics, so definitely, and sometimes a senior could
get a letter that says, you know, it needs to
(13:50):
be approved, and sometimes they think that's a denial and
they don't move forward. But what really needs to happen
is contacting the insurance company to make sure that they
contact the doctor to get that approval. Depending where it
falls through the cracks, you need to follow up with
your doctor to make sure that they send that approval.
(14:11):
So children can help navigate appeals on alternatives, and of
course using a independent, licensed insurance agent like myself would
definitely help. So how about adult children? How are they?
How could they help? Right? So this is where families
make the big difference. Step one is to create a
(14:32):
Medicare binder. Include your Medicare card, the id cars, the druggalists,
specialist list, the power of attorney in the hippaforms, copy
of their plan benefits and pharmacy information. Two ten yearly
plan reviews. Even a twenty minute zoom could prevent a disaster.
And I know some just want to go on medicare
(14:54):
dot gov and review that. But working with a licensed,
independent age makes all the difference, especially if their experience
and their local just because they know the ins and
outs well, the good ones know the ins and outs
of the plans. They know what's going on with their
local marketplace and what plans are strong and what plans
(15:15):
are unstable. So definitely. While you can read a lot
of information, you definitely want help from a licensed independent broker.
So step three is to organize medication, update the lists
every time something changes, and then step four help with appeals.
Most families don't know that they could appeal any denial
(15:38):
and they could even appeal it two, three, four how
many times, so sex rates are very high when documented.
Step five watch mail for changes, so parents often throw
away important letters, plan changes, authorization notices, denial letters, hospital
status notices. So it is who have you to check
(16:01):
your mail, check your phone, your voicemails, messages, just because
there might be important updates from the health insurance company
as well as your medical group or your doctor. So
step six set up email alerts, turn on not okay
patients for new claims, prior authorization decisions and pharmacy charge changes.
(16:25):
It's also like for the claims, you definitely don't want
something on there that was fraudulent or incorrect pharmacy. Sometimes
even labs. The insurance company or the medical group wants
you to change a different lab, so that's something also
to consider every once a year. Just attending doctor business
(16:47):
could help you understand their healthcare trajectory as well, so
red flags that signal your parents need help. There are
signs adult children often ignore confusion about medications, complaints about
high drug costs, difficulty explaining which plan they have, getting
(17:07):
multiple bills labeled denied notices that they were switched to
a new plan, trouble remembering doctor appointments, increased hospital or
urgent care visits, repeating questions about coverage, and quite frankly,
like I've even had that today where clients have asked
(17:29):
so several times. But I know sometimes it's just for
understanding being overwhelmed by mail or paperwork, so that definitely
is something that they might also be overwhelmed with that
suddenly relying on neighbors or friends for advice. So when
you see these signs, it's time to step in gently,
(17:49):
respectfully and supportively. So emotional realities of caring for Asian parents,
we also need to acknowledge the emotion outside. Adult children
often carry guilt. I know you are probably the Sandwich
generation taking care of elderly and taking care of also
(18:14):
your your sons and daughters, right, so that could be
in a guilt. Parents fear losing independence, so that's a
big one. Most seniors do not want to lose their independence.
They want to be independent and have that freedom, and
some some are willing to accept it and some aren't. Right,
(18:35):
I was talking to a daughter of a client and
she's actually one hundred four years old and she's like,
my mom just barely let me get her like a cane, right,
So things like that, these these topics are definitely touchy.
I would say role shifts, right. They used to take
(19:01):
care of you, They used to be your provider and
just do everything for you. Now like girles have reversed,
so conversations do become difficult. So to make it not difficult,
I would start early, easier way into things like that.
Don't wait till they're much older to talk about these things.
(19:21):
But here's the truth. Getting involved is not taking away independence,
it's protecting it. Medicare is definitely complex and no seniors
should have to navigate it alone, even for my case
right now. Unfortunately, I do have my mother in law
who has dementia. Ever since they retired, they've lived with
(19:46):
me and my husband, and so her husband he died
I don't know, maybe was it seven years ago now,
and she was really his care giver right. I mean,
he had also Alzheimer's, So when he passed I feel
(20:06):
like there was a lot of emotions because she was
with him for a very long time and she was
his caregiver, so to just lose that importance as well.
And then now even in her case, unfortunately, she had
a knee surgery replacement and it didn't quite go well.
(20:27):
I mean, the knees fine, but her mind just kind
of went out and she just has never been the same, unfortunately.
And so that's what me and my husband is having
to work with to figure out all this as we
come along. My parents are a little bit younger, right
(20:49):
in their late sixties early seventies, and now I think
I should They've always been set and we have talked
about things like this, so it's not going to be
like a big surprise, but I am definitely seeing that
as the years go by, I definitely need to have
(21:09):
more rampant conversations with them, including my brother that also
is nearby, and like roles and responsibilities that we could take,
because it is definitely tough, right with siblings. If your
siblings are close, everyone could work together, but if you
have siblings at a different state, it is tough, and
(21:31):
then for you as a caregiver, you do need to
take care of yourself and also take a break sometimes
on that. So I'd say today's episode we covered a lot.
This is just not a lot of the knowledge that
I usually part and taken, but just there is definitely
(21:55):
the logical aspect of making sure everything is set for
your parents when the time comes. My parents fortunately has
everything planned from what's going to happen when things do
happen to them, and so it is time to plan
(22:17):
and start really talking and thinking it over your parents
and your siblings to see, you know's what's going to
happen in the future, right even though it's five, ten, fifteen,
twenty five, even thirty years down the line. We just
never know. But every part matters. So there is that
(22:37):
logical part the planning. They're just taking action and getting
everything done. And there's also the part where it's the
emotional aspect that's not visible, that's not logical, that you
definitely what should talk to your parents about. So caring
for aging parents is one of the most meaningful roles
will ever take on. Right. Definitely, your parents took care
(23:02):
of you and now paying a forward and taking care
of them, I'm sure really means a lot. So Medicare
shouldn't add stress, it should offer support. If you'd like
help organizing your family's Medicare documents, we do have some
free software on that that could help you, at least
(23:25):
with the will and the Advanced Directive portion that you
have it in one portal and that's free for you.
Could help you with that, reviewing your coverage or preparing
for twenty twenty six plan changes. My team at Premiere
three six CE Insurance and Financial Solutions is here for you.
And so this was a very touchy episode. I hope
(23:49):
you learned a lot or just something to be reminded
of of what you want to start implementing. You know,
we usually always want to implement things, but definitely taking
action and just getting it done is very important. So
thank you for spending time with me today. Share this
(24:11):
episode with a friend. It may save a family from
a crisis. So once again, my name is Jennifer ALFONZOI
with the Medicare three sixty show. I look forward to
the next episode. Thank you and have a wonderful day.
Speaker 1 (24:32):
Thank you for joining the program Medicare at three sixty.
Hope you found today's episode insightful and empowering. Remember understanding
your Medicare options is key to making the right choices
for your health and financial well being. If you have
questions or topics you would like cover it in future
episodes of Medicare three sixty, don't hesitate to reach out
(24:54):
and speak with our licensed insurance agent until next time,
Stay informed and take shre charge of your healthcare journey.
This has been Medicare three point sixty, your trusted source
for all things Medicare. Take care
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