If you care for someone eligible for Medicare, it’s important to ensure you have the right information, permissions, and contact details to help manage their care effectively.
Getting to know Medicare coverage is important for any caregiver. However, there are also some other things to know, including enrollment periods, when to review coverage, and whether financial help may be available.
But before all of that, it’s crucial to ensure you have the right medical permissions. This caregiver guide will help you navigate Medicare and its many rules, processes, and procedures.
The most important thing to know is that Medicare cannot discuss anything with anyone other than the beneficiary unless they have permission. This is true of everything from medical information to billing and claims.
To ensure the right permissions with Medicare, the beneficiary must complete the Authorization to Disclose Personal Health Information Release Form, which is also available in Spanish.
Being familiar with the various Medicare enrollment periods can be helpful.
The enrollment periods are:
- initial enrollment period (IEP)
- open enrollment period (OEP)
- general enrollment period (GEP), also called Medicare Advantage open enrollment period (MA-OEP)
- special enrollment period (SEP)
Initial enrollment period (IEP)
Everyone eligible for Medicare has a 7-month initial enrollment period (IEP).
During this time, they can enroll in Original Medicare, which comprises Part A, which covers inpatient hospital care, and Part B, which covers outpatient medical services.
The IEP:
- begins 3 months before a person’s 65th birth month
- continues throughout their 65th birth month
- ends 3 months after their 65th birth month
Open enrollment period (OEP)
Medicare’s OEP runs from October 15 through December 7 every year.
During open enrollment, people can change their Medicare coverage. For example, they can:
- swap from Original Medicare to a Medicare Advantage (Part C) plan
- swap from Medicare Advantage to Original Medicare
- enroll in, leave, or switch Part D prescription drug plans
- change from one Medicare Advantage plan to another
General enrollment period (GEP)
If people miss their IEP, they can enroll during the GEP, which runs from January 1 through March 31 every year. However, unless they are eligible for a special enrollment period, they may have to pay a late enrollment penalty.
If someone already has a Medicare Advantage plan, this is the time they can change from one Medicare Advantage plan to another or leave a Medicare Advantage Plan to return to Original Medicare.
When returning to Original Medicare, people will also be able to join a stand-alone Medicare Part D prescription drug plan to ensure they have coverage for their medications.
Special enrollment period (SEP)
If someone misses their IEP, they may have an opportunity to enroll during a SEP.
There are various reasons someone may qualify for a SEP, including:
- having alternative coverage, such as through an employer
- moving back to the United States after living abroad
- a plan’s Medicare contract ends or changes
It’s a good idea to get to know the Medicare & You handbook, which is updated every year.
The handbook details general Medicare costs, coverage rules, plan rules, and any changes they have implemented for the new calendar year.
You’ll also find information on a person’s rights, appeals processes, and where to get answers to common Medicare questions.
If someone has a Medicare Advantage plan, you should ensure that the private insurer administering the plan has sent the plan documentation, which details its own plan rules and the coverage options selected.
Medicare offers people and their caregivers educational support and help navigating the healthcare system.
This includes:
- Principal illness navigation services: This is a type of care management that helps people understand specific medical conditions or diagnoses. It guides people through the healthcare system and provides support along the way.
- Principal care management services: This service covers condition-specific management services for complex chronic conditions that may result in hospitalizations, physical or mental decline, or that may require end-of-life care.
- Chronic care management services: If someone has two or more chronic conditions that they expect to last for at least 1 year, Medicare may pay for a healthcare professional to help manage their care specifically for these conditions.
- Coordinated care services: In an effort to stop unnecessary tests and services and medical errors, Medicare offers care coordination services that can help ensure medical information is shared across all healthcare professionals and facilities involved in someone’s care to ensure it is the most effective it can be. Coordinated care services include:
- Accountable care organizations (ACOs), which comprise doctors, other healthcare professionals, hospitals, and other healthcare facilities, all of which accept Original Medicare and work together to coordinate healthcare.
- ACO Realizing Equity, Access, and Community Health (ACO REACH), which helps different kinds of primary care doctors and specialists work together to improve healthcare quality and results for people with Original Medicare.
More services may be available based on a person’s specific needs. To find out more, contact Medicare or the person’s plan provider.
Both Original Medicare and Medicare Advantage plans offer many free preventive services. This includes not having to pay out-of-pocket costs like deductibles, copayments, or coinsurance.
The list is extensive and may not include all available options, particularly if someone has a Medicare Advantage plan, as these plans can include services that Original Medicare does not include.
Medicare may be able to offer some help to people with limited income and resources.
Help includes:
- Medicare Savings Plans (MSPs): There are four different MSPs, each offering different cost savings. The programs are:
- Extra Help: This program helps people with the cost of their medications.
- Medicaid: Medicaid is a joint federal and state program that helps with healthcare costs. Some people may be dually eligible for both Medicare and Medicaid. In some instances, Medicaid may cover some or all of the costs that Medicare does not.
Other local programs may also be available to help with healthcare costs, so always check with local and state departments where you reside.
Compiling a list of contacts can help you know who to contact and when. You can start by having a list of your loved ones:
- family doctor or another primary care physician
- nearest hospital, clinic, or other healthcare facility
- nearest or preferred pharmacy
Other important contacts include:
| Medicare | To reach Medicare, call 800-633-4227 (TTY: 877-486-2048). Lines are open 24/7, with the exception of some federal holidays. |
| Medicare mailing address | Medicare Contact Center Operations PO Box 1270 Lawrence, KS 66044 |
| milConnect | To reach milConnect, call 800-538-9552 (TTY: 866-363-2883). Alternatively, use this helpful web tool to find a local adviser. These contact details are for members of the military and can help identify military benefits and locate local military benefits advisers |
| Railroad Retirement Board (RRB) | To reach the RRB, call 877-772-5772 (TTY: 312-751-4701). Automated services are available 24/7. |
| Social Security Administration (SSA) | Register, enroll, and manage accounts via the SSA website. For those unable to access online services, call 800-772-1213 (TTY: 800-325-0778). Lines are open between 8 a.m. and 7 p.m. local time each weekday. |
| State Health Insurance Assistance Program (SHIP) | To reach SHIP, call 877-839-2675. This service offers tailor-made Medicare and other health insurance advice. |
| U.S. Department of Veterans Affairs (VA) | To reach the health benefits hotline, call 877-222-8387. Lines are open between 8 a.m. and 8 p.m. ET on weekdays. |
There are many ways to support someone with Medicare, and as a caregiver, it is vital to ensure you have all the information you need or know where to find it.
Getting the right permissions to manage Medicare on behalf of your loved one should be the first thing you do, so that you don’t experience any barriers when discussing their care.
Knowing about the different Medicare enrollment periods, coverage options, rules and procedures, and the financial help that may be available will ensure you have everything you need to manage Medicare as a caregiver.