Getting ahead

This is the time of year to get ahead of the “end of year pile-up” that occurs when it’s open enrollment season for everything medical and the calendar year deductibles need to be revisited. If you prepare now for the upcoming evaluations and decisions for your elders, you’ll save some of those precious marbles.

Put your seat belt on, we’re about to go for a ride through some tough territory!  Meaning – this can be complicated and hard to keep up your concentration. Don’t panic, hang on, stay with me. Now, here we go!

What is coming up?

  • Medicare Open Enrollment – October 15 through December 7
  • Medicare Supplemental Insurance Open Enrollment
  • Medicare Prescription Drug Insurance Open Enrollment
  • Calendar Year-end for Current Insurance Policies
  • Calendar Year-end for any Supplemental Dental, Vision or Hearing Policies

What should you do?

  • Evaluate the Medicare plan that your elder currently has. If they have Original Medicare and a Medigap supplemental policy, check out what the current Medigap policy offers to see if the coverage still matches what your elder needs. Medigap policies (Plans A through N) are standard throughout the country (except MA, WI and MN). Prices on the plans will vary by insurance company, even though the coverage is standard.


  • During Medicare Open Enrollment (Oct. 15-Dec. 7, 2018), your elder can change their Medicare coverage. They can switch from Original Medicare with a Medigap supplemental policy to a Medicare Advantage plan or a Medicare SELECT plan (only in some states). And vice versa – they can switch back to Original Medicare if they are currently on a Medicare Advantage plan.


  • Also during Open Enrollment, your elder can switch insurance companies, either staying on the same Medigap insurance plan (Plan A-N) or moving to a different plan entirely.


  • Prescription Drug Insurance Coverage (Medicare Part D) can also be changed during the Open Enrollment period. Your elder will need their list of current medications and costs to compare their current coverage to the formularies (drug lists) of other insurance carriers. Formularies and tier levels for medications can change year to year for the same insurance company.  It pays to check and compare.


  • If your elder has a high-deductible plan for their Medigap supplemental insurance, you can help them evaluate what they paid, what coverage their insurance carrier provided and whether the current plan still makes sense for them. Open enrollment is the time to change, if you find that the current plan is not a good fit.


  • Original Medicare has no coverage for dental, vision, or hearing. Your elder may have purchased supplemental plans for these. If not, you may want to help them check out the coverage options and costs.  If your elder is on a Medicare Advantage plan, they may have coverage for one or all of these three areas.  Your elder can look at what they’ve paid for dental, vision and hearing services this year to compare with costs and coverage to purchase supplemental plans.


  • If your elder has any benefits that are covered but that they have not taken advantage of (wellness checks, immunizations, etc.), you may want to encourage them to schedule those visits before year-end. Same with dental, vision or hearing coverage that they might have purchased.


Start here:

  • Go to to see what plans and prices are available where your elders live.


  • Mental sticky note the following info: Part A deductible for 2018 is $1340, Part B deductible for 2018 is $183 for the year, Part D deductible varies by plan and there might not be a Part D deductible (you’ll need to check out your elder’s policy).


  • Grab copies of the current policies that your elders have for all of their medical and prescription drug coverage, in addition to any policies that they’ve purchased for dental, vision or hearing costs.


Now, find these documents.  They will be helpful in evaluating current year costs, payments and benefits.  Hint: they may be in the filing cabinet and they may be in a deep dark corner of the guest room closet.

  • Medicare Summary Notices (MSNs) – these explain what costs Medicare covered for the claims submitted for your elder. They also provide the status of deductible payment for both Part A and Part B.  You can see what Medicare says is coinsurance or copayment (what they say your elder must pay) and compare those amounts to what the Medigap supplemental insurance paid.


  • Medigap Insurance Explanation of Benefits (EOBs) – these detail what Medicare paid and what the Medigap policy paid for each claim made. If your elder owes any amounts, those will be listed on the EOB. If any amounts were applied to the deductible, the EOB will list them.


  • Receipts from medical providers. Compare what they are billing your elder to what the MSN and EOB say was billed and is owed.  Don’t forget to make sure the medical provider billed your elder’s Medigap insurance. Many elders pay the bills before they question if all their policy providers have been billed!


  • Prescription Drug Explanation of Benefits Statements (RxEOB) – this summarizes the drugs purchased, where they were purchased and what stage of copay/coinsurance your elder is in as of the date of the EOB. They also show what out-of-pocket costs your elder paid for their medications.



  • After you’ve run the numbers and done your comparisons, you’ll know if your elder’s current plan is fine or if they need to make changes.


  • If the current plan and policies are a good fit, nothing needs to be done.


  • If they need to make changes, be prepared. If you thought this was long and tedious for you, it can be overwhelming for them.  Be slow and gentle and take lots of breaks while explaining to them what’s needed and why.


What else will you need?

  • Your wits about you. A stiff drink.  A chunk of time.


A wink and a nudge –

  • This is a task that out-of-town siblings can do for the “team”.


Don’t Panic!  Start now. Get the documents. Do the comparisons. Talk to your elders.  It can all be done before you sit down for pie at Thanksgiving.


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