Taking Care of Mom and Dad: The Essential Points

When it comes to reviewing your parents' medical coverage, it's easy to be intimidated. The mechanics of Medicare, Medicaid and Medigap coverages can seem impossibly complex. But focusing on a few essential points may help make sense of the system:

• If your parents are under 65, the best health care option is usually to keep whatever group medical insurance they have at work...or had at the last place they worked. Depending on their health, it may be cheaper to pay for COBRA coverage instead of buying an individual policy.
• If your parents are over 65 and still working, the group policy from work may still be the best coverage. If they aren't working or they can't get coverage at work, Medicare (combined with some form of supplemental coverage) will probably be the best health care.
• If your parents are over 65 and haven't applied for Medicare, get them signed up as soon as possible. Depending on how old they are and when they last had health insurance, they may not have coverage for six months.
• If your parents purchase Medigap insurance other than at the time of open enrollment, they will be subject to medical underwriting, physical examinations and pre-existing condition or other restrictions.
• One of the key questions to ask when helping your parents make health insurance decisions is: Will a plan pay for prescription drugs? Many plans do not, leaving members to pay one of the biggest expenses out of pocket.
• When your parents are covered by Medicare, it becomes important to know whether their health care provider will accept payment from Medicare as payment in full.
• Your parents need to know how to submit medical insurance claims and how to appeal a claim denial.
• The 10 standardized Medicare supplement plans have helped cut through the confusion and provide a clear basis for comparison when you are shopping for the best Medicare supplement policy.
• You should be concerned if your parents are thinking about replacing existing Medicare supplement coverage with a new and different policy. It is rarely a good idea. Ask them why they're doing it. And make sure the new policy doesn't have exceptions or exclusions that are worse than the existing policy's.
• The state insurance department or state office on aging can provide you and your parents with information and counseling regarding their decision to purchase or not purchase Medicare supplement insurance.

For more detailed information on Medicare, as well as a variety of other health-related materials, visit the federal government's Medicare Web site at www.medicare.gov or call 1.800.633.4227. This is a helpline that can provide answers to questions about the Medicare plan, managed care plans and private fee-for-service plans. You can also get information about the quality of care and member satisfaction in Medicare managed care plans, such as Medicare HMOs.

Finally, helping your parents with their health coverage means asking them questions and getting to understand their needs. Among the questions you should ask:

• What kind of medical conditions do they have that may influence the kind of health plan they need?
• How much can they pay for their health care?
• Will they have to pay a lot of out-of-pocket expenses for out-of-network doctors or specialists?
• How will your parents handle these extra costs?
• Are your parents giving up retiree coverage? Is this a mistake?
• Do your parents travel a lot and need to be concerned about out-of-area coverage when they're away from home?
• Do they need a plan for prescription drugs?
• Are they aware of the limits of their coverage and how these might come into play in the future? Are you?
• If they change their existing Medicare plan, will they lose any Medigap or supplemental coverage they might have?