By Elizabeth Guttenberg, LMSW, Senior Care Advisor
Prior to joining Care.com, I was a social worker in a hospital. One afternoon, while working on a suitable discharge plan for an elderly patient of mine, I asked him whether he was enrolled in Medicare Part B, or an Advantage Plan. To my wonder, he responded, “Part-what? An advantage-what?” and looked at me as if I had five heads. After silently pondering how someone over the age of 65 could not know the ins and outs of our national healthcare insurance program, I attempted to explain it to him—and quickly realized that even as a healthcare professional, I had only a limited understanding about how Medicare’s various parts work together to provide comprehensive health care coverage.
Since that eye-opening encounter, I am proud to say, I have gained enough Medicare knowledge to provide solid answers to my clients’ basic questions: What’s the difference between parts A, B, C and D? What’s a Medicare Advantage Plan? What’s a Medigap policy? What in holy heck is a donut hole? However, when it comes to choosing the best options for their particular needs from among the myriad available, I point them to a group of experts whose job it is to shed light into the farthest reaches of the system and guide seniors through it—for free!
Aptly referred to as SHINE (or SHIP) counselors (these acronyms stand for Serving the Health Insurance Needs of Everyone and State Health Insurance Assistance Program, respectively), these professionals typically operate out of Area Agencies on Aging or Aging Service Access Points. Is your mother eligible for Medicare or already enrolled? If yes, then you can use the Eldercare Locator to find your local agency and then schedule a counseling session either over the phone or in person, depending on the location.
SHINE counselors are also trained to use a special Medicare database; they can plug in your mother’s information to help determine which options would work best for her. And you can ensure that she will get the most out of her session by helping her do some homework beforehand. You may visit Medicare.gov, for a general overview of Medicare and its various parts—and prepare questions specific to your mother’s situation. For example, if she is already receiving extensive medical treatment or seeing a number of specialists, would switching from Medicare Parts A and B, to a Medicare Advantage Plan allow her to stay in-network? At a minimum, she should also bring the following information to her meeting with the SHINE counselor:
- List of medications
- List of doctors (primary care and specialty)
- List of hospitals and practices affiliated with her medical care providers
- Medical history, including current diagnoses, chronic conditions, past surgeries, allergies, and more
In addition, it would be very helpful for you or another family member to accompany your mother to the appointment. And take good notes! Even with guidance from an expert, Medicare can be very tricky to navigate — especially if she has issues with confusion or memory loss. Writing a few reminders on the information sheets the counselor passes out should enable you and your mother to recall later what you learned during the meeting.
Wondering about additional questions to ask during the counseling session? As always, you may contact your Senior Care Advisor at Care.com prior to your appointment and get help formulating individualized queries for your SHINE counselor.
Contact a Senior Care Advisor at Care.com. We are master’s-level social workers specializing in adult and senior care.
Call us today at (855) 781-1303 x3 or email questions to email@example.com