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You are here: Home / Billing/Insurance Information / Does Dad Really Have Medicare?

September 17, 2014 By Guy Terry PT, OCS

Does Dad Really Have Medicare?

A son or daughter (or in-law) will frequently have to take over care for an elderly relative, without any advance notice. Due to the number of alternative plans available today, well-meaning relatives could easily find themselves buried by a mountain of medical bills.

Many Seniors Have Selected a Commercial Medicare Advantage Plan

Why? Because the benefit plan under a private Medicare plan has been “rearranged” in a way that works better for some people. While Medicare has a deductible and coinsurance, a pharmacy plan with a “doughnut hole” coverage gap, and no vision benefits, a private Medicare replacement plan may have a copayment (more expensive) for professional services, but includes vision benefits and no prescription medication “doughnut hole.”

Before You Have to Care for an Elderly Relative

Conduct a yearly review of medical benefit plans. The Medicare Open Enrollment Period is usually mid-October to mid-December, so brief meeting at Christmas could save you thousands of dollars in uncovered medical expenses. At a minimum, get the following information:

  • All insurance company and plan names. An example would be “AARP – Medicare Complete”
  • All individual member and group/plan identification numbers, including Medicare/Medicaid numbers
  • All customer service contact numbers
  • Copies of all applicable plan cards

Before You Schedule an Appointment

Make sure you provide the applicable plan name, rather than “Medicare.” For example, if your Dad has a Humana Medicare Advantage plan, don’t say that he’s covered by Medicare, but clearly state that he has a Humana Medicare Advantage plan. Some clinics will accept Medicare, but not Humana, or vice versa. Make sure the clinic you are visiting has providers in the network plan for the insurance plan you will be using.

Filed Under: Billing/Insurance Information

About Guy Terry PT, OCS

I am a board certified specialist in Orthopedic Physical Therapy, with more than 20 years of experience worldwide, in a variety practice settings, as a therapist, manager, business owner, and educator.

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I am a board certified specialist in Orthopedic Physical Therapy, with more than 20 years of experience worldwide, in a variety practice settings, as a therapist, manager, business owner, and educator. Read More…

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