Helping a parent or spouse navigate Medicare

Medicare will not discuss anyone’s coverage with you until that person authorizes it. The standard instrument is the Authorization to Disclose Personal Health Information, form CMS-10106, signed by the beneficiary to name a representative. With it on file, you can call about claims and coverage on their behalf.

A signature helps with the health plan as well. Insurers keep their own authorization forms, and filing both at the same time beats discovering the missing one during a hospital discharge.

Home health draws the most questions. When a physician orders it and the person is homebound, Parts A or B can cover part-time skilled nursing, therapy, and aide visits tied to that skilled care. Medicare does not pay for custodial help with bathing and dressing on its own, and that distinction disappoints many families.

Following a qualifying inpatient stay, Part A covers up to 100 days in a skilled nursing facility, with a $217 daily copay from day 21 to day 100 that a Medigap policy often absorbs. Hospice adds respite care: brief inpatient stays of up to five days that give a family caregiver a genuine break.

Durable equipment such as a hospital bed, walker or wheelchair falls under Part B when medically necessary, typically with 20 percent coinsurance. Whether a supplement is in place makes that coinsurance a small number or a large one.

A parent on government Medicare without a supplement carries the uncapped 20 percent share, and one hospitalization can become a real financial event. A parent in an Advantage plan raises different questions: is the rehab facility in network, and did the plan authorize the stay?

Review the plan every autumn. Formularies shift, networks narrow, and a prescription costing $12 in January can cost $90 next year if its tier moves. The caregiver is usually the first person to notice.

Most of this is free. A SHIP counselor will confirm what a plan pays with no commission at stake, and Extra Help is worth checking even in households convinced they earn too much.

Ask where the Medicare card and any supplemental cards are kept, and who the physicians are. Ask whether there is a Medigap policy or an Advantage plan, because the answer changes what a hospital stay costs. Ask which prescriptions are filled and where.

None of that is comfortable to raise. It is far easier on an ordinary Tuesday than at six o’clock on a Friday during a discharge, which is when most of these calls reach us.

Networks, formularies and enrollment windows can be untangled with help. We will review a parent’s coverage with you, explain in ordinary language what a plan will and will not pay, and say plainly when leaving things alone is the right answer.

There is no charge for that conversation, whether or not anything changes.