Month: March 2024

An adult child’s role in their parent-child relationship often shifts from caregiver to advocate when a parent moves to a nursing home. The focus moves from providing hands-on care to supporting and advocating for their loved one to maximize the parent’s comfort and care. Though it sounds like less responsibility, advocating for a parent in a nursing home can be equal parts time-consuming, stressful, fulfilling, and important. In this article, we provide helpful information and tips that can help family advocates best support a parent in a nursing home. 

Nursing home environments can be unfamiliar territory for new residents and their families. There are multiple professionals with different specialties on the care team with whom you’ll interact. There are statewide regulations, facility expectations, and variations in the staff members who will care for your parent depending on the shift. Everyone involved, including the staff, the resident, and their family, wants to create the optimal care plan that maximizes the resident’s comfort and quality of life. Let’s explore our top five tips family members can utilize to be the best advocate possible for their parents in a nursing home.

Understand your parent’s care plan

The first step in advocating for your parent in a nursing home is to know the details of your parent’s care plan, which the nursing home creates after the resident moves in. Once you know what care your parent will receive as a facility resident, you will have realistic expectations and a tangible document that you, your parent, and the facility can refer to during conversation.

Talk with the nursing home staff about the care provided in your loved one’s care plan, including services for managing activities of daily living and instrumental activities of daily living and how frequently they’ll receive these services. Discuss if there are any scenarios that might keep your parent from receiving a service. For example, if your parent takes medications that the facility nurses administer, what happens if your parent refuses medication? What are some scenarios that would prevent your parent from receiving scheduled bathing?

Understanding the nursing home’s ability to provide for future care needs is also important. Ask about how frequently your parent’s care plan will be reevaluated and any events that might trigger an early reevaluation, such as a fall or a downturn in cognitive function. 

Talk with the nursing home administrator about community guidelines and resident rights. Ask questions about how they ensure that residents receive care and services and how the process works when concerns arise. Understanding these processes will give you peace of mind and help you identify when something may have been overlooked. 

Request regular meetings with your parent’s care team

Meeting with the care team regularly is a key way to maintain open lines of communication. These meetings should include a nursing supervisor and one of the nursing assistants frequently providing care to your loved one. It may also include a member of the activity team or the community social worker. Set regular meetings to stay connected with the professionals caring for your loved one. If it’s possible to visit the facility for the meeting, in-person discussions can foster a warmer relationship. Phone calls or video conference meetings work well if in-person meetings aren’t an option.

At these meetings, discuss any concerns you or your parent may have. Ask the team to describe any changes they have noticed in your loved one, whether positive or concerning. Ask about any goals the team may want to set for your parent. For example, they may suggest that your parent join some planned activities to establish friendships with other residents. The director of therapy might also set a physical or occupational therapy goal to support your parents’ functional movements. You can end the meeting with action steps if needed. 

Your parent’s care team is trained to care for residents and support their physical, emotional, and cognitive well-being. They’re also well-versed in family meetings, so they will likely review your parent’s status. You don’t need to enter the meeting ready to lead it, but it’s also important that you come prepared with what you’d like to get out of it. Do you want to know how your parent has adjusted to the new environment? Are you hoping to learn how they’re handling a change to the care plan? You can leave with tangible details if you have tangible questions.

Visit and talk regularly with your parent

It may seem simple, but a crucial part of advocating for your loved one is visiting and talking with them regularly. This will help you to notice changes in your parent’s demeanor or physical appearance. If you have concerns about their care when you’re not around, visiting at different times or days of the week can help determine if the quality of care changes at other times. 

Document the situation with all available information if you notice anything that concerns you. You might consider bringing a notebook and pen or using a note-taking app on your phone to jot down details you want to remember. If things escalate to the point where you need to speak with a facility team member, the facility owner, or even a long-term care ombudsman or elder law attorney, they will want to understand the history and have proof of your concerns.

Get to know the nursing home staff

It’s important that you trust the individuals providing care to your loved one, and the best way to do this is by getting to know them. Introduce yourself to the nursing assistants, dining assistants, and programming staff, as these individuals will frequently interact with your loved one. Becoming familiar with the staff can also put you at ease, knowing that your parent is being cared for by an array of dedicated, knowledgeable individuals. 

Share information about your parent’s preferences that may not be captured in a care plan, such as favorite songs, shows, hobbies, or what they did for work. Establishing a relationship with the staff will help you and your loved one feel more comfortable asking questions, making requests, and expressing concerns. 

Know when to get help for your parent

If you feel your loved one’s care needs are not being met, it’s important to make your concern known. If talking with the nursing team and nursing home administrator does not result in a positive change, consider escalating your concern to a long-term care ombudsman. A long-term care ombudsman is a person who advocates for the rights of residents of senior living facilities. You also might consider enlisting the help of an elder law attorney if you feel your parent is the victim of nursing home neglect or even elder abuse.

When you have a parent in a nursing home, your role as caregiver shifts to focus on providing comfort and support while advocating on your loved one’s behalf. By understanding your loved one’s care plan, building relationships with the staff, and visiting regularly with your parent, you can feel confident as an advocate in your loved one’s care.

Medicare fraud and abuse are fraudulent practices that can cause older adults to compromise their personal information or lose money. Whether the scam involves billing for services that were never provided, stealing a Medicare beneficiary’s personal information, or some other deceitful behavior, seniors need to know how to protect themselves from Medicare fraud. Here, we’ll explain what constitutes Medicare fraud, how to recognize it, and what to do to stop it.

What is Medicare fraud?

Medicare fraud happens when a health care provider or other individual uses deceitful practices to defraud and illegally benefit from the Medicare system. Fraud can take many forms, such as accessing a person’s information and filing false Medicare claims to steal benefits, services, or prescription drugs from them for profit or personal use. The scammers also might use the victim’s personal information to receive payment for unrendered services. Some unscrupulous health care providers may double-bill for services or file claims for more expensive services than those provided.

Victims of Medicare fraud can be negatively affected in a number of ways. They may end up paying copays for services and supplies they don’t need or never receive. They also may be denied access to the health care they need if it appears that the care was already given and paid for.

Recognize these Medicare fraud red flags

There are several telltale signs of Medicare fraud. Look out for the following to protect yourself from becoming a victim.

Pay attention to any communication from someone claiming to represent Medicare, especially if you have not initiated contact. A common sign of fraud is when a scammer reaches out to you unsolicited. While you may receive legitimate marketing materials from providers who offer Medicare Advantage plans, for example, scammers might contact you with coercive or threatening tactics about purchasing Medicare plans or claim that your Medicare number has been suspended.

People attempting this kind of fraud might ask you to confirm your Medicare number so that they can help you “fix” a problem that doesn’t actually exist to instill a sense of urgency in you. Medicare will rarely call you unless you have reached out first for help, and they will never call to sell you anything or threaten to suspend your benefits.

Scammers might also send invoices that look legitimate. These invoices might contain official-looking letterhead, but make sure that you review them carefully. Verify any suspicious or unexpected invoices with Medicare to ensure they are legitimate.

Medicare fraud can also come in the form of double-billing or phantom billing. These two scams involve billing Medicare for unrendered services or billing twice for one treatment or visit. Be sure to review the explanation of benefits that Medicare sends you to ensure that all claims are legitimate.

How to protect yourself when you suspect Medicare fraud

It is important to act immediately if you believe you are being scammed. Here is what you should do if you suspect Medicare fraud.

Do not continue communicating

If you believe that a scammer has targeted you, stop all communication with the scammer. Hang up the phone, and do not respond to emails or text messages. Do not click on any links or open email attachments in suspicious emails. Do not follow directions to call a phone number if you receive a questionable letter or voicemail message instructing you to do so. 

Do not provide information

Again, Medicare rarely spontaneously reaches out to you via phone, mail, or email requesting private information. If you get a phone call from someone asking for your Medicare number, you should immediately end the call. Do not provide the caller with any of your personal information, including your Medicare number, even if they seem to have access to some of your information. Do not enter any personal information into a suspect website. If you’ve received unsolicited contact from someone claiming to be a Medicare representative, you should call Medicare immediately at 1-800-MEDICARE (1-800-633-4227) to verify if the contact is legitimate.

Report the Medicare fraud

If you believe that a scammer contacted you, you should report the interaction to document the situation and to help prevent others from falling victim. If you have been the victim of Medicare fraud from a medical provider in original Medicare, call 1-800-MEDICARE or visit the United States Department of Health and Human Services Office of the Inspector General here to make a report. If you have been defrauded in a Medicare Advantage plan or Medicare drug plan, call 1-800-MEDICARE or contact the Investigations Medicare Drug Integrity Contractor at 1-877-7SAFERX (1-877-772-3379).

How can I keep my information safe from Medicare scammers?

Protecting yourself from Medicare fraud and keeping your information safe is important. Keep your information safe with the following practices:

• • Protect your Social Security number and Medicare number. Treat them like credit card numbers: Never share them online or over the phone unless you have verified the legitimacy of the website or caller.
• • Do not share your Medicare card or Social Security card.
• • Do not accept gifts from scammers offering money or free medical care in exchange for your information.
• • Do not give out your medical records to anyone other than your doctor, their team, or the trusted individual(s) you may state on estate planning or HIPAA documentation.
• • Do not respond to text messages, direct messages on social media, or emails from random people asking for sensitive information, even if they claim to represent Medicare. Verify the source of the communication by contacting Medicare directly.

Medicare fraud is a problem that costs billions of dollars each year. The best way to protect yourself from falling victim is to know the signs of a scam and what to do if a potential scammer has contacted you or if you’ve become a victim of fraud. With this knowledge, you can protect yourself and your Medicare benefits from fraudulent practices.

Medicare fraud is a deceitful practice that can cost older adults money and the security of their personal information. This type of fraud costs Medicare an estimated $60 billion a year. According to the United States Sentencing Commission, the number of reports of health care fraud increased by 1.4 percent from 2018 to 2022. Because seniors rely on legitimate Medicare services to preserve their health and wellness, it can be tough to avoid being the target of these scams. Here, we’ll explain Medicare fraud, like identity theft, illegitimate marketing schemes, forgery, phantom billing, and more, so you and your loved ones can avoid the potential consequences of falling victim to this kind of scam.

Types of Medicare fraud

Medicare fraud occurs in many forms and through many methods. Here are some of the most common types of Medicare fraud to which seniors might fall victim.

Identity theft

This type of Medicare fraud involves scammers contacting beneficiaries via phone, mail, text, or email to gain access to their personal information, like Medicare numbers, Social Security numbers, and addresses. They use this information to file false Medicare claims. They might receive medical care, prescriptions, or Medicare payments under the victim’s name and Medicare number.

Scammers might threaten to suspend your benefits if you do not provide your personal information. Be aware that no one from Medicare will ask for your details by threatening to suspend your benefits.

Bogus Medicare marketing

In this type of Medicare fraud, scammers call older people offering a too-good-to-be-true deal for expensive medical equipment or an unnecessary medical service at a discounted rate. They also might try to sell the individual on a Medicare Advantage plan (note that Medicare Advantage providers are not allowed to cold-call). The scammers will ask the victim to confirm their personal information and then use it to file high-cost Medicare claims in the beneficiary’s name. 

Medicare forgery

Medicare forgery fraud is when scammers write fake prescriptions for medicine and durable medical equipment, usually on legitimate stolen or photocopied prescription pads. A senior might receive a call from a bogus call center, medical equipment provider, or telemedicine representative asking the senior to verify their Medicare coverage before a consultation with their doctor. The scammer then writes the fake prescription.

Prescription drug diversion

Drug diversion scammers use methods similar to those of forgers and identity thieves to collect personal information. However, a diversion scam involves scammers using the information to divert legal prescriptions from seniors to themselves for illegal purposes. They will sell the older adult’s prescription medication for a profit or keep it for personal use.

Impersonating a health care professional

Health care professional impersonation scams happen when the beneficiary sees a doctor who is not properly licensed. The individual renders services and then files a false claim with Medicare. If the unlicensed doctor successfully receives a payment from Medicare, that is considered fraud.

Phantom billing

Phantom billing happens when an unscrupulous health care provider bills Medicare for services, equipment, or medication that the beneficiary does not need or never receives. Victims might receive equipment or medication they never requested or see services in their explanation of benefits that they never received. The scammer gets Medicare payments for these items or services.

Double billing

Double billing is when a provider bills Medicare multiple times for the same service or when two providers try to get paid by Medicare for the same service rendered to the same patient on the same date. Victims might notice two charges for the same service, charges from two health care providers for the same service, or a single charge with a duplicate charge listed within a bundled claim for several services in one. Double billing steals millions of dollars from Medicare every year. 

Upcoding

Upcoding is a type of Medicare fraud in which deceitful providers submit codes to Medicare for more serious and expensive services than they performed so that they receive more money from Medicare than they are entitled to. An example of upcoding is when a doctor sees a patient briefly during a routine examination but bills Medicare for an extensive presurgical consultation. 

Consequences of Medicare fraud

Scammers and health care providers who commit Medicare fraud can face substantial consequences. Depending on the state where the offense occurred, fraudsters could owe thousands of dollars in fines and face years in prison.

But what negative effects do seniors face after being victimized by a Medicare fraud scammer? Medicare fraud can negatively impact the beneficiary’s care. Potential consequences include owing copayments on unnecessary or unreceived items or services. The victim may also max out their insurance limits or be disqualified for future prescriptions or medical procedures since they show as having already been received or performed.

How to spot Medicare fraud

Medicare fraud can present in several ways. Targets may receive communication containing threatening language or offers that are too good to be true in an attempt to access personal information. The fraud may also occur silently, with the victim not knowing it has happened until they notice items listed in their explanation of benefits that they never received, that they were charged twice for, or that are exaggerations of services actually rendered.

What to do if you suspect Medicare fraud

Your first defense is not to disclose personal information to anyone making unsolicited contact requesting your Medicare information. You should treat your Medicare number as a credit card, not giving it out to anyone without verifying their identity. If you are on the phone with a suspected scammer, you should hang up and call Medicare at 1-800-MEDICARE to verify if the call is legitimate. Keep in mind that Medicare rarely initiates contact by phone. You may receive a phone call from Medicare if you’ve requested a callback or if a plan you’re already enrolled in needs to contact you.

You should also keep a close eye on the explanation of benefits provided to you by Medicare to check for any fraudulent claims. If you’ve fallen victim to a scam, you should report the fraud to the Office of the Inspector General at 1-800-HHS-TIPS. If your identity has been stolen, you can also file a complaint with the Federal Trade Commission.

Medicare fraud schemes are becoming more prevalent. They cost Medicare billions of dollars per year. However, by educating yourself with the information above and remaining vigilant, you can protect yourself and your benefits.

In today’s world, older adults who receive Social Security benefits need to be aware of how scammers try to swindle people by attempting Social Security fraud. Government impersonation scams affected more than 3,000 people aged 60 and over, according to the FBI’s Elder Fraud Report, resulting in more than $100 million in monetary losses. Some of these government impersonation scams were a form of Social Security fraud. 

In this article, we’ll describe common types of Social Security fraud, including the methods that scammers use to contact people, the fraudulent stories they tell to illegally access seniors’ money and personal information, and ways to avoid and report these kinds of scams.

Social Security benefit suspension or termination scam 

In this scheme, scammers may call, email, or text Social Security beneficiaries to try to trick them into providing their personal information and sending money by claiming the person’s Social Security benefits will end if they don’t take immediate action. This communication appears official because scammers often disguise their phone numbers to look like they come from the Social Security Administration (SSA) and use official-sounding voices and names. Scam emails might appear to come from an official SSA email address or include attachments with pictures of official-looking logos or an SSA employee’s government identification. 

These scams use serious language, threatening to suspend or terminate a person’s Social Security benefits unless the individual sends money or divulges personal information. The message or call might instruct the recipient to visit a web page (which is fake) and enter personal identifying information or pay with a gift card. 

Social Security records and services scam

Some scammers contact Social Security beneficiaries claiming to have discounted prices for replacement Social Security cards or an “official” record of their Social Security contributions. Some scammers might offer to enroll or re-enroll you or a family member into Social Security benefits for a fee. The Social Security Administration does not charge for replacement cards or benefits enrollment, so anyone asking for money is a scam. The SSA has some small fees associated with obtaining copies of certain records in very specific situations. They do not charge a fee for searching a system of records, and they often provide copies of records at no cost. You can look at the SSA’s fee schedule to learn more. If you receive communication about Social Security records, you can hang up and call the SSA directly to find out whether the claim and associated fees are legitimate.

It is also common for scam callers to claim there is a problem with an older adult’s Social Security number and they need more information to resolve it. Scammers might claim that your Social Security number has been linked to criminal activity, and they need you to confirm the number so they can issue a new one. Scammers can use this information to contact the Social Security Administration and change the address, direct deposit information, and phone number on the account to steal your benefits.

Social Security investment or benefits increase scam

This type of Social Security scam involves a fraudster claiming they have an opportunity that will increase a person’s Social Security benefits. Swindlers will insist that the person pay a fee or provide the caller with personal information to receive a benefit increase. In reality, when a person falls victim to this type of scam, they give the scammer money or their personal information, which the scammer can use to steal their money or commit other criminal acts.

While the SSA may increase Social Security benefits at the end of each year due to the cost of living adjustment (COLA), beneficiaries do not need to take action to receive their increase in benefits. The SSA mails each beneficiary an award letter stating their individual monthly benefit for the following year once it determines the benefit increases based on the COLA. These increases are automatic and require no action from beneficiaries.

How to recognize Social Security fraud

Social Security benefits provide more than half of the monthly income for 37% of men and 42% of women over age 65, so it’s no wonder that many seniors take communication about this critical benefit very seriously. Scammers know this and use people’s fear to their advantage. Contact from someone claiming to be from the SSA that seems scary or threatening indicates a Social Security scam. Scammers stoke fear, knowing that when a person is scared, they’re more likely to comply with outlandish requests. Understanding this is the first step to recognizing a Social Security scam.

Next, consider the four P’s as the basic signs of a Social Security scam: pretend, problem/prize, pressure, pay. Let’s explore what these four P’s mean and go over examples of each.

Pretend

In Social Security scams, someone is pretending to be from the SSA. They’re hoping to establish themselves as an authority figure you will listen to. Examples of this include:

• • Text messages or emails with an employee’s official government identification card.
• • Letters or emails that contain your personal information.
• • Direct messages from the SSA on social media.
• • Official-looking documents in the mail claiming to be from the Social Security Administration.
• • Use of the names of legitimate government organizations.
• • Altered phone numbers that appear to be law enforcement or the Social Security Administration.

The SSA will never send photos of ID cards or contact you via social media. Any other contact they make will not be threatening. If you receive communication that is threatening in nature or is about these “issues,” it may be a scam.

Problem or prize

The scammer may present a situation in which there is a problem with your benefits or you stand to gain some sort of prize or increased benefit. They might tell you that:

• • You received an overpayment from the SSA and need to pay it back.
• • Your benefits can increase.
• • Your Social Security number may be suspended.
• • Your Social Security benefits could be terminated.
• • You can get a discounted Social Security replacement card.

The SSA will never charge you for a benefits increase or replacement card. They will not suspend your Social Security number. If you owe money to the SSA, they will mail you a letter with payment options, never requiring specific payment methods like gift cards, cryptocurrency, or cash. It may be a scam if you’re presented with one of these situations.

Pressure

The scammer applies pressure to the situation and insists or demands that you take action immediately to avoid a consequence. This consequence might be losing or decreasing your benefits, arrest, or other legal action. The scammer might threaten to:

• • Arrest you.
• • Suspend your benefits.
• • Seize your bank account.
• • Pursue other legal actions.

The SSA will never threaten you with arrest or legal action. They cannot seize your bank account. Pay attention to whether the communication you receive makes you feel pressure to take action immediately to avoid a consequence. Because legitimate communication that the SSA sends to people does not apply pressure to beneficiates, feeling pressured is a red flag that you may be the target of a scam.

Pay

A scammer may try to make you send money to them. They might:

• • Require that you make a payment using a gift card, a cash payment by mail, or a wire transfer.
• • Ask you to visit a web page to confirm or supply your personal information. In this case, you’re “paying” with your identifying information, which they can use for illegal gains.

Again, the SSA will never require specific payment methods. They will not charge you for replacement cards, benefits increases, or enrollment services. They will never email you asking for personal information.

Remember that the scammer will attempt to apply pressure on you by demanding immediate action to avoid a consequence, which is intended to make you feel scared. Fear can prompt a person to make choices they normally wouldn’t, so this tactic is particularly tricky. 

If you receive communication that makes you feel threatened or afraid, that is a signal that you may be the target of a scam. The Social Security Administration will never threaten or demand that a person act immediately.

If you receive communication that appears to be from the SSA, you should call 1-800-772-1213 to find out whether it is legitimate. You can also set up a My Social Security account online. This is an official account with the SSA where you can log in securely to check your benefits online anytime. 

What to do and how to report Social Security fraud

After getting contacted by a scammer, you should protect yourself from future harm. Do the following to keep yourself safe:

• • Remain calm. Scammers want to elicit an emotional response, so keeping your wits about you is essential.
• • Hang up the phone or avoid clicking on links or opening attachments.
• • Do not offer any personal information to the scammer, even if they have some of your details.
• • Contact the Social Security Administration for a replacement Social Security card or a new Social Security number.
• • Call all three credit bureaus and add a fraud alert to your credit report.
• • Report the Social Security scam to the Office of the Inspector General at oig.ssa.gov/report.

Reporting a Social Security scam is important. Reporting fraud helps the Social Security Administration and the Office of the Inspector General collect data that can protect others from similar scams. 

Older adults are often the target of scams, with Social Security scams making up a fair part of fraud reports. Losing hard-earned money while on a fixed budget will make paying living expenses and senior care costs harder. Knowing how these scams work, how to spot them, and what to do if you’ve fallen victim can help protect your personal information and money.

Medicare, the federal health insurance program for adults 65 and over and some younger adults, can help individuals maintain their health and access necessary medical services. Knowing how and when to sign up, understanding late penalties, and deciding which plan to choose can be very confusing. We will review the basics so that you make a prudent decision and know how to apply for Medicare with ease.

What is Medicare?

Medicare is a federal insurance program that covers a wide range of in- and outpatient medical services, medical supplies, preventative care, and prescription services. 

Medicare Part A is hospital insurance. It covers inpatient hospitalization, short-term stays in skilled nursing facilities, some aspects of home health care for a limited time, and hospice care. Medicare Part B is medical insurance, which covers medically necessary and preventative services as well as durable medical equipment. Medicare Part D is prescription drug coverage. Some people opt for a Medicare Advantage (Medicare Part C) plan, which is an alternative to original Medicare. We discuss Medicare Advantage in further detail below.

Although Medicare has robust coverage for most health-related concerns, it doesn’t cover everything. You may have out-of-pocket costs depending on your plan.

How does Medicare help older adult beneficiaries?

Many people retire in their 60s and 70s and lose employer-sponsored health plans or, if self-employed, their private insurance plans. Without Medicare, many would be without health coverage. Here is how Medicare helps older adults:

• • Health care coverage: The health care services Medicare covers assist older adults in accessing the medical care they need to stay healthy, manage chronic medical conditions, and address medical events.
• • Financial protection: Medicare helps protect people from the high cost of health care by limiting out-of-pocket expenses. Beneficiaries are responsible for copays and deductibles, but Medicare covers a significant portion of health care costs.
• • Preventative care: Medicare covers a wide range of preventative services, such as vaccinations, wellness examinations, and health screenings at little or no cost.
• • Prescription drug coverage: Medicare Part D offers prescription drug coverage to help manage the cost of medications. 

Who is eligible for Medicare?

People qualify for Medicare at age 65 whether they have worked or not. Younger individuals with a disability, end-stage renal disease (permanent kidney failure requiring dialysis or a transplant), or ALS (also called Lou Gehrig’s disease) are also eligible.

When to apply for Medicare

Knowing when to sign up for Medicare is important. Signing up during the required period is essential to avoid gaps in coverage and late enrollment penalties. However, if you are covered through an employer group plan, you may decide to sign up for Medicare later or delay signing up for Part B. Here are the three enrollment periods:

Applying for Medicare when you turn 65

Medicare’s initial enrollment period is a seven-month window that begins three months before your 65th birthday and ends three months after your birthday month. If you already receive Social Security benefits, you will automatically be enrolled in Medicare Parts A and B when you turn 65. If you are not receiving Social Security benefits, you must sign up for Medicare online or by phone during this period.

Applying for Medicare after you turn 65 but have been covered by an employer health plan

Under this circumstance, you can sign up during a special enrollment period without penalties. If you have been covered by employer-sponsored health insurance:

• • You can sign up for Medicare anytime and still be covered by your employee health plan.
• • You can sign up for Medicare within eight months of the day you or your spouse stop working.
• • You can sign up for Medicare if you have a group plan within eight months of that plan ending even while you continue to work. 

Note that additional situations, such as losing Medicaid coverage or being impacted by a natural disaster, may trigger a special enrollment period.

Applying for Medicare when you miss the other periods

If you miss your initial or special enrollment period, you can apply for Medicare during the general enrollment period, which runs from January 1 to March 31. You may incur a lifelong penalty when you sign up during general enrollment. 

If you or a spouse worked long enough (generally 10 years), you’ve paid enough in Medicare taxes and therefore qualify for premium-free Medicare Part A. In this case, you will not incur a penalty for late enrollment. However, if you don’t have enough work credits to qualify for premium-free Medicare Part A, you will have to pay a monthly premium, and the penalty for late enrollment is 10% of that premium. You pay that penalty for twice the number of years that you could have paid Part A premiums but didn’t. 

For Medicare Part B, you pay an extra 10% for each year you could have signed up for Part B but didn’t. This penalty lasts for as long as you have Part B coverage. You may also have a higher premium, depending on your income.

For Medicare Part D, you’ll pay a late enrollment penalty if you go more than 63 days without a prescription drug plan that is similar to Medicare Part D. The late enrollment penalty is 1% of the national base beneficiary premium for each month that you went without coverage.

What decisions do I need to make when signing up for Medicare?

The biggest decision Medicare beneficiaries must make when signing up for Medicare is choosing between original Medicare and a Medicare Advantage (Medicare Part C) plan. Let’s look at the general differences between the two.

Original Medicare

Original Medicare is a fee-for-service program. Under original Medicare, you have Part A and Part B and will have to pay for some services as you get them. Medicare also requires that you sign up for a prescription drug plan (Part D). The Part D plan also has a monthly premium. Most people also sign up for a Medigap plan through a Medicare-authorized insurance company. Medigap plans are supplemental insurance that will pay for some health care costs that Medicare does not cover. They have monthly premiums that typically go up each year. 

Original Medicare covers any Medicare-contracted physician, skilled nursing facility, home health care agency, or hospital in the country.

Medicare Advantage (Medicare Part C)

Medicare Advantage plans remain attractive to older adults due to their no- or low-cost premiums. Private insurance companies offer Medicare Advantage plans and provide all your Medicare coverage, including Parts A and B coverage and a prescription drug plan. Many Medicare Advantage plans also offer services that original Medicare does not, such as hearing aids, dental care, eyeglasses, and more.

The potential downside of Medicare Advantage plans is that you must go to an approved network of providers, which can limit your choices. You cannot go to any Medicare-contracted health care service in the country and are likely limited to your primary geographical location. You may also have copays and need referrals to see specialists.

How to apply for original Medicare 

If you’re 65 or older, you can enroll in Parts A and B or Part A only. You can delay Part B enrollment if you’re already covered through an employer group health plan. To apply for Medicare, you’ll need to supply your Social Security number, your place of birth, and your current health insurance information. If you’re applying for Part B only, you’ll also need a valid email address and your Medicare number.

Online sign-up for Medicare

Most people don’t know that you sign up for Medicare on the Social Security Administration site. You’ll need to create or log in to your existing My Social Security account to begin the application process.

Sign up for Medicare by phone

Call 1-800-772-1213 and tell the representative you want to sign up for Medicare Parts A and B or Part A only. TTY users should call 1-800-325-0778.

Sign up for Medicare in person

If you’d prefer to apply for Medicare in person, you can contact your local Social Security Administration office, which you can find here.

How to apply for Medicare Advantage (Medicare Part C)

To apply for a Medicare Advantage plan, you must first have Medicare Parts A and B. After enrolling in Medicare Parts A and B, you can call 1-800-MEDICARE to learn about different Medicare Advantage plans, explore plans online, call the Medicare Advantage plan provider directly, or use an insurance broker. Take time to review all Medicare Advantage plans in your area so you can make an informed choice. 

Once you have signed up for a Medicare Advantage plan, you can make changes during the Medicare open enrollment period from October 15 to December 7. However, if you decide you want to switch back to original Medicare, you may not be able to get a Medigap plan, or you may have to pay very high premiums.

Final thoughts

Almost everyone is anxious about signing up for Medicare. The choices are complex and confusing. Informing yourself about your options — including scope of coverage, networks, deductibles, and premiums — can give you confidence that you have picked the best Medicare plan for your situation. With the information supplied above in addition to your own research, you can know how to apply for Medicare and start the process with peace of mind.

You have come to the conclusion that moving to senior living is the best option for your loved one, and you are confident they will receive the support they need to stay healthy and active. You also know that the move to senior living will reduce your stress and exhaustion. However, you still feel guilty for moving your loved one to senior living. It’s very common for adult children and spouses of seniors to feel guilt when someone moves to a senior living or long-term care community. It’s not as common, however, to talk about caregiver guilt and shame with others, which leaves many family caregivers feeling isolated, sorting out their emotions alone.

Here’s what you need to know to understand and cope with your feelings so that you and your loved one can get the most from their new senior living situation.

Feelings of caregiver guilt and shame

If you’re a family caregiver, whether an adult child of a senior loved one or a spouse of a struggling senior, you likely aren’t new to feelings of guilt. The Family Caregiver Alliance covers this common feeling when discussing caregiving’s emotional side. According to them, caregiver guilt can begin long before senior living comes into the picture. Caregiver guilt can occur when the family caregiver is impatient with their older loved one or when they feel they aren’t doing enough to support them. They may feel guilty for taking time for themselves because they think of all the responsibilities they must fulfill as a caregiver. Guilt can lead to feelings of resentment, shame, depression, anxiety, and even anger.

If your loved one needs increased support or if your mental or physical health is suffering, a senior living community might be the best solution for everyone. However, it’s common to feel added guilt when deciding to move your loved one to senior living because you may think you are not doing enough to support them. Guilt can also arise when you think about moving your loved one out of their home when they have expressed a desire to stay there as long as possible.

In many cases, those feelings of guilt and shame are a side effect of what is really going on: grief. A move to a senior living community and out of the family home is a significant transition not only for the senior but for their loved ones. It is common to grieve the loss of a family home and familiarity as well as your loved one’s health and independence. Grief is an entirely normal reaction to major life changes. Recognize this and be kind to yourself as you work through the transition.

Put feelings aside to make confident decisions about senior living

These feelings of guilt and grief can cause family caregivers to postpone bringing up senior living. Unfortunately, postponing the conversation can lead to a situation in which you have to make a decision in a crisis instead of with careful, thoughtful planning as a family.

For example, if you put off having a conversation about senior living with your dad for too long, he might end up falling while at home and have to go to the hospital for a broken bone or a concussion, with discharge planners recommending that he not return home and instead go to a skilled nursing facility. You might only have a few days before his discharge to select a community and get him settled in. This is not ideal.

Instead, by putting your guilt aside and bringing up senior living, no matter how awkward you might initially feel, you’ll have more time for honest conversations with your loved one about their care needs. You can candidly discuss the benefits of assisted living and nursing homes and involve them in the touring and selection process. You can empower your loved one to participate in the decision-making process and work as a family to get finances in order.

If you find that your guilt and grief are holding you back from bringing up senior living or advocating for your own physical or mental health, consider meeting with a therapist. Psychotherapy or talk therapy, when facilitated by a counselor experienced with family caregiving, can give you space to talk through your challenges, role-play conversations with your loved one, and learn new coping skills that will keep you as healthy as possible.

Coping with caregiver guilt during the move to senior living

Once you have decided that senior living is the right solution, it’s important to anticipate that those feelings of guilt and grief might grow throughout the moving preparation. Ask your loved ones and friends for support so that you can get the breaks you need. For example, perhaps your sister can coordinate packing up the house or your neighbor can pick up your kids from school. When asking for help, be specific with the tasks you need people to do.

In addition, try these tips to help manage your mental health in the time leading up to the move and after the transition:

• • Journal daily. Get your feelings out and on paper, or jot down things you are thankful for in this season of transition.
• • Create happy memories and moments with your loved one. Don’t talk about the move or other caregiver responsibilities. Get ice cream together or sit on the porch with cups of coffee.
• • Create a photo album or piece of art with your loved one that they can display in their new home.
• • Communicate with the new senior living community staff members to keep up with how your loved one is doing. Remember, you don’t have to be the sole caregiver any longer. Take a deep breath and allow the team there to do their job so that you can return to your role as a child or spouse.
• • Continue to see your therapist to unpack feelings of grief and guilt.
• • Focus on the positives: Your loved one is safe and cared for, and you’ll have more time to care for your own needs. Also, in no longer providing care for your loved one, you can focus on your relationship and spending quality time together.
• • Perhaps most important, challenge yourself to look for the peaceful moments of each day. Soon, you’ll find that you are feeling calmer and can be a better loved one to those around you now that you don’t have to worry about family caregiving duties around the clock.

As with any transition, you and your loved one need time to adjust. Caregiver guilt and grief over moving a loved one into senior living are normal. Give yourself grace, and remind yourself that grief is not something that goes away but that you learn to incorporate into the tapestry of your life. Sending you peace as you work through it.