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Health Insurance Dos and Don’ts For The Sandwich Generation

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Health Insurance Dos and Don’ts For The Sandwich Generation

Colleen McGuire

Updated: October 18, 2017    Published: October 19, 2015

The Sandwich Generation has become an increasingly more trendy term, although it isn’t technically a newly discovered population of people. Loosely defined, the Sandwich Generation consists of adults who are raising their family and balancing jobs while also taking care of elder parent needs, whether it be personal care, healthcare, finances or more. Nearly half (47%) of adults in their 40s and 50s have parents over the age of 65, yet they have their own children to shuttle to sporting events, dance recitals and sleepovers, which coincide with mom’s doctor appointment or healthcare needs dad can no longer handle himself. The double-role can be overwhelming and exhausting since both young and old are relying on the adult child and parent to be their champion.

Health insurance season for adults, children and those on Medicare falls during much of the same time, leaving the Sandwich Generation with not only the responsibility of selecting new health insurance benefits for their family during open enrollment, but reviewing Medicare and Medicare supplement benefits for their parents. In some cases, the Sandwich Generation is funding parent healthcare and living expenses as well.

While families with employer coverage typically contribute less to their health insurance costs compared to families paying 100% for their own healthcare plan, both groups are experiencing steep increases in medical deductibles associated with health coverage. Recent studies have shown that in the last five years, health insurance deductibles have risen 67%, while working wages have only increased 10%.

On the Medicare side, costs for original Medicare are rapidly increasing, although percentages aren’t confirmed of just how much seniors will have to pay for Medicare Part B. Congress and the President could get involved since Social Security payments are not increasing in 2016, yet about 30% of Medicare recipients are rumored to have 52% price hikes on the way.

With costs rising for both healthcare and health insurance, adults in the Sandwich Generation need to be aware of the do’s and don’ts when shopping for health insurance for themselves, and helping navigate Medicare paperwork for their parents. Thoughtful steps will go a long way towards saving on healthcare.

Dos and Don’ts for Buying Health Insurance

DO spend time in advance of purchasing to compare health insurance plans. There are many plans available in the marketplace, and the nuances can be slight. Focus on what is most important to you. Do you prefer copays for doctor office visits? Do you need a low prescription drug deductible? Determine what are your must-haves are for your healthcare, and it will make comparison shopping easier.

DON’T look at the price tag alone. Cheap plans can be deceiving, especially if you have medical conditions or take prescription drugs. Spending more each month on health insurance premiums will provide you additional coverage for medical services, and if you see a doctor frequently or take expensive prescription drugs, you could actually save money during the year by having a more expensive health insurance plan that covers the bills.

DO consider the provider network each plan has. The best way to determine if your doctor or preferred urgent care clinic is in-network with the insurance plan you are interested in is calling the health insurance company’s customer service line or visiting the company online to see if digital doctor directories are available by plan name. The insurance company will have the most update to date information on who is in-network for each plan you are interested in, since networks do change from year to year.

DO look at two price points when shopping for a plan. Above and beyond the monthly cost, what is the plan deductible, and what is the annual out-of-pocket maximum (also known as out-of-pocket limits)? The plan deductible will be the amount you have to pay for in-network services before your health insurance kicks in. The annual out-of-pocket maximum is the most you will have to pay for in-network services once you have paid your deductible, coinsurance, copayments and other charges. (The out-of-pocket maximum does not include your monthly insurance premiums.) Knowing the price of the plan deductible will help you determine if you can afford office visits and any medical procedures.

DON’T think the marketplace is the only place you can buy health insurance. You can also legally buy Obamacare plans directly from web entities or health insurance companies. These plans do not qualify for a tax subsidy, however, if you make too much to qualify for cost assistance, off-exchange plans offer more choice options not available on the state or federal marketplace.

Do’s and Don’ts for Buying Medicare

DON’T expect parents to receive notifications about Medicare open enrollment from the federal government. They are on their own. The Medicare open enrollment period is October 15 – December 7. During this time you can help enroll them in a new plan or change what Medicare plans they are enrolled in. If your parent’s 65th birthday is in the middle of the year, you can help  enroll them up to three months in advance of their 65th birthday.

DO make a checklist of what needs your parent(s) might have and consider the options.

  1. Medicare Part A, which covers hospitalizations, is free to all American seniors 65 years or older.
  2. However, Part B, which covers doctor’s office visits, medical equipment and outpatient care is subject to a monthly premium and a deductible.
  3. Medicare Part C is also known as Medicare Advantage. Medicare Advantage is Medicare Part A and Part B, purchased through private health insurance companies that work through the federal government to provide coverage. The benefits are the same and sometimes offer extra benefits like dental and prescription drug coverage, however, a primary physician must be named and services cannot go out-of-network. The covered individual may not purchase Medicare supplement insurance while on Medicare Advantage.
  4. Medicare Part D is prescription drug coverage, which has a sliding scale monthly premium expense based on annual tax returns.

Note that if your parent does not sign up for Medicare on time, they are subject to a Medicare Part B late enrollment penalty.

DO investigate Medicare supplement insurance. Supplemental insurance helps cover expenses that Medicare Part A and Part B do not. If your parent needs ongoing medical treatment in an outpatient facility or sees multiple doctors, Medicare supplement insurance could help curb overall expenses.

Being part of the Sandwich Generation requires organization, patience and fortitude. But armed with information, the process of helping both your family and your parents can be a smoother journey.

NOTE: The views expressed here are those of the author and do not necessarily represent or reflect the views of Healthcare, Inc. and

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