Before 1980, there was no name for us. No real name for what we face every day.
Thirty-four years ago, the late Dorothy A. Miller delivered a paper at the 1980 Annual Meeting of the Western Gerontological Association. In academic circles, it was a smash.
The following year, she revised her research and published an article in the September issue of the professional journal Social Work. It’s still as widely quoted as any article in her specialty. There’s a very good reason.
The article was entitled “The ‘Sandwich’ Generation: Adult Children of the Aging.” Professor Miller developed it to describe “the children of the aging in relation to their parents, children and grandchildren.”
If you’re over 40 and still working, Professor Miller spoke your language. Your own “loss of youth,” “the so-called empty nest,” a sense of peace with your “economic situation” and your “personal relationships.” But, then . . .
You sense your “grown children are not quite independent.” They still need you. And your “parents have moved to a degree of dependence.” They need you too.
They all need you. So you need help! But be encouraged. You’re not alone. There are millions like you.
A lot of people feel sandwiched and ill equipped to handle all you face, especially when it comes to your parents and their medical needs. Medicare. Supplemental insurance plans.
As your neighbors, we share your concerns. And we’re here to help.
Let’s Define Some Terms
Unless you’re allergic to TV, you’ve heard the term Part B. So, what about Medicaid, the so-called donut hole, Medigap, supplemental insurance, and Medicare Part D? Do they pertain to the same plans? Are they different things?
1. What is Medicare?
Medicare is a federal program. The federal insurance program for people 65 or older. Younger individuals—those with disabilities, for example—may also qualify. A person may begin the sign up process as early as 3 months before turning 65. For most people, key benefits are available at no cost. Other benefits require a monthly premium. Additional details follow, but a complete explanation is available through the dedicated website: www.medicare.gov
2. What About the Parts? Parts A, B, C, D, and F that relate to Medicare?
Medicare Part A is hospital insurance coverage: your hospital stay. Covering costs like nursing care, but not others—such as doctors’ fees. Most enrollees paid all necessary premiums through payroll taxes before retirement. After retirement, a monthly premium is not applicable, though annual deductibles might be.
Medicare Part B is medical insurance coverage: covering a significant portion of doctor visit costs, equipment, outpatient services, therapy, tests and home health care. Depending on income and assets, a monthly premium may apply, as will a modest deductible. Some opt out because of other health insurance coverage.
Medicare Part C is private insurance that includes the coverage of Medicare Parts A and B. Once enrolled in A and B, plan holders may choose to purchase a Medicare Advantage Plan, as it applies to all Medicare services. Various plans may require monthly premiums, deductibles or copays.
Medicare Part D is a prescription drug plan. Those already enrolled in Medicare Parts A and B are also eligible to select a Part D prescription drug plan. Like Medicare Advantage, these plans are provided through private insurance companies, require monthly premiums, and include applicable deductibles.
Medicare Plan F is a Medicare supplement plan (as are supplement plans G, K, L, M and N). As private insurance, a Medicare Supplement Plan F pays costs, fees and services not covered by Medicare Parts A and B. Coverage varies by state.
3. What Is Medigap, or Medicare Supplement Insurance?
Medigap, or Medicare Supplement Insurance, is private insurance that pays costs not covered by Medicare Plans A and B—deductibles for example. Again, as the name implies, Medigap policies supplement your coverage under Medicare, covering costs that Medicare does not. Plan F is a type of supplemental insurance.
4. What is the donut hole?
The donut hole is the “coverage gap” that begins after a Medicare recipient reaches a certain limit in prescription drug costs, and before he or she reaches the Medicare Part D “catastrophic coverage threshold.” Under the Affordable Care Act, Medicare recipients will begin to see the donut hole close.
5. What is Medicaid?
Medicaid is a health care program, funded jointly by the federal government and state governments, but managed by the individual states. It is designed for those with limited income and limited resources. Enrollees include many children and others with disabilities too. Many millions qualify for both Medicare and Medicaid.
Laws pertaining to Medicare, Medicaid, and care for the elderly are far from new. But just like the aging population, they are changing. With the passage of the Affordable Care Act—and the various ways elements have begun to be applied in the states—adult children of aging parents must remain vigilant. There is much to learn. And there is more all the time.
A few questions regularly surface.
Why would someone qualify for both Medicare and Medicaid?
Also known as “dual eligible,” Medicare beneficiaries—typically those 65 or older, who have limited financial resources, may receive help with out-of-pocket expenses not covered by Medicare.
What costs will a Medicare recipient have to pay?
According to the Medicare website, and “costs at a glance,” few pay any premium for Medicare Part A (in a sense, having paid those premiums through payroll taxes for years). Part B premiums run a little over $100 per month. The annual Part B deductible is $147, and Part A deductible and copay costs vary.
Why buy supplemental insurance? What does Medicare not cover?
All Medigap polices offer the same basic benefits. Some offer more. Among the items covered by one or all supplemental insurance plans are these: an additional year of coverage, copayments, blood, hospice care, coverage of deductibles, and skilled nursing facility care.
How do I enroll in Medicare, or assist a family member to enroll?
New enrollees can complete an Initial Enrollment Questionnaire online through the following portal and the “Getting Started” option: www.mymedicare.gov Sign up is secure and only takes minutes.
A Final Word about the Aging and Life Insurance
Life insurance is available at any age. Whole life insurance policies provide beneficiaries cash value. Term policies provide a lump sum settlement at death.
If, when addressing medical needs, resources are modest, it is possible an aging parent has only minimal resources for final expenses. Among the more obvious variables that determine costs is the age of the insured. Mature policy holders require more expensive policies.
Plan carefully. Choose wisely.
And don’t forget to maintain more than adequate life insurance on yourself as caregiver. Your family—including aging parents—can ill afford to do without you. After all, you’re part of the sandwich generation.
Your parents loved you and provided for you. Now it’s your turn to care for them.
