What To Do When a Loved One Is First Diagnosed With Cancer
Review insurance coverage.
How to Review Insurance Coverage for Someone Who Has Cancer
You'll need a complete picture of what's covered under your loved one's health insurance policies to estimate future costs and make care plans. Pay especially close attention to coverage for drug benefits, home aides, adult day services, and long-term care.
Plans and policies to look into include following:
Medicare.
This usually includes Part A hospital insurance and Part B medical insurance.
What to look for: If your loved one is age 65 or older, he or she will likely have a Medicare identification card, which has a beneficiary number on it and identifies whether he or she is enrolled in Part A, Part B, or both.
Why it matters: Knowing the Medicare number is essential for all contact with Medicare itself and with any healthcare provider.
Medicare Advantage (Part C) managed care plan.
Your loved one might be enrolled in Part C instead of Medicare Parts A and B; this means membership in an HMO or similar private health plan.
What to look for: If he or she has Part C, expect to find a separate enrollment card, identified with the name and number of the managed care plan and your loved one's membership number.
Why it matters: You need the name, address, and membership number of the plan for all correspondence. Also, members can switch into or out of a Part C plan during the plan's open enrollment period, which lasts for at least a month in the autumn.
Medicare Part D prescription drug plan.
This plan is issued and administered not by Medicare but by a private insurance company, which handles all its own paperwork.
What to look for: This plan also has its own enrollment card, identified by the issuing company's name and the name of the plan.
Why it matters: Filling prescriptions under the plan may be limited to certain pharmacies, which you can find out by contacting the plan or going to its website. Also, Part D plans have a yearly open enrollment period from November 15 to December 31; your loved one may want to switch plans if health needs -- or the coverage itself -- have changed.
Medigap.
This is a private health insurance policy supplementing Medicare coverage; the company issuing the policy issues its own paperwork.
What to look for: If your loved one has a Medigap policy, he or she will have a copy of the original policy, an identification card issued by the insurance company, and regular bills for payment of their premiums.
Why it matters: The terms of the policy will tell you what it covers and how much it pays. The policy name and number is necessary for all contact with healthcare providers and the insurance company concerning bills and coverage.
Retiree health coverage.
Your loved one may have this from previous work; it would supplement Medicare.
What to look for: You'll find a copy of the policy in paperwork from either the private insurance company that issues the policy or from the benefits office of your loved one's previous employer.
Why it matters: The policy name and number is required for all claims. Also, the policy may have a claims process that requires a separate submission of medical bills and records.
Veterans health coverage.
This offers a system of healthcare as a supplement or even an alternative to Medicare, if your loved one was in the military.
What to look for: If your loved one receives medical coverage from the Department of Veterans Affairs healthcare system, he'll have a card that indicates the V.A. ID number and the level of care he's entitled to. He may also have records indicating specific V.A. medical facilities where he's received care.
Why it matters: V.A. medical care may cost much less than care that is only partly paid for by Medicare.
Medicaid.
Operated by the state, this may be available to cover almost all medical care if your loved one has very low income and few assets other than his or her home.
What to look for: Look for a Medicaid identification card and number. If your loved one isn't enrolled in Medicaid but has low income and few assets other than a home, contact your local social services agency to see if he or she can qualify.
Why it matters: If your loved one is enrolled in Medicaid, he or she can only receive its benefits if he or she gets health care from participating providers. If he or she qualifies for Medicaid but isn't enrolled, he or she may be spending far too much in out-of-pocket medical expenses.
You should become familiar with the coverage and other terms of such insurance as your loved one ages.
What to look for: Long-term care insurance is issued by a private insurance company and will have a policy with very detailed provisions regarding eligibility for benefits and other conditions. There will also be billing documents showing the monthly premiums.
Why it matters: Getting to know what your loved one's policy does and doesn't cover, and how he or she might qualify for benefits, can help you and your loved one plan for long-term care and arrange it when the time comes in a way that maximizes benefit payments.
TIP: If you have questions about government health insurance, such as Medicare or Medicaid, you can get free advice from a local counselor.
