Your Situation
Helping a Parent With Medicare
Plenty of adult children end up sorting through a parent's Medicare letters, plan changes, and bills. You don't need to become an expert. You do need the right permissions in place, and a sense of when it's time to take a closer look at their coverage.
Step One: Get Permission to Help
Because of privacy rules, Medicare and insurance plans won't discuss your parent's information with you unless your parent has given permission. Set this up while things are calm — not in the middle of a hospital stay.
Medicare: Form CMS-10106
Lets 1-800-MEDICARE talk with you about your parent's claims, coverage, and benefits. Your parent signs it and chooses how long it lasts.
Their Medicare plan
Medicare Advantage, drug, and Medicare Supplement plans each keep their own permission form. Call the number on your parent's card and ask for an "authorized representative" form.
Appeals: Form CMS-1696
If you'll be filing an appeal for a denied service or prescription, this form names you as their representative for that appeal.
Wisconsin power of attorney for health care
A health care power of attorney lets you make medical decisions if your parent can't. Wisconsin has a standard state form. A financial power of attorney is separate and covers bills and money matters.
For legal questions about powers of attorney or guardianship, talk with an attorney who works with older adults.
Signs Their Plan Isn't Working Anymore
A doctor or specialist they rely on has left the plan's network.
A medication was added, and now it costs much more than expected.
Services or prescriptions keep getting denied or delayed for approval.
They moved — to a new county, closer to you, or into assisted living.
The plan's Annual Notice of Change (mailed each fall) shows big changes.
They can't explain what plan they have or how it works.
Most changes happen during Annual Enrollment, October 15 – December 7. How to review a Medicare plan →
What Medicare Does — and Doesn't — Cover as Needs Grow
Medicare generally covers
- Hospital stays and doctor visits
- Short-term skilled nursing or rehab after a qualifying hospital stay, for a limited time
- Home health care when your parent is homebound and needs skilled care
- Hospice care
Medicare generally does not cover
- Long-term nursing home care
- Assisted living rent and fees
- Help with daily activities like bathing, dressing, and meals, when that's the only care needed
Watch for "observation" status in the hospital
A parent can spend nights in the hospital without being formally admitted. Under Original Medicare, observation days don't count toward the 3-day inpatient stay needed for skilled nursing coverage. Ask the hospital staff directly whether your parent is admitted or under observation. Medicare Advantage plans set their own rules for this.
Help for Long-Term Care in Wisconsin
When a parent needs ongoing care, Wisconsin's Medicaid long-term care programs — Family Care and IRIS — may help pay for care at home, in assisted living, or in a nursing home for people who qualify. Your county's Aging and Disability Resource Center (ADRC) is the place to start. ADRCs also have elder benefit specialists who can help with benefits questions at no cost.
Some people who qualify for both Medicare and Medicaid, or who live in a nursing home, can join Special Needs Plans built for their situation. Moving into or out of a nursing home also opens a Special Enrollment Period to change plans.
Protect your parent from scams. Medicare will never call to ask for a Medicare number or to offer medical equipment or genetic tests out of the blue. Ask your parent to check with you before giving their number to anyone. Common Medicare scams →
Still have questions? Talk with Marit.
Licensed Wisconsin agent in downtown Appleton. No cost to talk, no pressure to enroll.
Or send us a message →