Helping Loved Ones with Health Care

Tips for talking to your loved ones about health care decisions.

Clear communication is an important part of making successful health care decisions, but it can be a challenge. These tips may help you talk to your loved one about his or her health care issues positively.

Define your role on your family member or friend's health care team
Depending on your relationship, you may be a coach, main care provider or decision maker. A health care team can also include physicians, pharmacists, friends, community groups and financial advisors. Each of these people contributes their expertise to arrive at a good decision.

Speak in an easy-to-understand way
Organize your information. Select three to five important points to begin your conversation. Give your family member or friend an overview, and then fill in the details. Use common words to explain your points.

Listen actively
Allow enough time for your family member or friend to complete their thoughts without interruption. From time to time in your conversation, repeat what you heard from your family member or friend. You can ask them to do the same. This demonstrates that you've been listening, and also measures how well you have understood others.

Demonstrate care and respect
Help your family member or friend feel valued and involved in decision making. Try to get their view on an issue before offering your own. Ask open questions that lead them to share what they are thinking, such as, “How do you manage paying for your prescription drugs?”

How your loved one reacts could be a sign that they may want to be independent, maintain their pride or privacy or that they need to express their feelings.

To keep the lines of communication open:

  • Imagine yourself in your loved one's situation.
  • Carry on an open-minded discussion.
  • Be sincere.
  • Be considerate and nonjudgmental.
  • Pay attention and acknowledge what is said.
  • Maintain open body language.

Set up a time to talk
Keep this appointment just like any other important meeting. Designate a quiet space, preferably at home or over the phone, so information and records are readily available. Try to talk at a time of day when your loved one feels his or her best.

Prepare for communication roadblocks
Your family member or friend may have an impairment that makes clear communication difficult. If your loved one has trouble:

  • Seeing: Your tone of voice is a particularly important cue. Put yourself in his or her line of sight.
  • Hearing: Speak in a clear, loud, low-pitched voice. Use short sentences. Speak without eating, drinking, smoking or covering your mouth. If you need to repeat yourself, consider rephrasing the sentence, as different words might be easier to hear.
  • Speaking: Speak as slowly and clearly as you can. This gives them permission to speak slowly, too.
Questions? Call UnitedHealthcare at:
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Optional supplemental service (rider)

Additional coverage you can add to your Medicare Advantage plan. Examples of optional plan services covered with riders include: dental coverage and fitness programs.

Optional supplemental service (rider)

Additional coverage you can add to your Medicare Advantage plan. Examples of optional plan services covered with riders include: dental coverage and fitness programs.

Optional supplemental plan (rider)

Additional coverage you can add to your Medicare Advantage plan. Examples of optional plan services covered with riders include: dental coverage, vision and hearing coverage and fitness programs.

Creditable Coverage

Refers to prescription drug coverage that offers benefits the same as or better than coverage available through Medicare.

Tier 1: Preferred Generic. Lowest Copay.

This tier includes lower-cost, commonly used generic drugs. Use Tier 1 drugs for the lowest out-of-pocket costs.

Tier 2: Non-Preferred Generic. Low Copay.

This tier includes most generic drugs. Use Tier 2 drugs, instead of Tier 3 or 4, to help reduce your out-of-pocket costs.

Tier 5 : Specialty Tier. Coinsurance.

This tier includes unique and/or very high-cost drugs. You pay a percentage of the total drug cost, called coinsurance.

Tier 4: Non-Preferred Brand. Highest Copay.

This tier includes non-preferred generic and non-preferred brand drugs. Many Tier 4 drugs have lower-cost options in Tier 1, 2 or 3. Ask your doctor if you can switch to one of these drugs to help reduce your out-of-pocket costs.

Tier 3: Preferred Brand. Medium Copay.

This tier includes many common brand name drugs, called preferred brands, and some higher-cost generic drugs. Many Tier 3 drugs have lower-cost options in Tier 1 or 2. Ask your doctor if they could work for you.

Tier 4: Non-Preferred Brand. Highest Copay.

This tier includes non-preferred generic and non-preferred brand drugs. Many Tier 4 drugs have lower-cost options in Tier 1, 2 or 3. Ask your doctor if you can switch to one of these drugs to help reduce your out-of-pocket costs.

Drug List tool tip

A list of drugs covered by your Medicare Part D plan. A drug list may also be referred to as a covered prescription drugs list (CML), a preferred drug list (PDL), a select drug list or a formulary. These drugs are dispensed through participating network pharmacies to covered members. Drug lists may differ between Medicare prescription drug plans.


Carefully weigh the differences in drug lists against the plan costs and other features when choosing a plan that may best meet your needs. A drug list may change during the year.

Tier 2: Low Copay

This tier includes most generic drugs. Use Tier 2 drugs, instead of drugs in Tiers 3 or 4 to help reduce your out-of-pocket costs.

Coverage Gap Stage:

During the Coverage Gap Stage, you (or others on your behalf) will pay no more than 72% of the total cost for generic drugs or 47.5% of the total cost for brand name drugs, for any drug tier until the total amount you (or others on your behalf) have paid reaches $4,550 in year-to-date out-of-pocket costs.

You may pay less if your plan has better coverage in the gap.

Always use your Medicare Part D member ID card during the coverage gap to get the plan's discounted drug rates. The money you spend using your card counts toward your out-of-pocket costs.

Out-of-Pocket Costs:

The amount you (or others pay on your behalf) pay for prescription drugs starting January 1, 2013 not including premiums.

Premium (or monthly premium)

The monthly fee you pay for Medicare coverage.

Deductible/annual deductible

The pre-set, fixed amount you must pay for healthcare or prescription drug costs before Medicare or the plan begins to pay.

Deductible/Annual deductible

The pre-set, fixed amount you must pay for healthcare or prescription drugs costs before the insurance company or Medicare begins to pay.

Coinsurance

A kind of cost sharing where you pay a percentage of the cost of a service. For example, a plan might pay 75% and you would pay 25%. In Medicare Advantage, coinsurance varies depending on the plan.

Copay

A kind of cost sharing where you pay a predictable, pre-set amount for a service, such as an annual check-up.

Copay

A kind of cost sharing where you pay a predictable, pre-set amount for a service, such as an office visit.

Primary Care Physician's name and ID

Your primary care physician (PCP) plays an important role in your health care, and we want you to have the opportunity to select one you are comfortable with. Your PCP can:

  • Help you make good lifestyle choices to maintain and improve your health.
  • Serve as a direct point of contact in case of an emergency.
  • Manage the drugs prescribed to you and identify potential adverse interactions.
  • Coordinate the care of specialists who may diagnose and treat your conditions.
  • Help ensure that you are getting the care you need while helping to minimize your out-of-pocket costs.

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