Medicare can be a complicated subject for a caregiver to understand and manage. The biggest challenge for caregivers is dealing with health insurance, especially Medicare. Trying to figure everything out on your own can be overwhelming, but luckily there are some great resources to learn from. Here is a basic overview of what Medicare is so you can provide the best possible care to loved ones.
What is Medicare?
Medicare is a federal health insurance program that offers health insurance to those over the age of 65 or certain younger people with a disability. It began in 1966 under the Social Security Administration and is now administered by the Centers for Medicare and Medicaid.
Medicare Part A is hospital insurance and it includes skilled nursing homes, hospice and some aspects of home care. Medicare Part B is medical insurance and that covers doctor visits, tests, shots, ambulance, etc. Part C, otherwise called Medicare Advantage, is run by private insurance companies. Medicare Advantage is a type of health insurance that’s run through a private-sector health insurer. Medicare Part D includes prescription drug plans. To be eligible for Part D, you must meet certain criteria.
You must fall in the following categories:
- 65 years or older
- Qualifying disability and have been receiving Social Security Disability Insurance for more than 24 months
- Been diagnosed with end-stage renal disease
- You’re entitled to Medicare Part A and/or enrolled in Medicare Part B
How is Medicare paid for?
Medicare is paid through monthly premiums, deductibles and copays at varying costs. If you’re in Medicare Part B, premiums are automatically deducted from Social Security or Railroad Retirement Board. If you’re not enrolled in either program, you’ll pay for the Part B premiums via a monthly bill.
Medicare Part D has a plan called “Extra Help” that will help people who have a limited income pay for prescription drug premiums, or copays.
What does Medicare cover?
As a caregiver, you need to know exactly what Medicare covers. Here are few key areas:
Home health care services: Nursing care, physical and/or speech therapy at home is covered if the individual is homebound and is under a doctor’s orders.
Personal home health aids: Medicare will pay for home health aids such as bathing, dressing, using the toilet, etc. It will not cover personal care on an ongoing basis and family members can not be paid by Medicare to provide this type of care.
Nursing facility: Medicare will pay nursing facilities only when certain qualifications are met. Spending three days as an inpatient in a hospital would fall under those qualifications, but only for a limited amount of time.
Assisted or independent living: Medicare does not cover this.
Medical supplies: Various types of medical supplies will be covered by Medicare. Items such as feeding tubes, catheters, oxygen and wound-care supplies would be covered. It will also help pay for wheelchairs, walkers and certain hospital beds.
What is Medigap coverage?
Since Medicare doesn’t pay for everything, insurance companies will offer what’s called Medigap. Medigap is supplemental insurance and depending on the policy you select, it can cover most out-of-pocket expenses such as copays. Depending on your employer, you may be offered retiree benefits. If this is available to you there is no need for traditional Medigap coverage.
When it comes to Medicare, there are so many different things to take into account. It can be as clear as mud and hard to know what is and isn’t covered. Luckily for you, we’re here to clear up any confusion along the way.
Our team of experienced staff has over 120 years of combined experience so we can answer almost any question you throw at us. If we don’t know the answer, we’ll figure it out and get back to you.
If you have any questions about what will be covered by Medicare plans, give Senior Insurance Marketing a call today!