I’ve recently started helping my mom manage her finances and medical information. She’s having difficulty keeping up with everything on her own and things were getting missed.
One challenge I have is understanding how Medicare works. I’m not old enough to receive the benefit and I find it very confusing. I thought questions and answers about Medicare for caregivers was something you likely had experience with.
Can you please help me gain a quick understanding of Medicare requirements and coverage?
Medicare and Caregivers: Understanding How Things Work
You aren’t alone! Older adults and their caregivers often have many questions about Medicare. It can indeed be a tricky benefit to navigate.
To start, Medicare is organized into different parts. Each is designed to cover a different type of medical care. Here’s a basic overview of each section:
Medicare Part A
Medicare Part A helps pay for hospital stays, short-term rehab at a skilled nursing center, hospice care, and skilled home health care. Seniors are most familiar with this benefit.
Medicare Part B
This part of the Medicare benefit is designed to cover 2 primary types of care: medically necessary services and preventive services.
These can include:
- Physician visits
- Outpatient rehab
- Durable medical equipment
- Cardiac rehab
- Ambulance services during an emergency
- Vaccines (e.g., flu shots)
- Preventive screenings (e.g., colonoscopy and mammogram)
- Laboratory services
- Some diabetic supplies and counseling services
Medicare Part C
This part of the Medicare benefit allows private insurance companies to contract with Medicare to provide health care services for seniors. They are called Medicare Advantage plans.
Medicare Advantage plans often have lower out-of-pocket expenses than traditional Medicare, making them a budget-friendly solution. Some plans even include prescription medications and fitness center memberships, such as Silver Sneakers.
While a senior’s care will still fall under the umbrella of Medicare, they will be required to follow the advantage plan’s rules. Common examples include obtaining a pre-authorization before a procedure or utilizing only in-network physicians.
Medicare Part D
For seniors who choose to stick with traditional Medicare, signing up for Medicare Part D provides for prescription drug coverage. In most cases, the older adult will need to sign up for drug coverage when they first enroll in Medicare or pay a penalty.
Free Medicare Guide
One resource you might find useful is “Medicare & You.” This free guide is published by the Department of Health and Human Services each year. It is a comprehensive explanation of all the benefits Medicare recipients are entitled to receive.
Please let me know if you have more questions. I’ll be happy to help you find answers.