If you’re a caregiver for someone enrolled in or about to be eligible for Medicare, you may not know much about the program and what it offers. This article provides an overview of Medicare and information to keep in mind so your loved one can make the most of his or her Medicare coverage.
Medicare overview for caregivers
The Medicare program is divided into different parts, with each part representing a different type of coverage. Original Medicare is the federally run and administered health-care program. It’s made up of two parts, Medicare Part A and Part B. Additionally, there are two other “parts” of the program known as Medicare Part C (Medicare Advantage) and Part D (prescription drug coverage). Both of these parts are available through Medicare plans offered by Medicare-approved private insurance companies.
If you’re a caregiver for someone who’s new to Medicare, here is a quick overview of what each part of the Medicare program covers.
Medicare Part A (hospital insurance): Part A covers inpatient hospital care, such as a semi-private room, hospital services, and medical supplies. Skilled nursing facility stays, hospice, and some aspects of home health care are also covered through Part A.
Medicare Part B (doctor services): Part B covers outpatient care, including doctor appointments, various home health-care services, mental health services, durable medical equipment, and certain preventive services (such as annual “Wellness” visits, screenings, and immunizations). Ambulance rides to the hospital or other facility are also covered in certain situations.
Medicare Part C (Medicare Advantage): This is an alternative way to get your Original Medicare, Part A and Part B, coverage. Offered by Medicare-contracted private insurance companies, Medicare Advantage plans offer at least the same level of benefits as the federal program (except for hospice, which is still covered through Part A of Original Medicare). There are several types of Medicare Advantage plans, including HMOs or PPOs. Unlike Original Medicare, many plans also include prescription drug coverage and may also include routine vision, dental, and/or hearing benefits. When enrolled in a Medicare Advantage plan, you must continue paying your Part B premium to keep this coverage, in addition to any premium for your plan.
Medicare Part D (prescription drug coverage): This is stand-alone prescription drug coverage that can be added to Original Medicare. If you take prescription medications, keep in mind that Medicare coverage under Part A and Part B is limited, and you’ll need to enroll in Part D for help with most prescription costs. These plans, known as Medicare Prescription Drug Plans, work alongside Original Medicare and are offered through Medicare-approved private insurance companies, so costs and coverage details vary by provider. It is recommended that you explore all available options in your area, which can be done by entering your location into the zip code box on this page.
Some beneficiaries with Original Medicare may decide they’d like help with out-of-pocket costs. If you’re a caregiver for someone who sees the doctor frequently or has a chronic condition, you know that copayment and deductible costs may quickly add up over a year. Medicare Supplement insurance policies are also available through private insurance companies and can cover costs for services under Part A and Part B, such as copayments, coinsurance, deductibles, and more. Keep in mind that Medicare Supplement plans can only pay for Original Medicare costs; these plans don’t work with Medicare Advantage.
Legal authorization you may need as a caregiver
When you’re helping someone with his Medicare coverage, it is important to start a dialogue with all of his health-care professionals as necessary. Keep in mind that many providers may require you to provide proof that the patient has given you permission to consult with them on your loved one’s behalf and discuss personal health information. For example, Medicare requires enrollees to fill out an Authorization to Disclose Personal Health Information form before it will release medical information to someone other than the beneficiary.
If you haven’t yet done so, it may be a good time to start a comprehensive review of your loved one’s legal needs. Talk with your care recipient to establish plans for the future and ask whether or not he would like you, or someone else, to make decisions on his behalf. If your loved one would like to authorize you to make decisions legally, you may need to apply to become his legal personal representative before you can do so. Depending on your level of involvement in your loved one’s care, you may need to obtain a power of attorney, which gives you the legal right to make medical and, in some cases, financial decisions for your loved one. You can contact Medicare for more information on how to do each of these by calling 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. Medicare representatives are available 24 hours a day, seven days a week. You can also consult your State Health Insurance Assistance Program (SHIP) to begin the process.
Getting started as a caregiver
Once you have the proper legal authority and paperwork to help your loved one with her medical care, it is important for you to ask as many clarifying questions as necessary. You may want to have this conversation with both your care recipient and her doctor. Important topics to cover include medical history; if health screenings and immunizations are up-to-date; current list of prescription medications; and past or ongoing treatments. It’s important to find out what type of coverage your loved one has, whether it’s Medicare, veterans benefits, retiree insurance, or other coverage. If your loved one has Medicare, find out what kind she has (Original Medicare, Part D, Medicare Advantage, etc). The more information you have, the better you’ll be able to manage her medical costs and make sure you’re taking full advantage of her health-care options.
It goes without saying that you are acting with your loved one’s best interests in mind. If the person you’re caring for is physically unable to do so, ask as many questions as necessary for you to comfortably make the decision(s) on her behalf. Again, make sure you have the legal authority to do so (see above).
Caregiving and Medicare resources
If you’re a caregiver, you may fully understand how the task can often be as emotionally draining as it is necessary and rewarding. Fortunately, there are many free Medicare resources available to arm you with the knowledge you need as you care for your loved one. Here are some good places to start:
- PlanPrescriber.com has an extensive Caregiver Resources library filled with articles to help you navigate your journey as a caregiver. Find information on topics like money management, fall prevention, tips for effectively communicating with your loved one’s health-care team, and more.
- The Centers for Medicare & Medicaid (CMS), which runs the Medicare program, hosts a quarterly Caregiver Workgroup meeting that helps connect caregiver organizations, community groups, and other government agencies that help older adults. You can also find information on local resources, caregiver self care, and Medicare coverage on the CMS website.
- Medicare.gov has many online Medicare resources available. “Medicare & You” is the official Medicare handbook, updated annually, that explains coverage and costs in detail.
There are also many local, state, and national resources to provide caregivers with relief. Here are some places to start:
- Your local hospitals may offer resources, including counseling services or caregiver support groups.
- Elder Care, a service provided by the U.S. Administration on Aging, provides information on local community services, including adult day cares, meal assistance, personal care, or medical transportation. Many of these organizations can help with the day-to-day care that you as a caregiver may currently be shouldering.
- The National Cancer Institute and the American Diabetes Association, offer support services for caregivers found at their respective links.
- Caregiver.org also contains useful information and resources for you and your family, letting you search for resources at the state level.
Finally, there may be services available that provide temporary respite care. Respite care provides a safe space for loved ones so that their caregivers can take a break from their daily responsibilities. Medicare covers limited respite care if your care recipient is in hospice care. However, if you need more frequent or long-term help and respite care is something you would like to look into, you can check the respite care website.
Medicare resources for managing costs
When you’re involved in the caregiving process, it is important to keep detailed records of every bill, appointment, and medication involving your loved one. That way, if a payment dispute comes up later with a doctor or insurance provider, you’ll have the paperwork at the ready.
Make a budget to review all of your loved one’s health-care costs each month and also a list of his or her income sources so you can figure out how to pay for each out-of-pocket medical expense.
If your loved one is enrolled in Original Medicare, keep an eye out for a Medicare Summary Notice, which is sent in the mail every three months. This document summarizes the maximum amount that the beneficiary may owe during the last three month period, as well as information on all medical services and equipment that were billed to Medicare and what Medicare paid. Your loved one can also opt to get this document sent electronically by email. MyMedicare.gov is a free online service that makes it easy to look up claim information and track costs, such as whether you’ve reached that year’s deductible; the person you’re caring for can sign up for an account at MyMedicare.gov, or you can show him how to do it. If your care recipient is enrolled in a Medicare plan, such as a Medicare Advantage plan, contact the plan directly to find out billing information works.
As a caregiver, it’s important to stay up-to-date on your care recipient’s preventive care, including all the screenings/tests his or her doctor thinks is necessary. The preventive process is one of the most important aspects of health care, as it can potentially catch issues before they intensify and/or become debilitating. Medicare covers many preventive services at no cost for those with Part B, including an annual “Wellness” physical exam and certain preventive screenings, such as depression screenings, flu shots, and more. Keep in mind that your care recipient may need to follow certain rules to be covered, such as seeing a Medicare provider that accepts assignment or, if he’s in a Medicare Advantage plan, using certain network providers. Certain preventive services have additional eligibility requirements.
Medicare resources if your loved one needs help with medical costs
If your loved one need financial assistance, BenefitsCheckup.org is a resource provided by the National Council on Aging that may help. You can use it to look up available programs in your area that may help cover some of your care recipient’s health-care costs. If the individual you’re caring for has limited income and you think she may qualify for state assistance, contact the Medicaid program in your state to learn about income eligibility requirements and how to apply. The Medicare and Medicaid programs work closely together, and those who qualify for both programs are known as “dual eligibles.” If your loved one qualifies for Medicaid, he or she may get help with costs like Medicaid premiums, copayments, deductibles, and more. Depending on the state, Medicaid may cover certain benefits that Medicare doesn’t cover, such as long-term or nursing home care.