It is not always easy to understand and navigate the complexities of government programs. Yet caregivers of seniors are often asked to give advice and help on the subject of Medicare. To facilitate that task, we gathered five basic tips to make navigating Medicare easier and more time-effective for senior caregivers.
There are two major Medicare plans:
Original Medicare and Medicare Advantage Plans
Original Medicare includes 1. Hospitalization and 2. Medical insurance. It operates at any healthcare facility or with any provider that accepts Medicare. Hospitalization and other aspects of institutional health care are free (as explained below). Premiums for medical insurance are low and reasonable; co-payments and deductibles are required out-of-pocket expenses.
A Medicare Advantage Plan (MA) requires that providers and facilities be part of a specified network. Premiums for MAs are also low and reasonable. Medicare Advantage Plans have varied co-payments and deductibles based on the plan.
Choosing between these two major categories of health care Medicare plans is mostly a matter of assessing the person's health care needs, financial situation, and preferences. This includes knowing the person's medical history, projections of health care needs in the near future, a full listing of the person's prescriptions and medications, and how the person prefers healthcare to be delivered.
Know the alphabet
When navigating medicare, caregivers must know their ABCs. Medicare has Parts A, B, C and D. It is important to know what these Parts refer to.
Part A is hospital insurance. Part B is medical insurance. Original Medicare includes both Parts A and B.
Part A is free; Part B includes premiums, co-pays, and deductibles.
A Medicare Advantage Plan is often referred to as Part C. However, MA plans include both Parts A and B.
Generally, Part A covers hospital care, skilled nursing facility care, nursing home care (if care requires more than residential care), hospice, and home health services. Part B covers other medical needs. Part C (an MA plan) covers both Parts A and B.
Part D is easy to remember because it deals with prescription drugs. This insurance is supplemental to Original Medicare and requires premiums. MAs also offer Part D plans, although they usually require that this insurance be purchased with the MA from the same insurer.
Medigap is not part of the Medicare alphabet but is equally important. Some people purchase Medigap insurance to cover what is not covered by Original Medicare. This extra insurance covers co-pays, deductibles, and other out-of-pocket Medicare expenses. Medicap is unavailable with MA (Medicare Advantage) plans, which offer their own &of "gap" coverage.
Missing deadlines to apply for Medicare can lead to
penalties through higher premiums for long period
Caregivers must remember Medicare deadlines one because timing is important. In general, people are eligible to apply for Medicare three months before they turn 65. For some persons, this is before their full retirement age. A person's Initial Enrollment Period (IEP) is the primary chance to enroll in Medicare. The IEP includes the three month periods before and after the 65th birthday. Seven months may seem like a liberal amount of time to sign up, but it can slip by quickly. Signing up for Medicare should take place during this IEP time window. If these time periods are missed, there is a sign-up period each year from January 1 through March 31.
Delaying signing up and missing the time windows may result in penalties and higher premiums throughout the lifetime of the person's Medicare coverage.
Visit Medicare.gov., the official government Medicare site
There is a wealth of information on the government's site, Medicare.gov. It includes valuable information on the Medicare alphabet, the two major categories of Medicare care plans, specifics of coverage, and even estimates of premiums, all allowing for close examination. The menu and site are user-friendly and the contents are written in simple, easy-to-understand plain English.
Caregiver Alert: The first Medicare health assessment is free
The first Medicare visit, called a "Welcome to Medicare" preventive visit to a healthcare provider, is free. Medicare recipients should take advantage of this first free visit to obtain a baseline of their health needs and to begin using Medicare.
The mysteries of Medicare can be broken down into easily manageable parts with a little foreknowledge. These five basic tips are a framework for caregivers, families and seniors facilities to guide them in navigating this sometimes complex and confusing vital government program, which celebrated its 50th birthday in 2016.
Field, C. (December 5, 2016). Caregivers Need Support When Helping Their Loved Ones Find a Medicare Plan. The Suburban Times. Available online at http://thesubtimes.com/2016/12/05/caregivers-need-support-when-helping-their-loves-ones-find-a-medicare-plan/. Retrieved January 2, 2017.
Medicare.gov. The Official U.S. Government Site for Medicare. Available online at https://www.medicare.gov/index.html Retrieved January 2, 2017.