Medicare Basics for CaregiversPosted by Medicare Made Clear
Taking care of a loved one on Medicare with a chronic illness, disability or frailty is not an easy job. Yet more than 90 million Americans do it every day, according to the Caregiver Action Network.
Being a caregiver also means navigating the health care system, which can be difficult and sometimes confusing. That’s why it’s important to have a good understanding about how Medicare works. Let’s start with the basics – knowing your ABCs…and D.
Medicare Part A and Part B
Medicare Parts A and B make up what’s called Original Medicare. This is traditional Medicare that is administered by the federal government.
- Part A is hospital insurance. It covers services such as inpatient hospital stays, skilled nursing care, hospice care and some home health care.
- Part B is medical insurance. It covers services such as doctor visits, outpatient care, some medical supplies and certain preventive services like flu shots.
- In general, Original Medicare pays 80 percent of the cost for covered services. Your loved one would be responsible for the other 20 percent. There is no limit on out-of-pocket spending with Original Medicare.
Once you’re enrolled in Original Medicare, you have other coverage choices. These other choices are offered by private insurance companies approved by Medicare.
Medicare Part C
Medicare Part C is also called Medicare Advantage. Medicare Advantage plans include the same coverage provided by Original Medicare (Parts A and B) and may offer extra benefits. Additional benefits may include prescription drug coverage; dental, hearing and eye care; and wellness services.
- Your loved one must be enrolled in Part A and Part B to be eligible to join a Medicare Advantage plan. They continue to pay the Part B premium to Medicare.
- Benefits come through the Medicare Advantage plan instead of through Original Medicare.
- In general, your loved one would pay a low or no monthly premium and co-pays or co-insurance when services are used. Plans are required to have a maximum out-of-pocket spending limit.
Medicare Part D
Medicare Part D is prescription drug coverage. Most Medicare Advantage plans include drug coverage, but stand-alone plans may be purchased separately by those with Original Medicare. Original Medicare does not provide drug coverage.
Medicare Supplement Insurance
Medicare supplement insurance (sometimes called Medigap) may help pay some costs not covered by Original Medicare, such as deductibles, co-pays and co-insurance. Plans are standardized by the federal government in terms of coverage, but costs may vary. Your loved one would continue to pay the Part B premium. (Medicare supplement insurance cannot be used in conjunction with a Medicare Advantage plan.)
Finding the Right Plan
Once you know what type of coverage might fit with your loved one’s needs, it’s important to look carefully at the different plans available. Specific benefits and costs may vary from plan to plan.
When assessing Medicare Advantage or prescription drug plans, consider these questions:
- How much might your loved one pay, including co-payments, co-insurance, premiums and deductibles?
- Does the plan’s network include your loved one’s health care provider and preferred hospital and pharmacy?
- Are the prescription drugs your loved one takes on the plan’s drug list (also known as the formulary)
Understanding Medicare may seem overwhelming at times, but help is available.
- Go to com to learn more about Medicare.
- Go to gov, or contact the Medicare helpline at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048, 24 hours a day, 7 days a week.
- Contact your local SHIP (State Health Insurance Assistance Program) office to speak with a counselor for no cost. SHIP counselors are volunteers who have been trained to advise, educate and empower people to make informed health care choices.
For more information, explore MedicareMadeClear.com or contact the Medicare helpline 24 hours a day, seven days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048.