If you’re helping care for a loved one who either has Medicare or will soon be eligible, it can seem overwhelming, particularly at first. In fact, the whole situation can feel overwhelming.
It may help to know that you’re in good company. Over 90 million Americans are currently acting as a loved one’s caregiver. Whether you’re new to the role or new to Medicare, this post helps walk you through what you need to know to help ensure your loved one gets the most out of their Medicare benefits.
The A, B, Cs – and Ds – of Medicare
Medicare is a federally-funded health insurance program. Americans aged 65 and over qualify, as do some people who are under age 65 if they have certain conditions, such as end-stage renal disease (ESRD).
The four parts of Medicare are Parts A and B (also known as Original Medicare), Part C (also known as Medicare Advantage) and Part D (also known as Medicare Prescription Drug Coverage). In addition, you can get Medicare Supplement Insurance (also known as Medigap).
Original Medicare includes two parts. Medicare Part A is hospital insurance. It covers in-patient hospital care, hospice and home healthcare, and care in a skilled nursing facility.
Part B is medical insurance; it covers common services from physicians and other healthcare professionals. In addition, coverage includes outpatient care, durable medical equipment, some preventive screenings and services, and home healthcare.
Original Medicare does not cover extended nursing home care, prescription drugs, or long-term care. It also does not include vision, dental, or hearing benefits.
Medicare Advantage (MA)
Legally, Medicare Advantage must provide all of the services and benefits offered under Original Medicare, but MA plans often include additional benefits, such as prescription drug coverage and vision care.
MA plans are provided by private insurance companies that must receive approval from Medicare. It’s important to note that most MA plans have a monthly premium in addition to the premium you must pay for Original Medicare.
Medicare Part D
Prescription Drug Coverage helps beneficiaries pay their prescription costs. These are also provided by private, Medicare-approved insurers.
Medicare Supplement Insurance helps pay the costs not covered by Medicare. This includes premiums, co-pays, co-insurance, and yearly deductibles. These plans are also offered by private insurers. You must undergo medical underwriting and may be denied a Medigap plan based on that process. The exception is the first six months you have Medicare Part B. During this time, you are exempt from the underwriting process.
Compiling Your Loved One’s Important Information
Assisting your loved one with their healthcare and Medicare needs requires having a variety of information at your fingertips. Make sure you have easy access to the following:
- Any allergies or food restrictions
- Complete list of current prescriptions and over-the-counter medications, including dosages
- Contact information for all healthcare providers, including primary care physician, pharmacies, and hospital
- Emergency contact list, including family, friends, neighbors, housing manager or landlord, and clergy
- Financial and legal information
- Medical history including past health problems and surgeries
- Medicare number
- Medicare plan enrollment/current coverage
- Policy numbers for any other insurance plans
- Social Security Number
Your best bet here is to create a folder with all of this information – as well as any other information you need to manage your loved one’s care.
How to Check Current Medicare Coverage
If your loved one currently has Medicare coverage, review their Medicare card. If they don’t have a Medicare card, or you can’t find one, go to MyMedicare.gov to determine their eligibility and plan enrollment. You can also call (800) MEDICARE (633-4227).
Look also at other coverage, such as through a union or Veteran’s Affairs. If they’re still employed, talk to the employer’s benefits administrator for current coverage information. You can call TRICARE at (866) 773-0404 for information about military benefits. Finally, your state Medicaid office can tell you whether they receive Medicaid benefits.
Taking Care of the Legal Stuff
Before you can talk to any providers about your loved one’s health or medical treatment, he or she has to give you the legal authority to do so.
Often called advance directives, these documents give medical providers permission to disclose your loved one’s information. The most important is the medical power of attorney (also known as a durable power of attorney and a health care proxy). This document names the person allowed to make medical decisions on behalf of the patient when he or she is unable to communicate their wishes due to physical or mental incapacity.
You may also want a living will, which provides direction as to resuscitation and “extraordinary” measures to keep your loved one alive, such as breathing machines and tube feeding.
These documents may be created with the help of an attorney who specializes in estate planning. However, most state government websites (usually the secretary of state) offer these forms free of charge. Simply complete the form and have a notary witness the signatures. One copy must be filed with the state, but you should also keep a copy in your important information folder, so you can easily display it if required.
In addition to these general legal documents, Medicare requires your loved one complete the Medicare Authorization to Disclose Personal Health Information form.
Final Thoughts on Medicare Basics
The easiest way to manage your loved one’s Medicare is to thoroughly understand the program. Of course, you also need the legal authority to talk to their healthcare providers. Gather their information, including the Medicare authorization form, and keep it handy. And, if you have any questions about Medicare Advantage or Medigap plans, call us toll-free at 855-350-8101 to speak to a licensed agent.
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