Medicare Basics for Family Caregivers of Seniors

Medicare is a health insurance plan administered by the federal government for seniors 65+ years old, people under 65 years if they have a disability or anyone suffering from end stage renal disease requiring dialysis or a transplant. It guarantees access to health insurance for seniors.

Medicare was established and signed into law by President Lyndon Johnson on July 30, 1965. Before Medicare was created, only half of America’s seniors had health coverage. Coverage at that time was either unavailable or cost prohibitive.

This social program also further influenced the integration of medical services since it did not pay providers who were segregated.

There were 47.5 million Americans enrolled in Medicare in 2010, seniors comprising 5 of every 6 people enrolled.

The more family caregivers of seniors know about Medicare, the better equipped they are to assist loved ones and assure they are receiving all the benefits to which they are entitled.

Types of Medicare Coverage

There are several “parts” of Medicare that provide coverage for specific services your senior may receive.

1. Medicare Part A (Hospital Insurance) helps cover your inpatient care in hospitals. Part A also helps cover skilled nursing facility, hospice, and home health care.
2. Medicare Part B (Medical Insurance) helps cover doctors’ services and outpatient care. Part B also helps cover some preventive services to help maintain your health and to keep certain illnesses from getting worse.
3. Medicare Part C (Medicare Advantage Plans)(like an HMO or PPO) is a health coverage choice run by private companies approved by Medicare. It includes Part A, Part B, and, usually other coverage including prescription drugs. These plans must cover medically-necessary services. However, plans can charge different copayments, coinsurance, or deductibles for these services.
4. Medicare Part D (Prescription Drug Coverage) helps cover the cost of prescription drugs. This coverage may help lower your prescription drug costs and help protect against higher costs in the future.

Did you know that:

• Medicare is basically mandated? If you refuse Medicare you can’t collect Social Security benefits.
• The average benefit per enrollee is $11,762?
• You can’t pay cash for services covered by Medicare unless your doctor chooses to opt out of the Medicare program? It prohibits agreements between doctors and patients.
• Your senior is automatically enrolled in Part B unless he refuses? If you choose later to join, you will pay a 10% higher rate
• Medicare does not pay for hospitalizations longer than 150 days and does not put a cap on your out of pocket expenses?
• Medigap plans are available to help handle additional out of pocket costs?

Learn about the benefits to which your senior is entitled so that you will participate fully in the program.

For more information about Medicare, you might want to check out their handbook “Medicare & You,” or visit them on the web.