Successfully Navigating the Medicare System with Senior Loved Ones

Over time many caregivers of senior loved ones find themselves taking on many more challenges than ever imagined. It certainly doesn’t stay as easy as simply going grocery shopping or preparing a meal for them anymore.

One of the tasks for which we may find ourselves taking responsibility is their health care financing. Do they have medical insurance and, if so, what does it cover? Who, how much and when does it need to be paid? Do they have supplemental benefits from Veterans Affairs or private insurance? What do those policies cover?

Many seniors are eligible for Medicare and may already be receiving benefits before you take over their care. Do you know what is covered and how to access your senior’s benefits?

What if you have to apply for Medicare or Medicaid on their behalf? Is there something that needs to be done to keep them eligible?

Tips to Get Started with Medicare

  1. Medicare is a health insurance program for Americans 65 years of age and over. Some people with certain disabilities or medical conditions can qualify earlier.
  2. You or your senior must apply for benefits, either online or in person, to elect for particular coverage. Medicare Part A, benefits that cover skilled nursing services in hospital and rehabilitation, is automatic but Medicare Part B, which covers other types of services such as oxygen, diabetic supplies, and medically necessary equipment for in home use, can be declined. Part B requires your senior to pay a monthly premium.
  3. Medicare Part D or prescription coverage plans can be selected from different providers according to your senior’s particular needs. Your senior will pay a premium for this plan, which can be deducted from their social security payment.
  4. Your senior’s healthcare provider makes claims for covered services to Medicare, as other health insurers do for you. Not all services or equipment are covered. Non-skilled services, such as nursing home placement, are not covered by Medicare but may be if your senior is Medicaid-eligible.
  5. Medicare will pay for Hospice care if your senior becomes eligible for those services.
  6. If you will be applying for Medicaid for your senior, it will require a multitude of documents to be filed to ascertain eligibility.  Remember that there are state requirements and timeframes for spending or using assets of which you’ll want to be aware. You may want to consult a qualified elder care legal or financial adviser to help you with securing financial assets and completion of appropriate paperwork to protect both your senior and you.
  7. There are deductibles, copayments, premiums and coinsurance costs associated with Medicare of which you should be aware. Your senior will receive a Medicare Summary Notice after a healthcare provider files a claim similar to your explanation of benefits detailing charges covered under Part A or Part B plans. This will inform you and your senior of any amount not covered which becomes your responsibility.
  8. Medicare has an appeals process if you disagree with any decisions regarding healthcare payments that you can (and should) investigate if needed.

The website has many resources to answer all your questions and we encourage you to learn as much as possible to be sure your senior gets all the benefits to which they are entitled.

1 thought on “Successfully Navigating the Medicare System with Senior Loved Ones”

  1. Medicare is usually a pretty hot topic as well as for understandable reasons. Treatment benefits provide a back-up for both the elderly and disabled and changes to the program may significantly affect both groups

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