A Lesson In Medicare for Caregivers
Being a caregiver is challenging enough. But when the person you’re caring for is reaching the enrollment age for Medicare – or is past that age but needs to be enrolled anyway – the prospect of engaging in what may seem like a bureaucratic battle may seem overwhelming. It doesn’t have to be, though. Before you start reading up on what you have to do, take a deep breath. All the information you need is easily available. Here are some facts to get you started.
Initial Enrollment in Medicare
What’s called the Initial Enrollment Period starts three months before a person’s 65th birthday and continues for seven months after the birthday. An important thing to remember is that there is no penalty for enrolling late in Medicare Part A, but in Medicare Part B, there will be a 10 percent cost increase for every year a person is not enrolled in Part B. The different parts of Medicare are explained in the following slides.
General Enrollment Period
If you missed your Initial Enrollment Period, you can still sign up for Medicare coverage during the General Enrollment Period between January 1 and March 31 of each year. However, your coverage will not begin until July 1, and you may have to pay a higher premium for late enrollment.
Medicare Part A
Part A is hospital insurance that will help cover inpatient care. It includes general nursing, a semiprivate room and essential hospital services like meals and supplies. It doesn’t cover private nursing, a private room (unless that’s required because of a medical condition) and non-essential services like television or a telephone. Most people don’t need to pay for Part A.
Medicare Part B
This part of the plan covers doctors’ services that are medically necessary, outpatient care, home nursing service and some preventive services such as screenings for diabetes, breast cancer and colon cancer. There is a monthly payment for Part B.
Medicare Part C
This is an alternative to Part A. The copayments for this plan are lower, although like an HMO, the patient can go only to certain doctors or hospitals. The doctors and hospital must also be in the geographical area where the person lives. This plan may offer additional benefits not found in Part A, including vision and hearing coverage and some wellness programs. A person can switch to Part A if that turns out to be a better plan for him or her. That change can be made between Jan. 1 and Feb. 14.
Medicare Part D
Unlike the other Medicare components, which are run by the government, Part D is run by insurance companies approved by Medicare. If a person signs up for Part A, he or she must sign up for a Medicare Prescription Drug Plan, or PDP. Someone enrolled in Part C will automatically receive prescription drug coverage through that plan, if the plan offers it, for an extra cost.
How to Get Help
The federal website www.medicare.gov is an invaluable resource. Since government rules and regulations can change unexpectedly, it’s best to use this website, rather than any pamphlets or written materials, to keep up on what’s happening in this area. You can create an individual profile for the person you’re caring for that will show you what he or she is entitled to, and even provide a checklist and schedule for preventive tests they should be undergoing. You can also call 1-800-Medicare (1-800-633-4227) for help.
Closer to Home
If the person you’re caring for has to go to the hospital unexpectedly and you’re uncertain what their benefits are, talk to the patient advocate, social worker, or financial counselor. It’s a good idea for you to also check out the National Family Caregivers (www.nfcacares.org), a comprehensive site that is a goldmine of caregiving resources – and can even connect you with others in your situation.