Helping a Loved One With Medicare? 5 Things Every Caregiver Should Know

With 10% of U.S. adults caring for an aging parent and nearly 20% of Americans aged 65 or older, there are more Americans stepping into the caregiving role each year. A critical caregiving role is understanding how Medicare works and what you need to understand as a caregiver for an aging relative.  

Caregiving roles vary differently for each situation. Caregivers often manage finances, healthcare, helping with home repairs, transportation to medical appointments, and simple daily errands. There are physical components of caregiving including basic tasks, assisting with physical therapy exercises, and caring for their health.

With an estimated 21% or more of Medicare recipients receiving support from a caregiver, it can be overwhelming for the caregiver to navigate Medicare decisions. Understanding the coverage, types of services available, costs and unique needs are vital to enrolling a loved one into the best Medicare plan for their needs.

To help you get started, we’ve prepared a checklist about what you should know as a caregiver navigating the Medicare process.

1.) Make sure you have the proper authorization to speak to Medicare or a Medicare agent on their behalf.

This can include Durable Medical Power of Attorney, Guardianship, Conservatorship, or Healthcare Agent. This is essential to being able to help with a loved one’s healthcare, including Medicare. Federal privacy law forbids unauthorized individuals talking to Medicare representatives – being a spouse, child, or emergency contact does not grant the right to call or get information from Medicare on behalf of an individual. Medicare and licensed insurance agents cannot speak with someone on behalf of a loved one without this authorization. So, ensuring you have it will be critical to help choose a Medicare plan and discuss Medicare options.

2.) Organize Essential Personal and Medical Documents.  

When looking for Medicare plans that work with a loved one’s needs, it is vital to have required and essential documents on hand. This will include medical records, insurance information, contact information (including addresses) for providers, a list of prescriptions, and more. Having these documents will make sure that their plan includes existing providers, treatments, etc. If you do not have this information on hand already, we strongly recommend reaching out to your loved one’s providers to obtain it so you are ready to seek out a Medicare plan that meets their unique needs when the time comes.

3.) Understanding Medicare Plan Options for Your Loved One.

Original Medicare contains parts A and B. Medicare Part A, or Hospital Insurance, helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care. Medicare Part B, or Medical Insurance, helps cover:

• Services from doctors and other health care providers
• Outpatient care
• Home health care
• Durable medical equipment, such as wheelchairs, walkers, hospital beds, and other equipment)
• Many preventative services like screenings, shots, vaccines, and yearly wellness visits

Medicare Part C, or Medicare Advantage, is an alternative for Original Medicare which includes “bundled” plans through a private health plan that is Medicare approved. These plans can include Part A, Part B, and usually Part D. These will typically have different out of pocket costs than Original Medicare and recipients within an Advantage plan may need to use doctors in that plan’s network and get approval for certain drugs and services. Most Advantage plans also offer extra benefits such as vision, hearing, dental, and more.

Part D is prescription drug coverage. Original Medicare recipients can get a drug plan or get it by joining a Medicare Advantage Plan (MAP) with drug coverage. Plans that offer Medicare drug coverage are run by private insurance companies following rules set by Medicare.

Medicare Supplement Insurance, or Medigap, is extra insurance purchased from a private company that can help share costs of Original Medicare. These polices are standardized, and in most states are named by letters like Plan G or Plan N. Regardless of insurance company, each benefit in each lettered plan is the same.

4.) If they are over the age of 65 and haven’t enrolled in Medicare, research your options.

If your loved one is over the age of 65 and lacks qualifying employer coverage, they could face permanent late enrollment penalties, coverage gaps, and out-of-pocket costs. A late Part B enrollment can result in monthly Part B premium increases by 10% for every 12-month period coverage is delayed after they were first eligible. This penalty is paid for as long as they have Part B after enrolling.

Health coverage by an employer must be through their own employer, or a spouse’s employer, with an employer  group health plan with 20 or more employees.

A person’s Initial Enrollment Period (IEP) is a 7-month window, starting 3 months before their 65^th birthday, the month of their birthday, and 3 months after their birthday. Missing this IEP means they generally must wait for the General Enrollment Period starting January 1^st and going through March 31^st each year. This leaves them without medical insurance during that time.

If your loved one is already receiving Social Security benefits at least 4 months before they turn 65, they will be automatically enrolled in Part A and Part B. Their Medicare card will arrive in the mail 3 months before their 65^th birthday.  ( ** Part B must be applied for it isn’t auto enrolled)

5.) Determine what kinds of aid can be covered by Medicare.

While Original Medicare will not cover services provided by family caregivers, some Medicare Advantage plans may. A small, but increasing, number of Medicare Advantage plans can now incorporate specialized supplement support for caregivers, such as Caregiver Coaching and Resources. Other common offerings can include Adult Day Care Centers, and Post-Hospitalization transitions.  The coverage specifics can vary depending on plan type, Carrier, and zip code.

Certain medically necessary part-time or intermittent skilled nursing care can also be covered by Medicare Part A and Part B. These can include wound care, patient and caregiver education, injections, physical or occupational therapy, and durable medical equipment. Recipients eligible for these benefits must need part-time or intermittent skilled services and be considered “homebound.” To be considered “homebound,” a recipient must meet both of the following criteria:

• Your condition or treatment makes you unable to leave your home without help, such as the use of a can, wheelchair, or crutches; special transportation or help from another person.
• You’re normally unable to leave your home and leaving can take a lot of effort.
• You need more than part-time or intermittent care.

Recipients eligible for part-time or intermittent home health care services can still leave for medical treatment or infrequent non-medical reasons such as religious services. They can also still receive these services if they attend daily adult care.

Remember You Need Help

Caregiving can take a mental, physical, and emotional toll. It’s important to take care of yourself while you’re taking care of a loved one. Resources are available for caregivers are available no matter who you are taking care of. The Administration for Community Living (ACL) provides valuable resources through their National Family Caregiver Support Program. The ACL also provides resources for Aging Services and Disability Services.

Each state also has a State Health Insurance Assistance Program (SHIP), that can provide free one-on-one assistance with Medicare questions.

The role of a family caregiver is becoming increasingly important and vital. Understanding the maze of Medicare is a critical step in ensuring your loved one has the coverage they need.

Contact us for free one-on-one assistance from an experienced Licensed Insurance Agent to help guide you and your loved one through their Medicare options. We can help guide you through understanding their Medicare plan options and enrolling them in a plan that works best.

Frequently Asked Questions

• Can a caregiver enroll someone in Medicare?

  Yes – caregivers can enroll their loved one in a Medicare plan. However, to discuss personal Medicare information, legal authorization will be required.

• How do I know what Medicare plan my loved one has?

  You can review their Medicare card, plan documents, insurance member ID card, or recent Explanation of Benefits (EOB) statement. Understanding what type of Medicare plan they have, and if it works for their current needs, will be important when choosing a new one.

• What’s the difference between Original Medicare and Medicare Advantage?

  Original Medicare includes Part A and Part B, which is hospital coverage and medical coverage. Medicare Advantage plans are offered by private insurance companies approved by Medicare and often include additional benefits such as vision, dental, hearing, drug coverage, and wellness benefits.

• Does Medicare cover family caregivers?

  No, Original Medicare generally does not pay family members for personal caregiving services. However, some Medicare Advantage plans may offer caregiver support benefits, care coordination services, training, and resources.

• Does Medicare cover home health services?

  Medicare may cover necessary home health services for eligible beneficiaries who qualify for home health benefits. Covered services may include skilled nursing care, physical therapy, occupational therapy, speech-language pathology services, and certain medical equipment.
  
  

Nothing in this post is intended as advice or a suggestion to elect or not elect to claim benefits of any kind, including Social Security benefits, nor is it intended as financial advice in any way. The decision to claim benefits is personal and contingent upon each individual’s unique circumstances. Nothing herein is considered medical advice, diagnosis, or treatment.