Medicare - An Essential Part of Elder Care

One time when we were taking care of my father-in-law I was explaining the costs involved in elder care, a befuddled person asked me, "Well, Medicare covers everything, right?" The short answer is that Medicare does cover a lot but it does not cover everything. In our case, my father-in-law was in the hospital thirteen times and in re-hab 8 times. Medicare and a Medi-Gap insurance policy covered his costs. This is how it works.

Medicare Part A

Medicare has different parts. Part A covers the hospital costs of people over 65. It also covers people under 65 who have kidney failure. It is paid for by contributions from employers, employees, and the self-employed and from premiums deducted from the social security payments of the person receiving the coverage. The premiums are deducted automatically from their Social Security payment. If your loved one (LO) is not receiving Social Security there is a seven month enrollment period, three months before their 65th birthday and four months after. Be sure they don't miss this enrollment period.

Medicare does not cover long term or custodial care, which is what elder care usually involves. The services that are covered have to be prescribed by a doctor and provided by a Medicare approved facility. Medicare also covers hospice care if a doctor certifies that a person has six months to live. The recipient has to give up his other rights under Medicare.

Medicare Part B

Medicare Part B is paid for by the premiums of people who voluntarily enroll. The federal government pays the rest. Medicare Part B covers physicians' costs, lab costs, outpatient care and certain home care services. It does not cover routine physical exams or routine eye exams, hearing aides, dentures, or orthopedic shoes. If your parent is covered by another form of insurance, such as a retirement program, he/she may not want to enroll in Part B. If that is the case he/she must let Social Security know about their decision.

Medi-Gap Insurance

Medicare Part B covers 80% of the bill. The remaining 20% has to be covered with a separate insurance policy.. We had the premiums automatically deducted so there would be no gap in the coverage. When buying Medi-Gap insurance make sure that it does not exclude pre-existing conditions. Be sure also that they buy the policy within six months of turning 65. If you enroll during that period, the insurance company can not charge more because of any pre-existing condition. Ask if the company is approved by the state insurance department to sell Medi-Gap policies. As always, fill out the insurance application completely. Don't give the insurance company a reason to refuse your claim.

Medicare HMO

If you don't want Medi-gap insurance you can enroll your parent in a Medicare HMO. He/she has to keep Medicare A & B but they use the doctors and hospitals in the HMO. One nice thing about an HMO is that it covers preventative care that is not covered by Medicare. An HMO also covers hearing aides (if you can your LO to wear one), dental care, and eye glasses. You pay monthly premiums to the HMO. Be aware that if your LO wants to get out of the HMO they have to apply for Medi-Gap insurance which could be more difficult if they develop a new health issue. They may not get guaranteed access to a policy.

Doctors and hospitals can go in and out of an HMO which may leave you with fewer options. When you inquire about joining an HMO find out how many doctors have left. Ask about switching doctors if your doctor leaves or if you are dissatisfied with his/her service. Since the elderly use so many prescriptions, be sure they can fill your current medications. Find out how often they update their formulary. How and who determine what is medically necessary and how can you appeal that decision? What happens when your LO needs emergency care while traveling beyond the area covered by the HMO?

Medicare Part D

Medicare Part D pays for part of the cost of prescription drugs. I think Part D was purposefully designed to be complicated. When I tried to figure the cost frameworks, the different tiers of drugs, the enrollment procedures I simply got more confused. I suggest you do what I did, and that is to talk with your pharmacist. He/she will know what medications your LO is on and which plan will offer the best coverage. That kind of advice is very valuable so it pays to patronize a good local pharmacist.

If You Have A Problem With Medicare

If a hospital or clinic wants to release your LO too early or if you have other issues with them ask the hospital for the phone number of the Peer Review Organization, or PRO. The PRO monitors the care given under Medicare.

Two Important Resources

Two of the best resources for more information about Medicare and Medi-Gap insurance is Medicare itself at Medicare.gov or 1-800-633-4227 or your local area agency on aging. That number is in your phone book.

I am certified by the Department of Health in New York State as a Home Health Aide to work with the elderly at home and those in hospice care. I addition, I provided care for an elderly relative both in his home and in our home for seven years. That care involved all the aspects of elder care such as legal, financial, medical, support, psychological, relationships, dietary, safety, physical therapy, and transportation. I have delivered lectures on these issues. For a free DVD on the basics of elder care go to HomeCareSurvival.com or visit my blog, HomeCareSurvival.com/blog, for more information.