Medicare

Medicare can be confusing at first, especially for caregivers trying to make the best decisions for a loved one. Here's a straightforward breakdown of what caregivers should know about Medicare Parts A, B, C, and D.

  • What it covers:

    • Inpatient hospital care 

    • Rehabilitation - both Acute and Sub-acute

    • Hospiice care 

    • Certified home health care 

    Cost:

    • Usually free if the person (or their spouse) worked and paid Medicare taxes for at least 10 years. 

    • There’s a deductible when you have a hospital admission and possible coinsurance if stays are extended (after 60 days in the hospital). 

    What caregivers should watch for:

    • Coverage for nursing homes is limited to skilled care (not long-term custodial care). 

    • Know the 3-day inpatient hospital rule for skilled nursing coverage to apply.

    • If your loved one was discharged home but really needed rehab they may be able to go directly there if within 30 days of coming home. Contact the skilled nursing facility you like and talk to the administrator

  • What it covers:

    • Doctor visits 

    • Outpatient care 

    • Preventive services (like flu shots, screenings) 

    • Durable medical equipment (like walkers, oxygen) 

    • Mental health services 

    • Some medications, like IV drugs given in an outpatient setting

    Cost:

    • Monthly premium (standard is around $174.70 in 2024, but it varies based on income) 

    • Annual Deductible and 20% coinsurance on most services 

    What caregivers should watch for:

    • Enrolling on time is crucial to avoid late penalties. 

    • Many essential health services fall under Part B, so it’s often just as important as Part A.

  • What it is:

    • An alternative to Original Medicare (Parts A & B), offered by private insurance companies. 

    • Often includes Part D (prescription drugs) and sometimes extra benefits like dental, vision, or hearing. 

    Cost:

    • You still pay your Part B premium, plus possibly an extra premium for the Advantage plan. 

    • Some plans have no monthly premium

    • Out-of-pocket costs vary based on plan details. 

    What caregivers should watch for:

    • Network restrictions – many plans are HMOs , so provider choice may be limited. 

    • Plans change annually, so review coverage during Open Enrollment (Generaly Oct-Dec each year) 

    • May offer more convenience and extras, but with less flexibility.

  • What it covers:

    • Prescription drugs (varies by plan) 

    Cost:

    • Monthly premium

    • Deductible, copayments now capped at $2000/year

    What caregivers should watch for:

    • Make sure necessary medications are covered under the plan's formulary. 

    • Switching plans annually may save money—drug costs and coverage can change each year.

    • Enrollment Periods Matter – Missing them can mean penalties or coverage gaps. 

    • Extra Help Program – Low-income beneficiaries may qualify for help with Part D costs. 

    • Medigap (Supplemental Insurance) – Helps cover costs not paid by Parts A & B (if not in Medicare Advantage). 

    • Keep records – Know your loved one’s Medicare number, plan details, and provider contact info.