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Everything You Need to Know About Medicare Before Enrolling

As a caregiver advocate for your parent, there are a myriad of things you’ll need to figure out in order to navigate your caregiving journey with the least amount of mistakes possible. So, if you’re not yet enrolled in Medicare or you’re not familiar with the benefits and options within the program, this article will give you a better understanding of them. We’ll also explore the pros and cons of choosing one program over the other.

I’m not personally enrolled in Medicare, but can share my perspective as my mother’s caregiver. As a caregiver advocate, I’ve done my best to gather information and synthesize it into a helpful reference for others. I encourage you to review your parent’s personal needs and thoroughly research the resources provided in this article to make the best decision for your loved one’s situation.




Medicare Eligibility

You’re eligible for Original Medicare Parts A and B if you’re at least 65 years old or if you’re under 65 and qualify for Social Security disability benefits, end state renal disease or ALS. If you or your spouse have worked for at least ten years (40 quarters) and paid Medicare taxes, you will be eligible for premium-free Part A benefits. Otherwise, you may be able to purchase Part A benefits. Everyone must pay a monthly premium for Medicare Part B. However, if you have limited income, you may qualify for assistance with paying for Medicare premiums.

What is Original Medicare?

Original Medicare is a government program designed to provide continued health coverage, similar to what your parents received in health care benefits while they were working. Original Medicare provides a pay-per-service model that reimburses health care costs, generally at 80%. When a senior enrolls into Original Medicare, they receive both Part A and Part B (which will be further explained).

To receive Social Security benefits, you’ll need to sign up in-person or via phone at your Social Security Office or online at https://www.ssa.gov/benefits/medicare/.

If at age 65, your parent will receive Social Security benefits, they’ll be automatically enrolled into Medicare and will receive a card in the mail.

Medicare Part A

Medicare.gov breaks Medicare into different parts offering support for specific areas of coverage.

In general, Part A covers

· Inpatient care in a hospital

· Skilled nursing facility care

· Nursing home care (not long term)

· Hospice care

· Home health care

Your parent’s physician or health care provider will explain your parent’s specific needs and you can contact Medicare at 1-800-633-4227 with questions regarding coverage. You can also reach out to your supplemental insurance company for prior authorization. You can work directly with Medicare to cover part of the cost and your supplemental insurance may cover the difference. If not, the balance must be paid out of pocket.

Medicare Part B Service Coverage

There are two different types of services, medically necessary and preventative services.

Medically necessary services or supplies are needed to diagnose or treat your medical condition and meet accepted standards of medical practice.

Examples of preventative services are health care that prevents illness (like the flu) or detects it at an early stage when treatment is mostly likely to work best. Generally, you pay nothing for these services.

Other examples of what might be covered includes:

➢ Routine services from doctors and other health care providers