What Medicare Covers: A Caregiver’s Guide


Are you responsible for caring for an aging loved one? As your parents, grandparents, relatives or friends face tough health care decisions and fight various ailments and diseases, they may need your help. Whether it’s providing encouragement, advice or physical assistance, being a caregiver is no easy task. Whatever your role looks like, you will need to be aware of the ways that health care and health insurance can meet their needs.

For an individual facing numerous health issues, understanding what insurance will and will not cover can seem like a job itself. As a caregiver for someone over the age of 65, you will likely have many questions about Medicare. These helpful steps will guide you through what to know about health coverage and what Medicare covers so you can provide the best care possible.

STEP 1: Know the type of health plan

Knowing the details of your loved one’s plan is important because the difference in the plan types can be complicated. Even if your loved one isn’t yet enrolled in Medicare, learning the different parts will help you understand what Medicare covers when the time comes for them to enroll. If you have more than Original Medicare, such as a Medicare Supplement plan, be sure to know what that plan is made up of as well.

STEP 2: Know who to ask

Remember that Medicare coverage is based on three main factors: federal and state laws, national coverage decisions, and local coverage decisions. Once you know what your plan is, you need to know who to talk to if something unexpected comes up or if you need clarification for a coverage question. Perhaps your loved one needs an appointment with a specialist and you aren’t sure if it’s covered by your plan. The best person to take questions to is your doctor or health provider. They can speak to their services and what Medicare will and will not cover.

STEP 3: Know what the parts of Medicare cover

If you know the type of Medicare plan, you will start to learn which services are covered and which are not. You can also determine if your loved one has the right plan for their care needs or if they need to choose another option during the next enrollment period.

Original Medicare covers:
• Hospital Care
• Skilled nursing facility care
• Nursing home care
• Hospice
• Home health services
• Clinical research
• Ambulance services
• Durable medical equipment
• Mental health (inpatient, outpatient, partial hospitalization)
• Getting a second opinion before surgery
• Limited outpatient prescription drugs

Medicare Advantage
• Medicare Advantage is an alternative to Original Medicare, but provides the same coverage as Original Medicare plus it can also cover extra benefits like routine vision and dental, health wellness programs and prescription drugs.

Medicare Supplement
• The coverage that Mutual of Omaha’s Medicare Supplement plans provide depends on what type of plan you have. It’s designed to fill in the gaps that Original Medicare leaves behind by covering things like copayments, coinsurance and deductibles.

STEP 4: Take care of yourself

It’s easy to get caught up in the responsibilities of caring for someone else. Between learning information on health conditions and physically taking care of your loved one, being a caregiver can be exhausting. However, the only way you’ll be able to provide excellent care for someone else is by taking excellent care of yourself.

Perhaps you make arrangements to take a day off, maybe even a week off. Along with the occasional vacation, make sure you take time throughout the day for yourself. Make your lunch time a priority, so you’re eating well to keep your strength. Take time to exercise. Pause for a moment just to breathe. Define clear boundaries in your role as a caregiver. Decide which tasks you’ll be able to do and where you may need help from a professional. Setting limits can allow you to say no without feeling guilty and keep you at your best to be able to care for someone else. These steps toward your own wellness will allow you to be the best caregiver possible for your loved one.

In your important role as a caregiver, make sure you know your loved one’s plan type, who to ask when questions arise, and what Medicare actually covers, but don’t forget to care for yourself. Although being a caregiver is no simple feat, by having this knowledge you’ll be prepared with the right tools. Just as you know your loved one and know their needs, knowing what Medicare covers will allow you to provide the best care possible.

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