As a case manager for many years, I have had to stay current on insurance and all it provides to my patients. As a proactive caregiver advocate, insurance knowledge is still very much required as I help families navigate the community side of caring for loved ones. Many caregivers do not understand their loved ones’ health insurance coverage. Medicare insurance (both original and Medicare Advantage), the coverage that most elderly carry has benefits that should be utilized when needed. Education is necessary to provide the best care for your loved one.
Parts of Medicare Coverage
Medicare has three parts that caregivers should know and understand.
Part A is considered the in-patient hospital side of the insurance. This section also covers skilled nursing facility(SNF) care. Skilled nursing care is given to loved ones who need licensed and trained professionals to treat, manage, and evaluate their care daily until they have recovered enough to return home or to another living environment. Our loved ones can use home care and hospice benefits under Part A.
Part B covers doctor visits, outpatient services, behavioral therapy, home care, medical equipment (like wheelchairs, walkers, hospital beds, oxygen, and other respiratory needs), and preventive services. Screenings, shots or vaccines, and annual physicals(wellness checks) are also covered. New: Medicare now covers training(20% of the Medicare-approved amount) that helps caregivers learn and develop skills to care for aging loved ones. Advance care planning is covered under your annual “Wellness” benefit, and you pay nothing.
Sidebar: It’s time to make sure your COVID-19, Flu, and pneumonia shots are up to date.
Part C is known as the Medicare Advantage plan, approved by a private insurance company. They bundle benefits from Part A, Part B, and Part D. The plan is network and doctor-specific, and approval for services is often required.
Part D covers the cost of prescriptions, drugs, injections, and vaccines. For prescription coverage, note that Medicare follows the rules of most private insurance companies. Drug costs, as well as premiums, deductibles, co-payments, or coinsurance, vary yearly. New: In 2025, out-of-pocket drug costs will be capped at $2000. New: Extra Help Program- Extra Help is a Medicare program that helps with Medicare drug coverage (Part D) costs. Some are automatically eligible, while others need to apply. It is based on income and resources. Medicare has savings programs available. Medicare.gov is the place to seek further information on prescription plans.
As Your Proactive Caregiver Advocate, knowledge is key! Insurance plans can be confusing. Explore your loved one’s coverage. Open enrollment season is coming soon. This will be the time to evaluate the current health insurance plan for the following calendar year. Be Safe! Be Well!
Dr. Cynthia J. Hickman is a retired registered nurse and case manager, CEO of Your Proactive Caregiver Advocate. She has released her newest book, The Essential Caregiver Training Course for Corporations and Community. From the Lens of Daughter, Nurse, and Caregiver: A Journey of Duty and Honor, and The Black Book of Important Information for Caregivers.