Medicare is a social Government run insurance program for people over 65 and younger people with disabilities. A large section of family caregivers are caring for elderly loved ones on Medicare. In addition, the caregivers themselves may be approaching the age where they will use Medicare for their own medical needs.
This post provides an overview of Medicare basics along with key resources families can use to increase services and lower costs.
Medicare is broken into four parts:
1. Part A: The Hospital Visit
Part A covers the majority of the expenses (often 80%) for a visit to a hospital. For example, if your loved one suffers a fall, the inpatient hospital stay, room costs for up to 60 days, tests in the hospital and food will be covered by Part A. Hospice benefits for palliative care for those in the end stages of life are also covered under Part A.
2. Part B: Tests And Recovery
Part B generally focuses on outpatient services (services delivered outside of a hospital stay). Part B centers on tests like an MRI, x-ray, blood tests and other evaluations made during outpatient stays. Part B is optional coverage.
3. Part D: Medicine
Part D covers prescription drugs and medicine. Those who enroll must choose a specific Part D prescription drug plan. The plan will dictate what portion of prescription drugs are covered by Medicare and what portion must be covered by the patient.
4. Part C: Private Insurance Program
The reason Part C is listed last is that it is an alternate plan to get Part A and Part B coverage. Part C is run by private insurance companies and is often referred to as Medicare Advantage.
A good resource for a more detailed look at the details of Medicare can be found at AARP’s “A Boomer’s Guide To Medicare”.
Each family has unique health challenges that require specific services. However there are a common set of resources that can help many families no matter the situation.
Below are some of the top resources to answer your Medicare questions:
- Medicare General Number – 800-633-4227 – I highly recommend insisting on speaking to the expert in the office you reach. The skill level of employees in Medicare is varied. Find a good person.
- State Health Insurance Assistance Programs (SHIP) – Find a counselor in your state. The service is free and you can work with someone one on one. Get answers about costs and coverage. Get assistance in choosing a plan.
- Medicare Rights Center – 800-333-4114 – You can also work directly one on one with a counselor. The services are available not only to the insured but to family members and caregivers as well.
Specific resources are also available that target lowering medical costs for the elderly.
- AARP Benefits Quick Link – Tailored list of programs to lower costs. Programs can be filtered by state. You can also apply for programs directly on the website.
- PACE – Helps the elderly receive care at home. PACE note available in all states.
- Medicare Savings Program – Targeted at low income or disabled individuals.
- State Pharmaceutical Assistance Programs – State specific programs to help with costs.
- Medicaid – Medical coverage for individuals with low income.
Dealing With Medical Bills
Medicare covers a large portion of medical costs. However, like private insurance, the individual needs to cover a section of the costs as well.
The process of working through medical bills can be exhausting. After an emotionally draining day caring for a loved one the last thing many people want to turn to is bills.
I want to give you some clear tips on how to navigate this stage of the process. You will feel more in control after adopting them.
Below are the best practices for navigating the maze that is medical bills:
1. Go To Locations / Doctors That Accept Medicare – Not all doctors do. It can be challenging to take the time to call in advance. A good way to cut down on this administration is to find principal doctors (e.g., G.P., Geriatrician) who accept Medicare. Continue to go back to them.
2. Don’t Immediately Pay Bills – Wait. There can be errors in the bill. You may have been charged too much. You can often wait several months to pay medical bills before real penalties come into play.
3. Negotiate Bills – Most people don’t know this but all medical bills are negotiable. Insurance companies charge different rates for the exact same procedure depending upon many factors (e.g., the state in which it was done, the amount the patient pays for).
A good negotiation script is:
“Hi my name is (name). I am calling about the bill for (name of loved one). We have been loyal customers of (name of insurance company) for (number of years) and paid premiums on time.
We currently are facing a set of multiple medical expenses. I wanted to see based upon our history as a good customer what you can do to help us lower the cost of this bill.”
You’ll be surprised how often the representative will try and lower the bill. A professional cordial question will often push the conversation in the right direction.
The Importance Of Self-Care
After a long day dealing with medical bills or multiple hours helping a loved one self-care is really important. Self-care is a path to giving more to others.
If you take care of yourself you will be more able to care for others.
Some great self-care approaches include:
- Cognitive Therapy – It can be enormously helpful to speak one on one with someone about how you are doing. They can be a guide to help you navigate challenging times.
- Yoga / Running / Working Out / Etc. – Investing in an activity where you connect with your body can be invaluable. There’s a powerful connection between mind and body.
- Spiritual Practice – Going to your local religious services, prayer, community support groups are all excellent ways to connect with your spiritual side.
- Support Groups – Many support groups exist for multiple issues (e.g., illness, addiction). Seeing the pain you experience in someone else can be a powerful and healing process.
- Passions / Hobbies – Take the time to invest in your hobbies. Take an hour and do something that makes you happy.
One final piece of advice is to set up a ritual. Make a weekly practice.
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May 14, 2015
By: JP Adams