Understanding Medicare: A Guide for Caregivers

If you provide long-term care to someone on Medicare, it can be helpful for you to understand their health insurance coverage and how it works.

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Most Medicare beneficiaries have the option to enroll in one of the following programs:

1. Original Medicare

Original Medicare is administered by the federal government and is made up of two parts: Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance).

Medicare Part A

Some examples of the types of services covered under Medicare Part A include:

  • Hospital care
  • Skilled nursing facility care
  • Hospice
  • Limited home health services

Note: Medicare Part A does not cover long-term home health services. Some limited home health services that are sometimes covered by Medicare Part A include: 

  • Part time or intermittent skilled nursing care
  • Physical therapy
  • Medical social services
  • Speech-language pathology services
  • Part time or intermittent home health aide care

Medicare beneficiaries must meet certain qualifications to be eligible for the home health services listed above.

For example, they must be getting services under a plan of care created and reviewed regularly by a doctor, and a doctor must certify that they need one or more of the following:

  • Intermittent skilled nursing care
  • Physical therapy, speech-language pathology, or continued occupational therapy services

Medicare Part B

Some examples of the types of services covered under Medicare Part B include:

  • Doctor’s visits
  • Ambulance services
  • Preventive services
  • Durable medical equipment
  • Mental health (inpatient and outpatient)

2. Medicare Advantage (Medicare Part C)

Medicare Advantage plans (Medicare Part C) are sold by private insurers as an alternative to Original Medicare. Every Medicare Advantage plan must provide the same hospital and medical benefits as Medicare Part A and Part B, and most cover prescription drugs, which are not covered under Original Medicare.

Some Medicare Advantage plans also offer additional benefits such as coverage for routine dental and vision care.

If you are a caregiver to someone who has Medicare Advantage, you should know that they may be limited to a specific provider network and may be required to get a referral from their primary care physician before seeing a specialist.

Additionally, they will use their Medicare Advantage card (rather than their red, white and blue card) when they visit the doctor or hospital.

Medicare Prescription Drug Plans

Medicare Prescription Drug Plans (Medicare Part D) help cover some prescription drug costs for people enrolled in Original Medicare. Medicare Part D plans may also be available to people enrolled in Medicare Advantage plans that don’t include prescription drug coverage (most do).

Helpful Tips for Caregivers

Caregiver burnout is a common psychological condition among people who provide long-term care to someone else. Some symptoms of caregiver burnout include:

  • Feeling hopeless, anxious, depressed or irritable
  • Withdrawal from social situations and loved ones
  • Changes in appetite
  • Loss of interest in hobbies and activities
  • Alcohol and substance abuse
  • Changes in sleep patterns
  • Thoughts of suicide
  • Thoughts of hurting your loved one 

Caregiver burnout sometimes happens as a result of a caregiver neglecting his or her own needs. If you think you’re experiencing caregiver burnout, the following tips may help.

1. Ask for help

Even if you haven’t experienced the effects of caregiver burnout, it is important to take time off from caregiving now and then. If possible, ask for help from friends and family and accept help when it’s offered.

2. Practice self care

To effectively care for someone else, you must first care for yourself. Be sure to get plenty of sleep, eat right and get some exercise to avoid burnout.

3. Confide in a friend or get help from a professional

If you’re experiencing caregiver burnout, the way you’re feeling is normal and not something to be ashamed of. Talking to someone can help you deal with your emotions in healthy ways, which can benefit you and the person you’re caring for. 

We’ll Help Answer Your Medicare Questions

You have enough on your plate — let us help! Our licensed insurance agents can help answer any questions you or your loved one have about Medicare Advantage plans. Speak with a licensed insurance agent now at TTY Users: 711.

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MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts; enrollment in any plan depends upon contract renewal.

Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.

Medicare has neither reviewed nor endorsed this information.