If you are a caregiver for someone who has Medicare, understanding this program and their healthcare options could make your life a lot easier. We’re here to help.
What is Medicare? An Overview for Caregivers
Medicare is a federal health insurance program for people 65 and older or younger than 65 with Social Security Disability. It is managed by the Centers for Medicare & Medicaid Services (CMS).
Types of Medicare Coverage
Original Medicare: consists of Part A (hospital coverage) and Part B (medical coverage). Part A is usually premium-free and Part B always has a premium. Most people pay 20% on covered services once they’ve met their deductible.
Medicare Advantage (Part C): plans offered by private insurance companies that are contracted with CMS. These plans include Part A and B coverage as well as usually offering vision, dental, and hearing benefits. Some Medicare Advantage plans called MAPDs also offer prescription drug coverage. MA premiums start at $0. There are a few different types of Medicare Advantage plans, including HMO, PPO and PFFS. You can find a comparison of HMO vs. PPO, the two most common plan types on our site as well.
Special Needs Plans: subset of Medicare Advantage plans that is only available to people in certain categories. Special Needs Plans can be for Dual Eligible, Chronic Conditions or Institutional.
Prescription Drug Coverage (Part D): stand-alone private plans that offer only prescription drug coverage. Cost assistance may be available through Extra Help.
Medicare Supplement (Medigap): private plans that help cover the 20% coinsurance required in Original Medicare. These plans require medical underwriting if you do not enroll during your Initial Enrollment Period; not all applicants who go through underwriting will be accepted.
Initial Enrollment Period (IEP): The Initial Enrollment Period begins 3 months before the beneficiary’s birthday month when they are turning 65. It includes the birthday month and continues for 3 months after, for 7 months total. During this time, beneficiaries can enroll in Medicare Parts A and B, a Medicare Advantage Plan, a Medicare Supplement plan, or a Part D plan. Beneficiaries can be charged late fees if they do not have Part B coverage or prescription drug coverage after their IEP.
Annual Enrollment Period (AEP): This period occurs every year from October 15 – December 7. During this time, beneficiaries can change their Medicare coverage for the following year by enrolling in a Medicare Advantage Plan, swapping MA plans, or dropping Medicare Advantage and enrolling in a Part D plan. Coverage is effective January 1.
Open Enrollment Period (OEP): From January 1 – March 31 each year, Medicare Advantage beneficiaries may change their Medicare Advantage plan only once, either to enroll in another Medicare Advantage Plan or to return to Original Medicare with the option to enroll in a stand-alone Part D Prescription Drug Plan.
Special Enrollment Periods (SEP): Throughout the year, a beneficiary can be eligible for a Special Enrollment Period if they meet the SEP criteria. Common special circumstances include moving to a new state, leaving employer coverage, moving in or out of an institution, or having Medicaid (low-income subsidy).
General Enrollment Period (GEP): If a beneficiary does not enroll in Medicare Part B during their Initial Enrollment Period, they can do so during the General Enrollment Period from January 1 – March 31. Coverage is effective July 1.
Caregiver Through Medicare: Medicare Benefits That Support Caregivers
Original Medicare (Parts A and B) offers specific and limited Medicare caregiver coverage. The benefits offered with Medicare Advantage Plans can change each year, sometimes in big ways. In the past few years, Medicare Advantage plans have been able to add new benefits, many of them for increased home care support. Some of those benefits include caregiver support, in-home health services, meal delivery, adult day center membership, transportation, home safety modifications, and more.
Reviewing Medicare Caregiver Options
A licensed insurance agent can help your Medicare beneficiary review the Medicare plans in their area. During that consultation, the agent can help find specific benefits, compare costs, ensure that doctors are in network, and check prescription drug coverage. You may be able to participate in the consultation or enrollment if your beneficiary gives permission or if you hold Power of Attorney.
Because plans change each year, the Medicare plan your beneficiary has been enrolled in may not still be the right plan for their needs and situation.
Medicare Made Easy: 6 Part Series
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Last Updated: November 1, 2022 MULTIPLAN_ETQEZMwebsite_0722_M