Caring for an aging relative can be a rewarding experience. Still, it can raise many questions, especially regarding their healthcare needs and financial security. Medicare, a government health insurance program for Americans 65 and older, covers these costs for millions. Continue reading for vital information on eligibility and how to apply for these life-saving benefits.
Medicare is a federal health insurance program that provides coverage for essential healthcare services. It has four parts, each covering different services. Part A covers inpatient hospital stays, skilled nursing care, hospice care, and home healthcare services under specific conditions.
This means that if your loved one needs any of these services, Medicare may be able to help cover the costs. Remember this information to make informed decisions about your loved ones' healthcare.
Medicare Part A is a component of Original Medicare. It primarily covers inpatient hospital care, skilled nursing facility care, hospice care, and limited home health services.
The following services are included under Medicare Part A:
Eligibility for Medicare Part A is generally determined by age, disability status, or specific medical conditions:
While Medicare Part A provides vital hospital insurance, there are various costs associated with it that beneficiaries should be aware of. Understanding these costs can help in budgeting and planning for healthcare expenses.
Most people do not pay a premium for Medicare Part A if they or their spouse have paid Medicare taxes while working for at least ten years (40 quarters). This is often referred to as "premium-free Part A." However, you can still purchase it if you do not qualify for premium-free Part A. In 2024, the standard Part A premium is up to $499 per month, depending on how many quarters you or your spouse worked and paid Medicare taxes.
Medicare Part A involves certain out-of-pocket costs, including deductibles and copayments. As of 2024, the Part A hospital inpatient deductible is $1,600 per benefit period. There are copayments for hospital stays: $0 for days 1-60, $400 per day for days 61-90, and $800 per each "lifetime reserve day" after day 90, up to a maximum of 60 lifetime reserve days. Skilled nursing facility stays also have copayments: $0 for the first 20 days and $200 per day for days 21-100.
If you do not sign up for Medicare Part A when you are first eligible and decide to enroll later, you may have to pay a late enrollment penalty. The penalty involves a higher premium of 10% more for twice the number of years you could have had Part A but didn't sign up. For example, if you were eligible for Part A for two years but didn't enroll, you would pay the higher premium for four years.
The Initial Enrollment Period (IEP) for Medicare Part A begins three months before your care recipient's 65th birthday month, includes their birthday month, and ends three months after their birthday month, lasting seven months. This is the first opportunity to enroll in Medicare Part A without penalty.
If your care recipient missed their Initial Enrollment Period, they can enroll during the General Enrollment Period (GEP), which runs from January 1st to March 31st each year. Coverage for those who enroll during the GEP will begin on July 1st of the same year.
The Open Enrollment Period (OEP), also known as the Annual Enrollment Period, runs from October 15th to December 7th each year. During this time, beneficiaries can change their Medicare coverage, including switching from Original Medicare to a Medicare Advantage plan or vice versa and adding or dropping Medicare Part D (prescription drug coverage). Changes made during the OEP take effect on January 1st of the following year.
If your care recipient experiences certain life events outside the standard enrollment periods, they may qualify for a Special Enrollment Period (SEP). Events that can trigger a SEP include:
During a SEP, beneficiaries can enroll in or change their Medicare coverage. It is important to speak with a local Office of the Aging or a case manager to understand how these changes might affect your family's overall coverage and get assistance with enrollment.
While Medicare Part A provides essential hospital insurance, there are several services and items it does not cover, including the following:
To address the gaps in Medicare Part A coverage, beneficiaries can explore additional coverage options that provide more comprehensive protection against healthcare costs.
Medicare Part B covers medically necessary services and preventive care, including doctor visits, outpatient care, home health services, durable medical equipment, screenings, and vaccines.
Part B complements Medicare Part A by covering many services that Part A does not, such as outpatient care and doctors' services. Enrollment in Medicare Part B typically requires a monthly premium and involves deductibles and coinsurance.
Medicare Supplement Insurance, also known as Medigap, helps pay for some out-of-pocket costs not covered by Original Medicare (Parts A and B), such as copayments, coinsurance, and deductibles.
Medigap policies are sold by private insurance companies and are standardized to offer the same basic benefits, though some plans may provide additional benefits.
Different Medigap plans are available, each labeled with a letter (e.g., Plan G, Plan N), and they can significantly reduce beneficiaries' out-of-pocket expenses.
Medigap plans do not cover prescription drugs so that beneficiaries may need Medicare Part D for comprehensive drug coverage.
As a family caregiver, you play an essential role in advocating for your loved one's healthcare needs. Make informed decisions and give your relative the appropriate medical care with Medicare Part A. Help your loved one get the best healthcare possible.
