Updated: Nov 11, 2020
If you are like me, regardless of age, then many other words come to mind when someone mentions Medicare. Mainly words like retirement, older, government insurance, not required yet, too young to consider, and even - it can wait. Yet for the growing number of Millennial and Sandwich generation caregivers, this topic can't wait. Why? Well if you had a chance to listen to my previous podcast with attorney Virginia Samson, as we discuss Caregiver C
ompliance then you know your loved one will need a designated person to speak on their behalf to help them establish or maintain their Medicare coverage. In that respect, you will need to know more about Medicare sooner than you probably planned on.
Even though I am not of age yet, like many others, my age and younger, this is yet another side of caregiving which can seem overwhelming with SO MANY details.
Meet Joe & Monique Barajas, co-owners of Barajas Insurance Group. Both are licensed agents who live and breathe the ins and outs of Medicare and train new agents as well to do the same. Today's podcast is a BIG deal, pun intended, so I wanted two experts instead of one, to help me dig into the details within Medicare. So find a comfy spot, maybe grab a pen and paper because you’re going to want to take more than mental notes during this Medicare part 1 episode.
>What is Medicare?
Well, it began back in 1966 under the Social Security Administration and is now administered by the Centers for Medicare and Medicaid Services. It is a broad program of health insurance designed to assist the nation's elderly to meet hospital (emergencies and surgeries), medical (doctors and treatments), and other health costs (services and medicines). Medicare is available to most individuals 65 years of age and older, along with younger people with disabilities.
What is the difference between Medicare and Medicaid?
Medicare is a federal insurance program that pays medical bills from a trust fund paid into by the working public. It serves people over 65 primarily, younger disabled people, and dialysis patients. Medicare is basically the same everywhere in the United States. With Original Medicare, you can go to any doctor or facility that accepts Medicare.
Medicaid is an assistance program. It serves low-income people of every age. Patients usually pay no part of the costs for covered medical expenses; however, it varies from state to state. Medicaid is different because it is run by state and local governments within federal guidelines. For this reason, Medicaid will vary from state to state.
>What is Medicare Part A and B?
Part A is also considered "hospital insurance." Part A also covers skilled nursing facilities and home health care. Most Americans who worked in the U.S. already paid for it through their payroll taxes over 40 quarters or 10 years, so you do not have to pay for Part A premium. If you never worked, you may still qualify for premium-free Medicare Part A, if married, through your spouse's work history or based on certain medical conditions.
Part B, also referred to as the "medical insurance" is paid for through monthly premiums. Part B covers the medically necessary services to treat illnesses which include doctor office visits, lab work, x-rays, and outpatient surgeries. It also covers preventative services such as cancer screenings or flu shots.
>What is a Medicare Advantage Plan?
Medicare Advantage is also referred to as Medicare Part C. It is an alternative to Medicare and not a replacement for Medicare. Medicare Advantage plan is more so the "all-in-one" plan that bundles Medicare Part A, Part B, and commonly Part D (prescription drugs). The cost and plan will vary because Medicare advantage plans are offered by private companies that have been Medicare-approved. Many of these plans also offer benefits like dental, hearing, and vision that are not covered by Original Medicare.
Having Medicare does not mean everything is covered though. This is where supplemental coverage comes in to help with the cost of dental care, eye exams, hearing aids, acupuncture, and any cosmetic surgeries. Medicare does not cover long-term care expenses which many find out when they need it most. This is where some of the confusion comes in because many pass on purchasing Long-term Insurance with a false understanding they don't need it if they have Medicare or can qualify for Medicaid, but that is not true.
If you are caring for a loved one with a disability or meet the age requirements and struggle financially then it is beneficial to spend the time with an agent like Joe and Monique Barajas to find out what you may qualify for or update the current coverage you have if need be. When Mom needed additional help through Home Health services for occupational therapy it was such a relief to know her appointments would be covered through her chosen coverage rather than having one more out-of-pocket expense.
>Will Medicare or Medicare Advantage cover Respite Care needs?
Although Long-term care is not covered through Medicare it does cover Respite care through a hospice benefit for your loved one under Part A. Respite care allows the caregiver rest while their loved one temporarily stays in a hospital or other facility under the hospice benefit. Medicare's hospice benefit offers end-of-life palliative treatment, including support for your physical, emotional, and other needs. Hospice is to help your loved one live comfortably, not cure them while providing you with a break. Your loved one must be enrolled in Medicare Part A.
The details are vast and approaching them in crisis mode can be overwhelming. It is better to know what it is, what it is not, and how it can help you to proactively plan ahead for your loved one. You don't have to wait until they are 64 before you begin to figure out the system. As a child taking care of an aging parent you might have to get into the details long before they are of age to help them decide on the type of insurance and coverages are needed year after year
You can listen to this episode by clicking the Podcast tab above.
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Intro: Vacation Time by Khris Paradise
Outro: Misty by Khris Paradise