Caregiving Guide

What Caregivers Need to Know About Medicare & Medicaid

Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD). Keep in mind Medicare does not pay for long-term care (assisted living, long-term skilled nursing care). Medicare will pay for hospice care.

The different parts of Medicare help cover specific services including:

Medicare Part A (Hospital Insurance)
Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.

Medicare Part B (Medical Insurance)
Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services.

Medicare Part C (Medicare Advantage Plans)
A Medicare Advantage Plan is a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. If you're enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan and aren't paid for under Original Medicare. Most Medicare Advantage Plans offer prescription drug coverage.

Medicare Part D (Prescription Drug Coverage)
Part D adds prescription drug coverage to Original Medicare. These plans are offered by insurance companies and other private companies approved by Medicare. Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans.

Medicare Supplemental Insurance (Medigap)
A Medicare Supplement Insurance (Medigap) policy, sold by private companies, can help pay some of the health care costs that Original Medicare doesn't cover, like copayments, coinsurance, and deductibles. A Medigap policy only supplements your Original Medicare benefits.

Some Medigap policies also offer coverage for services that Original Medicare doesn't cover, like medical care when you travel outside the U.S. If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Then your Medigap policy pays its share.

If you have questions about Medicare, your Medicare rights, and / or would like to access local assistance, the following resources will be helpful:

Medicare
Website: www.medicare.gov
Call: 1-800-633- 4227 or 1-800-MEDICARE

Medicare Rights Center
Call: 1-800-333-4114 (Monday through Friday)

Senior Health Insurance Program (SHIP)
SHIP is a free health benefits counseling service for Medicare beneficiaries and their families or caregivers. SHIP's mission is to educate, advocate, counsel and empower people to make informed healthcare benefit decisions. SHIP is an independent program funded by Federal agencies and is not affiliated with the insurance industry.

To find local resources, visit the SHIP website.

Medicaid is a joint federal and state program that helps with medical costs for people of all ages with limited income and resources, including doctor visits and medications. Medicaid varies by state and also covers services not typically paid for by Medicare, like nursing home care, some assisted living, adult day services, home modifications, in-home care and personal care services. Many of the long-term services and supports covered by Medicaid for people with low income help them live and age in the setting of their choice. Medicaid is administered by individual states, with oversight and collaboration from the federal government.

In some states, through Medicaid self-directed funding or other state-run programs, family caregivers may be paid to provide care to loved ones.

To find out if you qualify for Medicaid in your state, apply at Healthcare.gov.

Next Step: Legal and Financial Planning Resources

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