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5 Things You Need to Know About Medicare

By Carol White, 9:00 am on January 25, 2016

Signing up for Medicare can be confusing, which is why seniors and their families should know as much about the coverage as possible. Here are just a few of the basic aspects of the program you and your loved one should make sure to learn and understand.

1. The 4 Parts of the Program

Part A covers qualifying hospital or nursing home stays your loved one has, in addition to approved Prescott home care services or hospice care. Part B covers the costs of your loved one’s medical services, such as doctor visits, as well as some in-home care services, preventative services, outpatient care expenses, and medical equipment costs. Part C consists of similar benefits to Part A and Part B, but also includes additional dental and vision coverage. Part D includes prescription drug coverage, which will be essential to your loved one as he or she ages.

2. The Enrollment Period

Your loved one is eligible to enroll in Medicare at the age of 65. However, he or she will be automatically enrolled if he or she is receiving social security benefits. Your loved one’s enrollment period falls between the 3 months prior to his or her 65th birthday and the 3 months after. Failing to sign up could lead to late penalties and fees. If your loved one misses the initial enrollment period, he or she can enroll between January 1st and March 31st, which is the general enrollment period.

3. The Ways Primary and Secondary Coverage Works

There are instances when Medicare may not pay your loved one’s health care expenses due to other coverage he or she has. Typically, Medicare is the primary insurer for many small companies, but larger employers sometimes list Medicare as the secondary insurer. If your loved one has group insurance through his or her employer, Medicare will be the secondary insurer unless the employer has less than 20 employees. If this is the case, Medicare will not pay your loved one’s claim unless he or she is enrolled in Part B coverage.

4. The Additional Benefits

Due to the Affordable Care Act, your loved one has access to more services to help him or her stay up to date on personal health. Some of the additional benefits include free annual wellness visits and preventative health benefits. Keep in mind the annual wellness visits are not physicals. These visits help doctors create a customized health plan your loved one can benefit from. Preventative benefits will vary from state to state. For example, some states will waive the costs of colorectal cancer screenings and mammograms.

5. The Costs and Other Expenses

Your loved one will be required to pay a deductible for Medicare each year. Even after the predetermined deductible has been paid, he or she may need to pay a coinsurance fee for doctor and hospital visits. Depending on the type of coverage your loved one has, he or she may need to pay a monthly fee. For example, Part A does not require a monthly fee for individuals who have worked for at least 10 years in the U.S. However, Part B does.

Though Medicare is a great help for seniors, the program does not cover every important need. To learn about solutions that can help pay for in-home care services, turn to Home Care Assistance. We offer both part-time and live-in caregivers who are available 24/7 to assist with a wide variety of daily tasks. We also offer comprehensive stroke, dementia, and Alzheimer’s care Prescott seniors can rely on. For more information on our senior care services and to schedule a complimentary consultation, call 928-771-0105 today.