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Caregivers guide to Medicare

Mark Vallet | July 25, 2011

According to a 2009 report by the National Alliance for Caregiving, 29 percent of the U.S. population is providing care for a chronically ill, disabled or aged family member. These caregivers spend an average of 20 hours per week caring for loved ones. While the majority of caregivers look after aging parents, caregivers also look after family friends and neighbors.

Caregiving requires you to make many decisions about the health care of another. Understanding the choices offered by Medicare, including Medicare Advantage and Medigap, can help you make the best decision for your parent or loved one.

If you are in a caretaking role, it's likely that you'll have to talk to your aging loved one about health care and health insurance--and in some cases you may be the decision-maker. For the elder in your life, a conversation about health insurance will probably be about Medicare.

Original Medicare

Original Medicare is made up of Medicare Parts A and B. Beneficiaries can go to any health care provider or hospital that accepts Medicare. Additionally, coverage is provided by Medicare, as opposed to a private health insurance company.

Medicare Part A is hospital insurance and provides some coverage for inpatient care at a hospital, hospice, skilled nursing facility, as well as home health care. Generally, Medicare beneficiaries do not have to pay a premium for Medicare Part A.

Medicare Part B, on the other hand, is medical coverage that requires a monthly premium. It covers, in part, doctor's visits, home health care, certain preventive services and outpatient care.

If prescription drug coverage is needed, Medicare Part D plans are available as well. Keep in mind that this coverage is separate from Medicare Parts A and B.

Medicare supplemental health insurance or Medigap

Medigap policies are written and sold by private insurance companies. These plans supplement Original Medicare coverage to pay some of the out-of-pocket costs. Many Medigap plans cover co-payments, coinsurance or deductibles. Certain plans offer additional coverage, such as hospital expenses for up to a year after your Medicare benefit is used up, foreign travel emergencies and at-home recovery.

Insurance companies are only allowed to sell standardized Medigap supplemental health insurance policies. These policies are assigned a letter A through N, and all standardized policies with the same letter must offer the same benefits.

For example, Medigap Plan A in New York offers the same benefits as Medigap Plan A in California. The difference between standardized supplemental health insurance plans is the price.

Medicare Advantage

Medicare Part C, or Medicare Advantage, expands coverage and choices available to Medicare beneficiaries. These private health insurance companies contract with the federal government. Each state has numerous plans, each with its own individual options, such as an HMO or PPO structure, deductibles and co-pays.

Medicare Advantage plans are not standardized and prices vary depending on the insurance company and the type of policy you choose.

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