Dear Savvy Senior,
I’m taking care of my elderly father who recently had a stroke and have a lot of questions about how Medicare works and what it covers. He’s enrolled in original Medicare. Can you help me?
Caregiving Connie
Dear Connie,
Taking care of a parent after a stroke is hard enough without having to figure out Medicare too. The good news is that understanding the program can make life a lot easier. Knowing what’s covered – and what isn’t – can help you plan ahead, avoid costly surprises and make sure your father gets the care he needs. Here’s a practical guide to get you started.
Medicare basics
One of the best places to start is the official “Medicare & You” handbook. It explains benefits and services in plain language. Medicare mails an updated copy every fall, but you can also view it online at medicare.gov/medicare-and-you.
For questions, call Medicare at 800-633-4227 to speak with a representative. They can clarify coverage for doctor visits, hospital stays, home health care, and more.
Your state’s State Health Insurance Assistance Program (SHIP) is another great resource. SHIP counselors provide free, one-on-one counseling to help you understand your coverage, identify cost-saving programs, and answer questions about Medicare. Find a counselor near you at shiphelp.org or 877-839-2675.
Caregivers should also create a secure Medicare account at medicare.gov/account/login. Once your father’s account is set up, you can review his coverage, track claims, check the status of medical services and prescriptions, and see which preventive benefits he’s eligible for. It’s an easy way to stay organized and keep all of your father’s Medicare information in one place.
Choosing providers
Medicare also lets you compare providers online at medicare.gov/care-compare. You can search for doctors, hospitals, rehab centers, nursing homes, hospice providers, and medical equipment suppliers in your area. This is especially useful after a stroke, when your father may need rehabilitation or specialized care at home.
Covered services
Original Medicare covers many services your father may need, including hospital care, doctor visits, lab tests, and outpatient treatments.
It also covers home health care if your father is homebound, under a doctor’s care, and needs part-time skilled nursing or rehabilitation therapy, such as physical, occupational or speech therapy.
Medicare also covers medically necessary durable medical equipment and supplies prescribed by a doctor, including oxygen, wheelchairs, walkers and catheters. Short-term skilled nursing care in a facility may also be covered for up to 100 days after a qualifying hospital stay.
Prescription medications are generally covered through a separate Medicare Part D plan, which helps pay for many outpatient drugs your father may need.
Hospice care is covered for patients with a terminal illness and a life expectancy of six months or less, as certified by a doctor. It includes nursing care, medications for comfort and short-term respite care to give caregivers a break.
However, Medicare generally doesn’t pay for long-term custodial care at home, in an assisted living facility or in a nursing home. That means it generally won’t cover ongoing help with daily activities like bathing, dressing, eating, using the bathroom or supervision for someone with dementia. Routine dental care, dentures, eye exams for glasses and hearing aids are also not covered.
Cost help
If your father has limited income and resources, check programs that help reduce Medicare costs. Extra Help assists with prescription drug expenses, and Medicare Savings Programs can help pay premiums, deductibles, and coinsurance.
Visit medicare.gov/basics/costs/help or call 800-633-4227 to learn more or check eligibility.
Taking time to understand Medicare can make caregiving a little less stressful. It helps you stay on top of appointments, treatments and equipment needs, while giving you greater confidence that your father is receiving the care and benefits he’s entitled to.
Journalist and senior advocate Jim Miller is the creator of Savvy Senior, a weekly information column devoted to older adults that appears in more than 250 U.S. newspapers and magazines. He is also the author of The Savvy Senior: The Ultimate Guide to Health, Family and Finances for Senior Citizens (Hyperion) and is frequently featured in major media outlets, including Time, USA Today, The New York Times, CNBC and CNN.
