Understanding Medicare: A Caregiver's Quick Guide

Navigating Medicare is one of the most confusing aspects of caregiving. This guide breaks down the basics so you can help your loved one make informed healthcare decisions.

The Four Parts of Medicare

Part A: Hospital Insurance **What it covers:** - Inpatient hospital stays - Skilled nursing facility care (limited) - Hospice care - Some home health care

Cost: Usually premium-free if you/spouse paid Medicare taxes for 10+ years

Part B: Medical Insurance **What it covers:** - Doctor visits - Outpatient care - Preventive services - Durable medical equipment - Some home health care

Cost: Monthly premium (starts at ~$174.70 in 2026, income-based)

Part C: Medicare Advantage **What it is:** Private insurance alternative that combines Parts A and B, often with additional benefits

Pros: Often includes dental, vision, hearing; may have lower out-of-pocket costs Cons: Limited provider networks; may need referrals

Part D: Prescription Drug Coverage **What it covers:** Prescription medications

Important: Each plan has a "formulary" (list of covered drugs). Check that your medications are covered before enrolling.

What Medicare DOESN'T Cover

This surprises many families: - Long-term care (nursing home stays beyond 100 days) - Dental care (routine) - Vision exams and glasses - Hearing aids - Most overseas healthcare

Key Enrollment Periods

Initial Enrollment Period (IEP) 3 months before + birthday month + 3 months after turning 65

Annual Enrollment Period (AEP) October 15 - December 7 each year

Special Enrollment Periods Triggered by qualifying events (moving, losing employer coverage, etc.)

Common Pitfalls to Avoid

1. Missing Enrollment Deadlines Late enrollment can mean permanent penalties and coverage gaps.

2. Assuming Medicare Covers Everything Plan for out-of-pocket costs and consider supplemental insurance (Medigap).

3. Not Reviewing Coverage Annually Plans change. Review during AEP to ensure coverage still meets needs.

4. Ignoring the Donut Hole Part D has a coverage gap. Understand how it affects medication costs.

Resources

• Medicare.gov - Official resource, plan finder
• SHIP - Free counseling in every state
• Social Security - Enrollment and eligibility questions

What Caregivers Should Know

Healthcare Proxy Ensure you're authorized to discuss Medicare matters on behalf of your loved one.

Keep Records Maintain copies of Medicare cards, plan documents, and correspondence.

Track Costs Monitor out-of-pocket expenses to plan for supplemental coverage needs.

*CareConnect's upcoming insurance tracking feature will help you stay organized and never miss an important deadline.*