Care-Giver Support

Transitioning into being the Care-giver for an adult family member can be one of the most difficult transitions anyone has to make.  For some the transition is a gradual process and for others it comes as an abrupt and rude awaking.  We have helped dozens of families make a smooth transition into understanding Medicare and how supplement insurance works with it.  The biggest adjustment comes in understanding the terms used by Medicare and  in understanding how Medicare pays and works with a supplement.  This article will address some of these concerns.

A Medicare “policy-holder” is known as a beneficiary.  For most people Medicare is their primary insurance unless the beneficiary has group/ employer insurance.   Medicare covers about 80% of a health event while the beneficiary is responsible for the 20%.  This 20% can be covered by insurance, widely referred to as “medigap.”  Supplements fill the gap when someone has original Medicare and the other way to fill part of a gap is with a Medicare Advantage plan.

Most beneficiaries have Medicare Part A -that covers hospitals;  Part B -that covers doctors and doctor services, like DME (durable medical equipment) or outpatient services.  Together Medicare Part A and B are referred to as “Original Medicare.” The last piece of the Medicare pie is Part D for prescription medication.   Part A comes automatically to anyone who has worked in the USA for a certain period of time.  Part B has a monthly premium that is paid from the Social Security check. Part D is paid for separately in one of three ways: Social Security check deductions, bank draft deductions or direct bill.

People on original Medicare often purchase a supplement to pay all or part of the 20% that Medicare doesn’t cover.  These are purchased from private insurance companies but are standardized by the government and are lettered A-N; with each letter representing a different plan with a different level of coverage.

Some beneficiaries may have Medicare Advantage plan, also known as, Medicare Part C that typically combines Part A, B and D into one insurance plan.  These plans cover all that Medicare covers, provides a “stop-loss” and has cost sharing when receiving medical attention.  These plans are purchased from an insurance company and would have the insurance company’s name on the top of the card.

How will you know if your loved one uses Original Medicare or Medicare advantage?  If the beneficiary shows two cards, the Medicare card and the “supplement” card when visiting a doctor or hospital then they likely have original Medicare and a “supplement.”  If the beneficiary does NOT show the Medicare card but shows only one card that has the name of an insurance company on the top then they likely have Medicare Advantage.

Usually, a care-giver gets involved because there is a crisis.  Call me if you have questions or situations that need to be addressed regarding your loved one’s situation.  We have helped dozens get answers to their urgent situation.  Call 888.412.4599 or email for help.



Leave A Reply (No comments so far)

No comments yet

Choose a Category