What caregivers should know about Medicare coverage

DEAR SAVVY SENIOR: I am the caregiver for my 81-yearold mother, who recently fell and broke her hip, and have a lot of questions about how original Medicare works and what it covers. Can you help? — Overwhelmed Caregiver

Dear Caregiver: Having a working knowledge of Medicare can help you take full advantage of the coverage and services it provides to ensure your mom receives the best care possible. Here’s what you should know:

Medicare assistance

A good starting point is the official “Medicare & You” handbook. This overview is mailed to all beneficiaries every fall and provides an up-to-date description of services and benefits. You can also view it at Medicare. gov/medicare-and-you.

If you have a particular question, you can contact a Medicare customer service representative at 800-6334227. Medicare also works closely with State Health Insurance Assistance Programs to provide free health insurance counseling. To find a SHIP counselor in your area, visit Shiptacenter.org or call 877-839-2675.

Caregivers also find Medicare’s secure website — Mymedicare.gov — especially useful. After setting up a personal account for your mom, you can view details of her coverage, track recent health care claims and keep up to date on the preventive services she qualifies for.

Compare tools

Medicare can also help you locate the right health care provider s. At Medicare. gov/care-compare you can find and compare doctors, hospitals, home health

agencies, dialysis facilities, inpatient rehab facilities, long-term care hospitals and nursing homes in your mom’s area.

What Medicare covers

Medicare can reduce many of your mom’s out-of-pocket medical expenses, but it doesn’t cover everything. Understanding what Medicare does and doesn’t cover can save you time and spare you frustration when navigating the caregiving maze.

Besides basic hospital and physician services (including telehealth) and optional prescription drug benefits, Medicare covers home health care. To qualify, your mom must be homebound, under a physician’s care and in need of part-time skilled nursing care or rehabilitative services such as physical therapy.

Medicare also helps pay for oxygen, catheters and other medical supplies that a doctor prescribes for home use. The same is true for medically necessary equipment such as oxygen machines, wheelchairs and walkers.

Medicare covers skilled care in a nursing home for limited periods — up to 100 days — following hospital stays. It does not cover long-term stays. Patients who need custodial care (room and board) must pay out of pocket unless they are eligible for Medicaid or have private long-term care insurance.

Medicare pays for hospice care for those with a terminal illness who are expected to live six months or less. The hospice benefit also includes brief periods of respite care at a hospice facility, hospital or nursing home to give caregivers an occasional rest.

Original Medicare typically doesn’t cover regular dental care or dentures, regular eye exams or eyeglasses, and hearing exams and hearing aids. Likewise, it won’t pay for nonemergency ambulance trips unless a doctor certifies medical necessity.

To find out what Medicare covers, visit Medicare.gov/coverage and type in the test, item or service you have questions about, or download the Medicare “What’s covered” app in the App Store or Google Play.

Financial assistance

Is your mom on a limited income? You can check whether she qualifies for help with prescription drug costs or with other Medicare-related premiums, deductibles and copays. For help with drug costs, visit Ssa.gov/ prescriptionhelp or contact Social Security at 800-772-1213 and ask about the “Extra Help Program.” For help with other Medicare costs, go to Medicare.gov or call 800-633-4227 and ask about the “Medicare Savings Programs.”