What Ev­ery Care­giver Should Know About Medi­care

Washington County Enterprise-Leader - - NEWS - By Bob Moos

The phone call can come at any hour. Your el­derly par­ent has fallen ill and needs your help. If you haven’t got­ten the call yet, chances are you will. About 70 per­cent of our par­ents will re­quire some kind of per­sonal care dur­ing their old age. Some­times, the care will ex­tend for years.

Care­givers of­ten find them­selves at wits’ end, ca­reen­ing from one cri­sis to an­other and hav­ing lit­tle time to con­front the prob­lem that cropped up yes­ter­day, let alone tackle the one that just reared its head to­day. The chal­lenges can quickly be­come over­whelm­ing.

Hav­ing a work­ing knowl­edge of Medi­care may help you keep your bal­ance and en­sure that your par­ent, or other loved one, re­ceives the ap­pro­pri­ate care. Medi­care doesn’t have to be a mys­tery. There are sim­ple ways to get an­swers to your ques­tions.

The best over­view of the Medi­care pro­gram is the of­fi­cial “Medi­care and You” hand­book. It’s mailed to all ben­e­fi­cia­ries ev­ery fall and pro­vides an up-to-date-de­scrip­tion of all ser­vices and ben­e­fits. It’s also read­ily avail­able on Medi­care’s main web­site, at www.medi care.gov.

If you have a par­tic­u­lar ques­tion, you may want to visit with a Medi­care cus­tomer ser­vice rep­re­sen­ta­tive at 1-800-633-4227. Medi­care also works closely with State Health Insurance As­sis­tance Pro­grams to pro­vide free health insurance coun­sel­ing. The Arkansas num­ber is 1-800224-6330.

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

Medi­care can also help you lo­cate the right health care providers for your par­ent. Its “Com­pare” web pages — at www.medi­care. gov — are a good place to be­gin your search for a nurs­ing home, hos­pi­tal, home health agency, dial­y­sis fa­cil­ity or physi­cian that fits your par­ent’s needs.

Medi­care can re­duce many out-of-pocket med­i­cal ex­penses, but it doesn’t cover ev­ery­thing. Un­der­stand­ing what Medi­care cov­ers, as well as what it won’t cover, can save you time and spare you frus­tra­tion when nav­i­gat­ing the care­giv­ing maze. Here are a few key points:

Be­sides ba­sic hos­pi­tal and physi­cian ser­vices and op­tional pre­scrip­tion drug ben­e­fits, Medi­care cov­ers home health care. To qual­ify, a ben­e­fi­ciary must be home­bound, un­der a physi­cian’s care and in need of part­time skilled nurs­ing care or re­ha­bil­i­ta­tive ser­vices like 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 like oxy­gen ma­chines, wheel­chairs and walk­ers.

Medi­care cov­ers skilled care in a nurs­ing home for lim­ited pe­ri­ods fol­low­ing hos­pi­tal stays. But it doesn’t cover long-term stays. Pa­tients who need cus­to­dial care (room and board) must pay out of pocket un­less they’re el­i­gi­ble for Med­i­caid or have pri­vate long-term care insurance.

Medi­care pays for hospice care for some­one with a ter­mi­nal ill­ness whose doc­tor ex­pects will 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 the pa­tient’s care­givers an oc­ca­sional rest.

Be­sides long-term nurs­ing home stays, 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 non-emer­gency am­bu­lance trips — un­less a doc­tor cer­ti­fies they’re med­i­cally nec­es­sary.

Money can quickly be­come a worry when man­ag­ing a par­ent’s health care. If your par­ent lives on a lim­ited in­come, you should check whether he or she qual­i­fies for help with pre­scrip­tion drug costs or with other Medi­care-re­lated pre­mi­ums, de­ductibles and co­pay­ments.

For help with drug costs, con­tact So­cial Se­cu­rity at www.so­cialse­cu­rity. gov or 1-800-772-1213 and ask about the “Ex­tra Help Pro­gram.” For help with other Medi­care costs, go to www.medi­care.gov or call 1-800-633-4227 and ask about the “Medi­care Sav­ings Pro­grams.”

It’s com­mon for care­givers to suf­fer from stress, loss of sleep, and poor health them­selves. So it’s im­por­tant to eat prop­erly, get reg­u­lar ex­er­cise and set aside some time each week to do some­thing you en­joy. You can’t care for some­one else if you don’t look after your­self.


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