Commentary: Knowing Medicare Basics
Written by Barbara T. Baylor
August 21, 2014
On July 30, 2014, the nation observed the 49th anniversary of the signing of Medicare and Medicaid into law by President Lyndon Johnson in 1965. Today, more than 52 million people are covered by Medicare and more than 60 million people by Medicaid. Though many of our nation's leaders are still trying to dismantle Medicare, and some states are opting out of expanding Medicaid, the Affordable Care Act continues to improve the quality and length of life for many Americans by providing needed health and economic security to the most vulnerable in our nation.
Having lost my mother seven months ago and, last week, my mother-in-law, I am grateful for the promises of Medicare. During the three months that I cared for my mother-in-law, I learned more about the complexities in the health care system specifically related to Medicare. I thought I would take a "look back" and share five things that I learned about Medicare that might be helpful if you are caring for a loved one.
1. Gather Information: It's important to collect all information you can about your loved one and have it readily available at all times: social security number, Medicare number, Medicare Enrollment Plan, health history, prescription drugs.
2. Understand your Medicare Enrollment Plan: Is your loved one in original Medicare or in a Medicare Advantage Plan? Original Medicare is the traditional program administered directly through the federal government and includes part A (hospital) and part B (medical) coverage if you enroll in both. Medicare Advantage Plans are sold by private insurance companies (such as HMOs or PPOs) that provide Part A & B Medicare benefits but through a private plan that may have different costs and restrictions. I knew my mother-in-law had Medicare but I didn't fully understand the difference in the plans until I started receiving feedback from her health care providers about restrictions on her care and services.
3. Advance Directives: It is so important to have an advance directive to know what your loved one wants. I didn't have any documentation on this, and I had to continually search my soul to make difficult decisions about her care options.
4. Long-Term Care: Medicare doesn't pay for long-term care; it only covers medical care delivered by doctors and hospitals. Many people believe that Medicare covers nursing home stays. Medicare covers up to 100 days of "skilled nursing care" per illness if it is medically necessary and if your loved one is showing progress.
5. Medicaid: Did you know that you are forbidden from having more than two or three thousand dollars in the bank before you can be eligible for assistance from Medicaid? The requirement to spend down assets has been cited as one the flaws in the system and a major challenge for seniors and their families.
Medicare is good for our seniors and good for our country. Celebrate it! Protect it! Learn all you can about it! Learn more: Medicare Basics
Barbara T. Baylor is the UCC's Policy Advocate for Health and Wholeness Issues
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