Become a health care advocateYou’ve probably already figured out that our health care system is complex. For our elderly loved ones, it’s usually even more complicated because they’re more likely to be juggling multiple medications, a rotating list of health care providers, and the stress of an ongoing condition. You can step in and help your loved one by attending doctor’s appointments with them, flagging new symptoms or concerns for doctors, helping them understand treatment options and tests, as well as navigating Medicare and other insurance options.
Compare Medicare and Medicaid coverage
Health care can be confusing, and you and your loved one might feel a bit intimidated when discussing how to pay for their care. There’re multiple versions of Medicare to consider and each one offers its own type of coverage—as well as other insurance types that might cover what Medicare doesn’t.
As a first step, review and compare these options and see what they cover. When you’re ready, apply for or revise your loved one's Medicare coverage.
Medicare Part A: Hospital insurance
Medicare Part A is health insurance that covers inpatient hospital care, skilled nursing facility care, hospice care, and home health care. Your loved one might not have to pay a monthly premium for Part A if they or their spouse paid for it through payroll taxes when they were working.
Medicare Part B: Medical insurance
Medicare Part B is health insurance that covers doctor visits, ambulance services, durable medical equipment, and many other services not covered by Part A. Your loved one might have to pay a monthly premium for Part B, which is determined by their income level.
Medicare Part D: Prescription drug coverage
Medicare Part D helps pay for brand name and generic medications. Medicare drug plans are offered by insurance companies and other private companies whose plans are approved by Medicare. Your loved one isn't required to enroll in Part D, but if they don't enroll when they become eligible for Medicare, they could face a late penalty fee later when they do enroll.
Medicare Part D Extra Help: Prescription drug coverage
The Extra Help program helps with prescription costs for those of limited financial means. You can apply for Extra Help any time before or after you enroll in Part D. Learn more
Medicare Advantage plans
Medicare Advantage, sometimes referred to as Medicare Part C or MA, is a type of health insurance that provides your loved one with an "all-in-one" alternative to Original Medicare. Original Medicare coverage refers to the combination of Medicare Part A and Part B, and if your loved one is eligible, they’ll still need to enroll. Medicare Advantage is offered by private health insurance companies approved by Medicare—it bundles Part A, Part B, and usually Part D.
Medigap: Medicare Supplemental Insurance
Medigap, or Medicare Supplement, is another health insurance provided by private health insurance companies and regulated by Medicare. This coverage can help your loved one pay costs not covered by Original Medicare, like copayments, coinsurance, and deductibles. Also, some Medigap plans cover benefits Original Medicare doesn't, like emergency foreign travel expenses.
Other differences: Medicare can limit the number of coverage days for hospital stays, time in a skilled nursing facility, or if hospice care is needed. Medigap plans can sometimes cover longer stays. For example, Medicare only covers your loved one for up to 20 days in a skilled nursing facility, while Medigap plans sometimes cover up to 100 days. This can be helpful for your loved one in situations like post-surgery or rehabilitation after a fall.
Medicaid is a joint federal and state program that provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities. Medicaid is administered by states, according to federal requirements.
There are strict income and asset limits set by states to decide if your loved one qualifies for Medicaid. Eligibility rules are different between states, but qualifications are always based on income, household size, disability, family status, and other factors. Some states have expanded their Medicaid programs to cover all people with household incomes below a certain level, and your loved one’s eligibility for Medicaid will depend partly on whether your state has expanded its program.
Manage caregiving costs
It might be a shock to find out that Medicare doesn’t normally cover caregiving costs, except in certain instances. Private medical insurance is usually the same way. It’s important to understand what options are available to your loved one for covering and reimbursing medical costs—outside of personal savings and retirement accounts.
Long-term care insurance
Long-term care insurance is designed to help cover the costs of long-term caregiving services. This type of insurance uses “hybrid” policies to make sure premiums don't increase if your loved one’s financial situation changes. Long-term care insurance can be an important part of your loved ones overall financial plan, but it becomes more expensive the longer you wait to buy it. Not everyone qualifies, so make sure you help your loved one do some research to see if this might be a good fit for them.
A reverse mortgage is a loan that allows a homeowner to withdraw part of their equity and not have to pay it back until they leave or sell their home. The money from the loan can be used for living expenses, debt repayment, health care costs, and more. These loans are designed to help seniors stay in their homes but can be risky if the home is an important part of your loved one's estate.
Veterans Administration benefits
If your loved one draws a VA pension, they may be eligible for financial help with caregiving with the VA Aid and Attendance benefits and Housebound allowance. Find out more