You must have end-stage renal disease (permanent kidney failure) and be on dialysis or be a kidney-transplant patient.
What Does Medicare Cover?
Medicare pays 80 percent after you have met your deductibles. Medicare is split into two parts. Part A covers in-patient services in hospitals and some nursing facilities and has an $812 deductible per benefit period. Part B covers doctors services and has a $100 deductible per calendar year.
Part B also covers some occupational and physical therapies as well as nebulizers and external effusion pumps. There is some additional durable medical equipment that Medicare helps cover, such as canes, crutches, walkers, seat lifts, diabetic equipment, wheelchairs, and hospital beds. It also covers eyeglasses after each cataract surgery.
What's Not Covered?
Medicare does not cover prescription drugs. This can be a very costly part of health care, especially for older family members. Unfortunately, because secondary dependents are not eligible for TRICARE, they cannot have their prescriptions filled at military facilities.
Because only 80 percent of your medical charges are covered, that leaves 20 percent to pay out of pocket in addition to any deductibles and co-payments.
How Can You Cover the Financial Gaps in Medicare?
Educate yourself on the various state and federal programs that supplement Medicare that your parent or grandparent may be eligible for. Follow legislation that can effect changes to Medicare benefits. With solid information on how the system works and what your family member is entitled to, you can make sound decisions on the different supplemental programs that are out there.
Medicaid is a joint federal and state program that helps individuals with limited resources. It can also help cover some nursing-home care. Eligibility varies from state to state, so with each move into another state you have to reapply.
Supplemental insurance is additional coverage you can purchase. Just as with any insurance, you need to shop around and educate yourself on the world of medical insurance, supplements, HMOs and PPOs so that you and your family member can make the best decision. You can purchase plans that typically cover everything that Medicare does not. Insurance companies such as Physicians Mutual can help cover prescription costs, co-pays, and deductibles. Out-of-pocket costs will depend on a number of variables such as location, age, and the type and extent of coverage.
HMO vs. PPO
An HMO is a health maintenance organization as opposed to a PPO, or preferred provider organization. Companies such as Secure Horizons offer both options. They suggest that individuals on a fixed income would benefit more from their HMO. HMOs use a selected network of doctors and facilities. To get specialist care, you must have referrals from the primary care manager. There are often low or no premiums. The PPO allows you to go to any doctor or hospital, but has a higher premium cost.
Availability of Supplemental Insurance
You must be sure to ask about the transferability of any additional insurance you purchase. Military life dictates frequent moves, and you need to be aware of any lapse in insurance coverage or the need to reapply. Secure Horizons, for instance, is only available in Arizona, California, Colorado, Nevada, Oklahoma, Oregon, Texas, and Washington. Physicians Mutual is typically available nationwide; however, if you're transferring overseas you may need to find other coverage.
In addition to researching health insurance, take a few moments to discover senior programs that are offered in your area. Senior centers, the YMCA , YWCA , and fitness centers usually offer exercise programs for older people. Aquatic classes, yoga, and walking groups are all examples of safe exercise, and they have an added benefit — they help older people create a social network. Wellness of both mind and body can mean a big improvement in quality of life for families.
The world of health insurance can be confusing and overwhelming, but with determination, good note taking, and family meetings, you can ensure that your loved ones are financially covered and have every opportunity to live a healthy life.