a caregiver’s guide to medicare

Taking care of a parent or loved one after a stroke is hard enough without

having to figure out Medicare too. The good news is that understanding the program can make life a lot easier. Knowing what’s covered – and what isn’t – can help you plan ahead, avoid costly surprises and make sure your loved one gets the care they need. Here’s a practical guide to get you started.

Medicare basics

One of the best places to start is the official “Medicare & You” handbook. It explains benefits and services in plain language. Medicare mails an updated copy every fall, but you can also view it online at medicare.gov/medicare-and-you.

For questions, call Medicare at 800-633-4227 to speak with a representative. They can clarify coverage for doctor visits, hospital stays, home health care, and more.

The New York State Health Insurance Assistance Program (NYSHIP) is another great resource. NYSHIP counselors provide free, one-on-one counseling to help you understand your coverage, identify cost-saving programs, and answer questions about Medicare. Find a counselor near you, go to

https://aging.ny.gov/health-insurance-information-counseling-and-assistance-programs

or call 1-800-701-0501.

Caregivers should also create a secure Medicare account at medicare.gov/account/login, if your loved one doesn’t already have one. Once your the account is set up, you can review coverage, track claims, check the status of medical services and prescriptions, and see which preventive benefits are available. It’s an easy way to stay organized and keep all of the Medicare information in one place.

Choosing providers

Medicare also lets you compare providers online at medicare.gov/care-compare. You can search for doctors, hospitals, rehab centers, nursing homes, hospice providers, and medical equipment suppliers in your area. This is especially useful after a stroke, when your loved one may need rehabilitation or specialized care at home.

Covered services

Original Medicare covers many services, including hospital care, doctor visits, lab tests, and outpatient treatments.

It also covers home health care if your loved one is homebound, under a doctor’s care, and needs part-time skilled nursing or rehabilitation therapy, such as physical, occupational or speech therapy. 

Medicare also covers medically necessary durable medical equipment and supplies prescribed by a doctor, including oxygen, wheelchairs, walkers and catheters. Short-term skilled nursing care in a facility may also be covered for up to 100 days after a qualifying hospital stay.

Prescription medications are generally covered through a separate Medicare Part D plan, which helps pay for many outpatient drugs.

Hospice care is covered for patients with a terminal illness and a life expectancy of six months or less, as certified by a doctor. It includes nursing care, medications for comfort and short-term respite care to give caregivers a break.

However, Medicare generally does NOT pay for long-term custodial care at home, in an assisted living facility or in a nursing home. That means it generally won’t cover ongoing help with daily activities like bathing, dressing, eating, using the bathroom or supervision for someone with dementia. Routine dental care, dentures, eye exams for glasses and hearing aids are also not covered.

Cost help

If there is limited income and resources, check programs that help reduce Medicare costs. Extra Help assists with prescription drug expenses, and Medicare Savings Programs can help pay premiums, deductibles, and coinsurance.

Visit medicare.gov/basics/costs/help or call 800-633-4227 to learn more or check eligibility. You can also get free help via the Westchester County Medicare Helpline at 914-813-6100.

Taking time to understand Medicare can make caregiving a little less stressful. It helps you stay on top of appointments, treatments and equipment needs, while giving you greater confidence that your loved one is receiving the care and benefits they’re entitled to.