Medicare is a federally funded insurance program that provides health coverage if you are 65+ or under 65 and have a disability, no matter your income, and includes a defined hospice benefit. Medicare Advantage programs are all-in-one programs similar to managed care, which may or may not include hospice services. Programs of All-inclusive Care for the Elderly (PACE) is a Medicare and Medicaid program that helps people meet their healthcare needs in the community instead of going to a nursing home or other care facility. Benefits vary between programs and states, so it is wise to understand what is available to you.
Medicare is for:
- People who are 65 or older
- Certain younger people with disabilities
- People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD)
Five important facts about Medicare:
- Some people get Medicare automatically, and some have to sign up. You may have to sign up if you are 65 (or almost 65) and not getting Social Security.
- There are certain times of the year when you can sign up or change how you get your coverage.
- If you sign up for Medicare Part B when you’re first eligible, you can avoid a penalty.
- You can choose how you get your Medicare coverage.
- You may be able to get help with your Medicare costs.
What are the parts of Medicare?
The different parts of Medicare help cover specific services:
- Medicare Part A (hospital insurance): Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health.
- Medicare Part B (medical insurance): Part B covers certain doctors’ services, outpatient care, medical supplies, and preventive services.
- Medicare Part D (prescription drug coverage): Helps cover the cost of prescription drugs (including many recommended shots or vaccines).
With Medicare, you have options in how you get your coverage. There are two main ways:
- Original Medicare – Original Medicare pays for much, but not all, of the cost for covered healthcare services and supplies.
- Medicare Advantage – Medicare Advantage is an “all in one” alternative to Original Medicare. These “bundled” plans include Part A, Part B, and usually Part D.
Learn more about Medicare coverage at Medicare.gov.
What is PACE?
Programs of All-inclusive Care for the Elderly (PACE) is a Medicare and Medicaid program that helps people meet their healthcare needs in the community instead of going to a nursing home or other care facility. With PACE, you have a team of healthcare professionals working with you and your family. You can have either Medicare or Medicaid, or both, to join PACE. PACE is only available in some states that offer PACE under Medicaid. See the PACE website to see if there is a PACE program in your area.
Does Medicare cover hospice?
Original Medicare has covered hospice services since 1982. Detailed information is available on Medicare.gov. Hospice benefits may be available to people enrolled in Medicare Advantage plans. Some Medicare Advantage plans now include hospice services. Check with your plans and Medicare.gov to see if hospice services are covered.
Medicare will also pay for a hospice physician to consult with terminally ill patients who are not yet in a hospice. The consult, which could occur in a hospital, nursing home, other facility, or at home, may include a pain assessment as well as counseling on care options and advance care planning. One of the most important hospice benefits is its coverage of medication related to the terminal illness, which is covered at no more than a $5 copay. This alone can save a family a huge amount of money, since pain medication is extremely expensive.
Does Medicare cover palliative care?
There is no standardized program for palliative care as there is for hospice. Original Medicare will pay the usual benefits and some Medicare Advantage plans may have a palliative care program. Check with your doctor to see what is available to you. Get Palliative Care’s website offers information to help you understand what is covered.
Can Medicare help me with the cost of my medical treatments and prescriptions?
Medicare has a number of programs to help with costs; visit their website to learn more.
