What's covered by Medicare?

Providing care for family members or friends requires more than just a big heart. From organizing trips to the doctor and picking up medications to wading through complex health care information to determine the best care option to meet your loved ones’ needs, caregiving requires a lot of work.

That’s why, every year, we observe National Medicare Education Week, (Sept. 15 to 21) to help seniors, Medicare beneficiaries, and their caregivers learn about their Medicare options in preparation for Medicare’s Open Enrollment Period, which runs from Oct. 15 to Dec. 7. In the spirit of National Medicare Education Week, here’s a short primer on the ABCs of Medicare:

You’ve probably heard of Original Medicare, the health insurance program offered by the federal government. Original Medicare, sometimes called “traditional” Medicare, generally covers 80 percent of medical expenses with the individual responsible for the other 20 percent. It’s made up of two parts:

• Part A: helps pay for inpatient care, such as hospital visits.

• Part B: helps pay for outpatient care (doctor’s visits, preventive care, etc.)

There are also government-approved Medicare plans that are provided through private insurance companies. These include:

• Part C: Also known as Medicare Advantage, these plans include all the coverage of Original Medicare plus a variety of additional benefits and features — all combined in a single plan — such as access to a nurse helpline, hearing, dental and/or vision coverage, or a gym membership. All Medicare Advantage plans also have a maximum out-of-pocket limit, so you can better predict how much your loved one may have to pay for health care services each year.

• Part D: Prescription drug coverage. Medications are often included in Medicare Advantage (Part C) plans but can also be purchased separately for those with Original Medicare (Parts A and B) because Original Medicare does not cover most prescription drugs.

Once you understand the ABCs of Medicare, it’s important to look at the costs and coverage benefits to determine which plan is right for your loved one. When comparing different options, make sure to consider the following factors:

• The costs: This will include copayments, coinsurance, premiums and deductibles.

• The health care providers: Review the plan’s network of hospitals and physicians, if there is one, to see if the doctors your loved one sees or the nearby hospital are included.

• The formulary: Make sure your loved one’s prescription drugs are included on the plan’s list of approved drugs, known as the formulary.

Caring for your loved one is a big responsibility. But you don’t have to do it alone. Resources are available to help you understand Medicare, such as MedicareMadeClear.com. Caregivers can also visit a local SHIP (State Health Insurance Assistance Program) office with their loved one where they can speak with a counselor who can answer questions and help them understand health care choices.

Medicare Open Enrollment Period will be here before you know it –– so now’s the time to start looking into Medicare options for your loved ones.

Dr. Efrem Castillo is the chief medical officer for UnitedHealthcare Medicare & Retirement.