INSIDE: Caregiving is a multi-series project from WOSU uncovering the journey of caregiving, from health disparities and inequities to exploring if our healthcare system is prepared to support the future aging population.
Seniors often face increased needs as they age. The bills can be huge and mount quickly. So, how can aging Ohioans plan for those expenses?
Becky Hayward is the Outreach and Education Supervisor with the Ohio Senior Health Insurance Information Program (OSHIIP), which is part of the Ohio Department of Insurance.
Matthew Rand: When you think of paying for elder health care, you first think of Medicare, which pays for most expenses for people 65 and older. As seniors need more services like home health care, assisted living and nursing home care, what does Medicare cover in these cases?
Becky Hayward: Medicare is going to be only covering anything that's related to your health care. (That includes) doctor visits, hospital inpatient stays, emergency room, durable medical equipment, prescription drugs, things like that. That is where Medicare comes into the program. It's for your health care needs. Regarding long term care, that is not something Medicare is actually paying for. Medicare pays just for that skilled nursing care that you might need after hospitalization. But once it's no longer skilled care, the nursing home stay is not Medicare covered.
Becky Hayward: Medicare does cover some home health care, but again, it needs to be medical necessity care. So that is the key when it comes to what Medicare covers in that sense. If you need to be in an assisted living or an independent type of stay, you're probably looking at privately paying it, maybe purchasing a long term care insurance policy. But that is something that you purchase and pay into before you get to this situation, so something we pick up maybe in our early 60s or even in our 50s. And then maybe somebody may have to reach into Medicaid to help pay for those types of care if they don't have insurance or the financial needs to pay for those programs.
Matthew Rand: What are some other medical expenses Medicare doesn't cover that folks should be aware of?
Becky Hayward: I think the biggest misconception when people call us about Medicare, they don't realize it actually costs. So, everybody actually pays Medicare. It's split into two parts. We have a Part A program which we pay into while we're working. But when we go on Medicare full time, when we're eligible at 65 or maybe when we retire after the age of 65, everybody pays the Part B, so there is a premium for Medicare that people need to plan for. This year, it's $185 per person. There's not a family plan when it comes to Medicare.
Becky Hayward: You are an individual in the program, so you do have to keep that in mind, that in addition to your Social Security retirement that you may receive, they're going to deduct the Part B premium. There are also expenses, so it's not 100% of coverage. It's an 80/20 health insurance, so generally you're going to be responsible for 20% of the health care bill. Medicare also doesn't cover dental and vision. Regular dental visits are not part of the Medicare program. There are things that have been added throughout the years, but those are the biggest programs as well that people look for, maybe how to pay for those types of costs.
Matthew Rand: As we said, paying for caregiving for seniors can be awfully complex. What's the biggest mistake that you try to help people avoid?
Becky Hayward: We often joke that, you know, don't talk to your friends, don't talk to your neighbors. Don't pay attention to what you get in the mail or on TV. Find reliable, objective resources. That's where OSHIIP can come in. I think it's very important that you understand that it's a personal choice for each person going on Medicare. What works for them?
Becky Hayward: It's insurance, so you are looking at insurance that you're comfortable with, your needs and that you understand there's risks involved. What those risks are, how much risk you want to take and then the types...how much protection that you want for something that may or may not happen down the road, depending on your situation as you age.
The Ohio Senior Health Insurance Information Program (OSHIIP) offers support and advice to Medicare enrollees. To contact OSHIIP, call 800-686-1578 or email oshiipmail@insurance.ohio.gov.
