Medical care in the United States is expensive. Generally, people need more medical care the older they get. Many assume that they will have adequate healthcare coverage through Medicare once they turn 65. However, Medicare may not cover as much as you think.

It is vital for older adults and their adult children to understand how to obtain appropriate medical coverage and make sure they have medical care plans to take care of their parent’s needs. Here’s some background health information on Medicare, long-term care, and options for adult children to ensure their parents get proper medical care.

Medicare is a federal program, but retirees’ medical care options may differ in every state. For advice about planning for medical coverage and care options, talk to an older adult law attorney in your state to understand how to maximize your care benefits.

Medicare Coverage for the Older Adults

Medicare is a federal government health insurance program for 65 and older. Coverage under Medicare includes four programs:

• Part A is a hospitalization coverage plan that provides basic coverage for most hospital visits, home care, and nursing facility visits.
• Part B is a medical insurance plan that pays for most doctor and laboratory costs, along with some outpatient medical services, like home health care and physical therapy.
• Part C is a privately purchased supplemental insurance plan that provides additional services.
• Part D is for prescription drug coverage that defrays the costs of some prescription medications.

Medicare Part A provides coverage to most seniors without the need to pay premiums. However, most people have to pay premiums to receive coverage under Parts B, C, and D. The Medicare website has a good description of each Part’s benefits and costs which you can review with your parents. Your local Social Security office can also help your parents obtain medical care.

It is essential to consider that the cost of Medicare Part B may go up significantly if older parents do not initially enroll at age 65. The initial enrollment period for Medicare Part B is seven months long, beginning three months before one’s 65th birthday and ending four months after one’s 65th birthday. If a retired person doesn’t sign up for Part B benefits during this time, the monthly premiums may increase by 10 percent for every year they were eligible for coverage and chose not to enroll. This penalty does not apply to people still working at 65.

For example, if your retired parents waited to enroll in Medicare Part B until they were 75, their monthly premiums would be double what they would have been had they enrolled at age 65. In addition to the monetary penalty, there is also a limited enrollment period. Enrollment in Part B outside the seven-month window at age 65 is limited to January 1 to March 31 of each calendar year at a local Social Security office.

Medicare Options for Supplemental Care

Your parents may also consider enrolling for supplemental care through a Medicare Advantage Plan. Several plans are available in each state. The plans vary both in cost and the coverage they provide. Individuals can view Medigap plan comparisons for their state on the Medicare website. The comparison includes the monthly premiums, annual deductibles, summary ratings, telephone numbers, and links to the health plan website.

While Medicare Part A may cover almost all of a patient’s costs if the patient is admitted to the hospital, it will not cover all of their outpatient health care expenses. People can spend hundreds of thousands of dollars on health care throughout their lifetime, with much of those costs coming after they turn 65. You should plan carefully for the likelihood that your parents will have significant medical expenses during their later years, not all of which Medicare will cover.

Long-Term Care, Medicare, and Medicaid

One of those medical expenses not covered by Medicare is long-term care. Long-term care can take many forms but generally helps older adults with the basic activities of daily living. Care can be temporary or permanent, in-home care, at an assisted living residence, nursing home, or medical facility. Long-term care programs also help people suffering from chronic illness, Alzheimer’s disability, or other health conditions to provide for their basic living needs.

Because Medicare does not cover long-term care, many retirees turn to Medicaid to help pay those costs. Medicaid has become the largest source of long-term care funding.

Medicaid is an assistance program for low or no-income individuals of all ages, administered by states and local governments within federal guidelines. Federal government mandates coverage for certain services deemed “medically necessary,” including long-term care, nursing facility services, and home healthcare for people eligible for nursing facility services.

However, eligibility for Medicaid is limited to people with no financial or property assets, so older parents who require long-term medical care but don’t qualify for Medicaid could be paying for that care out-of-pocket. Medicaid services and eligibility also differ from state to state.

Long-Term Care Insurance for Older Parents

Older people can have their retirement plans turned upside down after being forced to drain their personal savings or retirement benefits, remortgage their homes, and even sell off their personal property to finance long-term care later in life. However, there are long-term care insurance policies that can cover care costs.

Medical/Legal Documents and Decisions

Sometimes ensuring your parents receive the best medical care means having some hard conversations before the time comes. End-of-life care issues are critical for parents and children to address to ensure they fulfill an older person’s medical wishes and can give you and your parents peace of mind that they are protected.

Low-cost do-it-yourself (D.I.Y.) wills, living wills, and powers of attorney are possible in some simple cases and can be found on our companion site, FindLaw.com.

Living Wills

Also known as a medical directive or advance directive, a living will sets out what kind of care a person wants to receive in an emergency or if they become incapacitated. Living wills can cover topics like resuscitation, desired quality of life, and end-of-life treatments, including any life-saving treatments a parent may not want to receive.

Durable Powers of Attorney

A living will doesn’t cover everything when someone is incapacitated. With a healthcare proxy, an older parent can name a health care agent who will make medical decisions for them if they are not able because of impairment. A durable power of attorney is a more expansive option that names someone to handle additional financial or healthcare matters.

Do Not Resuscitate (DNR) Orders

A do not resuscitate (DNR) order is a written physician’s order in a person’s medical record that instructs health care providers not to attempt specific life-saving measures. These decisions can be based on religious grounds or the quality of life for the patient. Older parents should document their desires on this issue clearly, to avoid any confusion later.

You may also find additional state government resources to help you get medical information about care for older parents. For example, in Maryland, the state Department of Aging has a Family Caregiver Support Program to help family members care for their loved ones at home. For older adults living in Rhode Island, the local State Health Insurance Assistance Program (SHIP) helps people find the right Medicare coverage. In Washington, DC, the Department of Aging and Community Living provides programs and services for families and caregivers to seniors.

Caring for aging parents can be emotionally, financially, and legally complicated. An experienced older adult law attorney should help draft or review contracts, insurance policies, or medical directives to ensure the best preparation and care possible.