12 Things Caregivers Need to Know About Medicare — and 1 They Wish Would Change

2. Get access to your loved one's online Medicare account

An online Medicare account is a great resource for personalized information about Medicare coverage, claims and costs. You can review claims as soon as they’re processed rather than waiting for the quarterly Medicare summary notice (MSN).

That can help you identify claims problems or potential Medicare fraud. Account information may include eligibility for preventive benefits and a list of drugs taken regularly, which can give you a head start when comparing Part D prescription drug plans during open enrollment.

3. Review the Medicare & You handbook

Updated annually, the Medicare & You handbook is a great resource for Medicare’s rules, coverage, costs and changes. The booklet also spells out Medicare rights, steps for appealing denied claims, and where to get help with Medicare questions.

4. Find out about free preventive care

Medicare Part B covers more than a dozen preventive services without deductibles or copayments and with eligibility based on age and risk factors. It also covers an annual wellness visit, when a primary care physician creates a personalized prevention plan for the year.

And thanks to AARP’s advocacy for the Inflation Reduction Act of 2022, your loved one can now get all vaccines recommended for adults covered by Part B or Part D without any cost sharing, including vaccines for the respiratory syncytial virus, better known as RSV, and shingles.

5. Review Part D, Medicare Advantage during open enrollment

If your loved one has a Part D prescription drug policy or Medicare Advantage plan, you should review the options annually during Medicare open enrollment, which runs Oct. 15 to Dec. 7. New coverage starts Jan. 1.

Coverage, costs and provider networks can change significantly from year to year, as they did in 2025 when Part D and Medicare Advantage insurers adjusted premiums, copayments and lists of covered drugs to account for a $2,000 cap on out-of-pocket costs for covered drugs.

Compare what’s covered for all medications and health care needs, not just premiums. Use the Medicare Plan Finder to review costs for Part D and Medicare Advantage plans in the area.

6. Learn about programs to help with chronic conditions

Medicare has several programs to support people with chronic conditions, including a yearlong diabetes prevention program for those diagnosed with prediabetes and a nutrition therapy program. A $35 monthly cap on insulin costs also helps with expenses.

Medicare’s chronic care management services can help people with two or more chronic conditions. Check out Your Medicare Coverage at Medicare.gov and use its handy search tool.

If your loved one has Medicare Advantage, consider a special needs plan that focuses on coverage for one chronic condition, such as diabetes, cardiovascular disease or end-stage renal disease.

7. Take advantage of Medcare's caregiver resources

Medicare’s increased focus on helping family caregivers includes paying doctors and other providers for time spent training family caregivers to help with medical tasks, such as giving injections and managing medications. For Chiquita Brooks-LaSure, former administrator of the Centers for Medicare & Medicaid Services, that meant learning how to give a relative an injection.

“That’s not something you necessarily know if you have never done that,” she says. “It’s so important that we value making sure caregivers have knowledge about how to care for their loved ones, and if you pay doctors and nurses for their time, it sends the signal that it’s important.”

Another program, Medicare’s Principal Illness Navigation Services, helps patients with serious illnesses and their caregivers understand diagnoses and guide them through the health care system. This helps people with AIDS, cancer, chronic obstructive pulmonary disease, congestive heart failure and heart disease, dementia or severe mental illness — and their caregivers — make decisions.

8. Find out about financial assistance

While Medicare covers the bulk of medical expenses, beneficiaries still pay out-of-pocket costs, including premiums, deductibles and copayments. Your loved one may qualify for federal or state programs that help pay some of these costs.

Medicare Savings Programs help pay Medicare premiums and copayments, and the Extra Help program assists with Part D prescription costs. In 2024, Extra Help’s income limits increased to 150 percent of the federal poverty level from the previous 135 percent, so more people are eligible.

Your loved one with limited income and resources may be eligible for full Medicaid at the state level. Participants in full Medicaid, Extra Help or Medicare Savings programs may qualify for a dual-eligible special needs plan. This type of Medicare Advantage plan can provide benefits not available in original Medicare or other Medicare Advantage plans, and they typically do not charge a premium.

9. Understand what care is and isn't covered

Medicare doesn’t cover long-term care in a nursing home or assisted living facility, which is one of its biggest gaps. It pays for some short-term skilled nursing care in a Medicare-certified skilled nursing or rehab center, generally after a three-day stay in a hospital as an inpatient. But other resources might help with these expenses.

If your loved one needs skilled nursing services or physical or occupational therapy services at home, Medicare’s home health benefit might cover some services.

Home health covers part-time or intermittent skilled nursing care, as well as medically necessary occupational, physical and speech-language therapy your doctor orders. It may also cover a limited amount of home health aide services. 

To qualify for Medicare’s home health benefits, your loved one must usually be homebound — meaning under a doctor’s care and unable to get to places outside home without considerable difficulty or help from another person. And the services must be provided through a Medicare-approved home health agency.

10. Learn how to appeal a prior authorization or claim denial

Some health care plans require approval of a service or medication before paying for it. While original Medicare has few prior authorization requirements, a growing number of Medicare Advantage and Part D plans require it before approving certain types of care or drugs.

If denied, an appeal can be worthwhile. A KFF study found that in 2023, only 11.7 percent of Medicare Advantage prior authorization denials were appealed, but nearly 82 percent of the appeals were overturned in part or full. The Medicare Advantage claim denial notice will outline steps for filing an appeal.

If original Medicare denies a claim after a service is performed, the quarterly summary notice will report the amount of noncovered charges and the maximum you may be billed. It, too, will explain steps to appeal the denial.

Consider contacting the provider’s billing office before you appeal. The problem may be a coding error or other mistake that’s easy to fix. Otherwise, you have up to 120 days to appeal a denied claim in original Medicare, 65 days for Medicare Advantage or Part D plans.

11. Be prepared for hospice when the time comes

For a person at the end of life, hospice care, particularly its medical, emotional, spiritual and social services, can bring improved peace of mind and quality of life for care recipients and caregivers. Medicare Part A covers certified hospice care in the home, inpatient hospice center, nursing home or other facility.

Choosing hospice does mean stopping treatment to try to cure the illness or injury. Instead, it focuses on palliative care to ease pain and provide comfort.

To qualify, the doctor must certify that the patient is terminally ill and has a life expectancy of six months or less. Medicare covers most expenses related to terminal illness with few out-of-pocket costs, including some respite care to provide a break for you.

12. Know how to get help

Great resources are available to help with your questions about Medicare enrollment, coverage, costs and claims.

Each state has a State Health Insurance Assistance Program (SHIP), which provides free one-on-one assistance with Medicare questions, including over the phone at 877-839-2675. Medicare’s 800-MEDICARE and the Medicare Rights Center’s helpline at 800-333-4114 are also good resources.

This story, originally published June 5, 2024, was updated throughout, including information about lack of Medicare payments for family caregivers and other options outside of Medicare.