Medicare

With that word of caution, here's what you need to know up front about Medicare. First, consider it a supplement to your parents' long-term care, not the nut to foot the entire bill. Yes, it will pay for checkups with doctors and most expenses if your dad is hospitalized for at least three days. But will it pay for long nursing-home stays, an assisted-living facility or the vast majority of prescriptions? No, no and no. In fact, Medicare will cover only up to 100 days of skilled nursing-facility care provided your parent has been in the hospital for three consecutive days — and often the coverage is for less than 20 days, according to Judith Stein, executive director of the Center for Medicare Advocacy.

If nursing care extends past 20 days, the patient is responsible for a hefty co-pay of $101.50 per day — not per month. It's the skilled component of care that is the clincher. Say your mom needs a nurse to handle tube feeding after surgery. Medicare has you covered. But it won't pay the cost of a health aide to help your mom get around town afterward.

You can certainly fight for better treatment. If Medicare declares it will no longer pay for your parent's nursing care, you can ask to have the decision reviewed, although you will have to privately pay in the meantime. "Accept the review, because if it rules in your favor you will get reimbursed for whatever you paid during the review period," says Harry S. Margolis, a Boston attorney specializing in the elderly.

You can also hire a geriatric-care manager to badger the Medicare providers. Their services aren't cheap ($50 to $200 an hour), but many care managers came out of the public health agencies. They know the system and how to phrase an appeal to make a difference. For example, say your dad requires physical therapy, but Medicare refuses to pay because the program covers only rehabilitative therapy, not therapy to maintain strength or flexibility. "If you argue that without the therapy the patient will significantly regress, that can be fought," says Claudia Fine, president of the National Association of Professional Geriatric Care Managers. (You can check the new National Council on the Aging Web site — www.benefitscheckup.org — for a list of benefits, services and discounts available to older Americans, from Medicare to often overlooked veterans' benefits.)

Just remember: Medicare doesn't cover prescription drugs or most preventive screenings, so your parents will need supplemental insurance. The choices include a Medigap policy (choose from 10 plans, A through J); a Medicare HMO plan; or, starting next month as a pilot program in 23 states, a preferred provider organization (PPO). The differences among these three plans? Price and coverage.

The Medicare HMO plans, some of which offer prescription-drug coverage (albeit limited), cost an average of $390 a year. The planned PPOs will offer more flexibility in choosing doctors and facilities, but will most likely charge more than the HMOs. The drawback with both of these options is that your parents could end up having their coverage discontinued. HMO insurers, fed up with low Medicare reimbursement rates, have dropped coverage of almost 2.5 million seniors since 1998. That has left customers scrambling for coverage. In Florida, for instance, half of the state's counties have no Medicare HMO plans. The fear among consumer advocates is that PPOs will eventually do the same.

That's one reason your folks may want to consider Medigap when they first have the opportunity (they have six months after turning 65, but they must also sign up for Medicare Part B). Yes, the Medigap plans can range dramatically, from around $350 for the bare-bones Plan A with no prescription-drug coverage to $10,000 for the deluxe Plan H. Still, Medigap remains the safer bet. Here's why: If your parents join an HMO, get dumped, then can't find another managed-care plan locally, Medigap may be their only choice. Problem is, since they missed the original enrollment period, they'll have only three, not 10, Medigap plans to choose from, none of which include drug coverage. And they will now have to undergo health checks, something those who sign up in that six-month window avoid.