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How to Help - Dual Special Needs Plans

How to Help

Step 1: Understand Medicare Basics

  • Medicare Part A: Hospital insurance that covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
  • Medicare Part B: Medical insurance that covers certain doctors’ services, outpatient care, medical supplies, and preventive services.
  • Medicare Part D: Prescription drug coverage.
  • Medicare Supplement Plan (Medigap): Additional coverage to fill “gaps” in Original Medicare.
  • Medicare Advantage Plan (Part C): An alternative to Original Medicare that includes Part A, Part B, and usually Part D, offered by private companies approved by Medicare.

Step 2: Confirm Eligibility and Enrollment Periods

  • Eligibility: Ensure your parents are eligible for Medicare (typically age 65 or older, or younger with certain disabilities).
  • Enrollment Periods: Be aware of important dates:
    • Initial Enrollment Period (IEP): Starts three months before the month your parent turns 65 and ends three months after.
    • General Enrollment Period (GEP): January 1 to March 31 each year.
    • Open Enrollment Period for Medicare Advantage and Prescription Drug Plans: October 15 to December 7 each year.
    • Special Enrollment Periods (SEP): For specific circumstances, like losing employer coverage.

Step 3: Gather Necessary Documents

  • Social Security Number and Card
  • Medicare Number (if applicable)
  • Proof of Residency (e.g., utility bills)
  • List of Current Medications
  • List of Doctors and Hospitals Used

Step 4: Enroll in Original Medicare (Parts A and B)

  • Online: Visit the Social Security Administration website (www.ssa.gov).
  • Phone: Call the Social Security Administration at 1-800-772-1213.
  • In Person: Visit your local Social Security office.

Step 5: Compare Medicare Supplement Plans and Medicare Advantage Plans

  • Medicare Supplement (Medigap):
    • Compare different Medigap plans (Plan A, B, C, D, F, G, K, L, M, N).
    • Visit the official Medicare website (www.medicare.gov) to compare plans.
    • Check state regulations, as Medigap plans may differ by state.
    • Consider factors like coverage, premiums, out-of-pocket costs, and whether their doctors accept the plan.
  • Medicare Advantage (Part C):
    • Compare different Medicare Advantage plans in your area.
    • Visit the official Medicare website (www.medicare.gov) to compare plans.
    • Consider plan benefits, premiums, network restrictions, out-of-pocket costs, and additional services (e.g., vision, dental, hearing).

Step 6: Enroll in a Medicare Supplement Plan or Medicare Advantage Plan

  • Medigap:
    • Contact the private insurance company offering the Medigap plan.
    • Complete the enrollment forms and provide any required documents.
  • Medicare Advantage:
    • Visit the plan’s website or contact the plan provider directly.
    • Enroll online, by phone, or by submitting a paper application.

Step 7: Review Prescription Drug Coverage (Part D)

  • Compare Plans: Use the Medicare Plan Finder on www.medicare.gov to compare Part D plans.
  • Check Coverage: Ensure that the plan covers your parents’ medications.
  • Enroll: Follow the plan’s enrollment process, which can be done online, by phone, or via a paper application.

Step 8: Monitor and Review Annually

  • Annual Review: Each year, review your parents’ coverage during the Open Enrollment Period (October 15 to December 7).
  • Adjust as Needed: Make any necessary changes to their plans to better meet their needs for the upcoming year.

Step 9: Get Help if Needed

  • Medicare Assistance Programs: Contact your State Health Insurance Assistance Program (SHIP) for free, personalized counseling.
  • Medicare Customer Service: Call 1-800-MEDICARE (1-800-633-4227) for assistance.

Step 10: Keep Records

  • Documentation: Keep copies of all enrollment forms, correspondence, and insurance cards.
  • Update Information: Notify Medicare and insurance providers of any changes in contact information or health status.

By following these steps, grown children can effectively assist their parents in navigating the complexities of Medicare and ensuring they have the right coverage to meet their healthcare needs.

For further assistance, please call or email us through www.medicareformyparents.com. We are here to help!

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