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How To Navigate The Nuances of Family Medicare

by Melissa Bell
4 minutes read

Medicare can be a tricky topic to understand, especially when it comes to family coverage. There are so many nuances and details that it can be hard to know where to start. Understanding the basics is prudent if you’re responsible for a loved one. Here are some of the nuances of family Medicare and tips on navigating the system best.

Not Everyone Is Eligible For Medicare

For eligibility, a person must either be 65 years of age or older or have a qualifying disability to be eligible. If you’re responsible for a loved one who does not fall into either of these categories, then they will not be able to get Medicare coverage.

There are a few exceptions to this rule. If a person is under 65 but has End-Stage Renal Disease (ESRD) or Lou Gehrig’s disease, they may still be eligible for Medicare.

Additionally, if someone is younger than 65 but receives Social Security disability benefits for at least 24 months, they may also be eligible for Medicare.

If you’re unsure whether or not your loved one is eligible, you can check with the Social Security Administration.

Medicare staff opening a black case with medical device

There Exist Four Different Parts To Medicare

Medicare comprises four parts: Part A, Part B, Part C, and Part D. Each part covers different medical expenses.

Part A covers inpatient hospital care, skilled nursing facility care, hospice care, and home health care.

Part B covers doctor’s visits, outpatient care, preventive services, and medical equipment.

Part C is known as Medicare Advantage. This part of Medicare is offered through private companies. It covers everything that Part A and B cover, plus additional benefits like prescription drug coverage and routine dental and vision care.

Part D covers prescription drugs.

If your loved one is on Medicare, it’s important to understand which expenses are covered under each part. That way, you can be prepared when medical bills start coming in.

There Are Two Different Types Of Medicare Advantage Plans

There exist two types of Medicare Advantage plans Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs). HMOs typically have lower premiums but more restrictions. PPOs have higher premiums but offer more flexibility.

The type of plan best for your loved ones will depend on their individual needs and preferences. If they’re healthy and don’t mind sticking to a network of doctors, an HMO might be a good option. But a PPO might be a better choice if they need more flexibility.

Medicare Advantage plans also offer extra benefits like dental and vision coverage. If your loved one is interested in one of these plans, compare the costs and benefits before enrolling.

AEP And OEP Are Important Dates To Remember

AEP, or the Annual Election Period, is when people on Medicare can make changes to their coverage. This includes enrolling in a new plan, switching from Original Medicare to a Medicare Advantage Plan, and changing prescription drug plans.

OEP, or Open Enrollment Period, is a similar time of year when people on Medicare can change their coverage. The main difference is that OEP is only for people already enrolled in a Medicare Advantage Plan.

The difference Between AEP and OEP can be confusing, but knowing the difference is important to ensure your loved ones get the coverage they need.

There Are A Lot Of Different Medicare Plans To Choose From

There are different Medicare plans to choose from, and it can be overwhelming to figure out which is best for your loved one. There are resources available to help when choosing between Medicare Advantage or supplemental plans.

The first step is to visit the Medicare website and use the Plan Finder tool. This tool will help you compare plans and find one that meets your loved one’s needs. You can also contact the Medicare helpline at 800-MEDICARE (800-635-4327). The representatives there can answer any questions about Medicare and help you find the right plan for your loved one.

There Are Some Things That Medicare Doesn’t Cover

There are some things that Medicare doesn’t cover, including long-term care, dental care, and vision care. That’s why it’s important to understand your loved one’s needs and choose a plan accordingly.

You can purchase a separate dental or vision plan if your loved one needs dental or vision coverage. Or, you can enroll in a Medicare Advantage Plan that includes dental and vision coverage.

If your loved one needs long-term care, you’ll need to purchase a separate long-term care insurance policy. Medicare does not cover long-term care.

There are a lot of different factors to consider when choosing a Medicare plan for your loved one. With a little research, you can get a plan that meets their needs and gives you peace of mind. For any questions, don’t hesitate to contact the Medicare helpline at 800-MEDICARE (800-635-4327). The representatives there can help you navigate the nuances of family Medicare and find the right plan for your loved one.

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