Seniors have more options when it comes to obtaining health insurance than any other segment of the population. Here’s some information about, and expert advice for, each of them.
Buying health insurance tends to be a rather joyless experience for a lot of people, no matter how young or old they may be.
That certainly seems to have been the experience of Gail Cavanaugh, an agent with Columbia, South Carolina-based Colonial Life, who admits that “choosing a health plan today is an overwhelming task.”
Given the sheer number of options that are made available to American seniors when it comes to this process, though, the argument could be made that the older members of our population have it quite a bit worse than their more youthful counterparts.
After all, it isn’t out of the question for today’s seniors to find themselves contemplating one or more of the following forms of health insurance as they age: retiree coverage, other private insurance, Medicare, and Medicaid.
Coming to grips with each of these offerings should be a little easier for you and your loved ones once you’ve made your way through the following descriptions and explanations.
Actually, some seniors don’t have a whole lot to worry about in terms of acquiring health insurance in their retirement years (or near-retirement years), as the coverage they first obtained via their employers continues to remain in force—to varying degrees--even after they walk away from their jobs.
These folks tend to be fairly small in number, though, as the majority of employer health plans end when the people attached to them retire.
If you’re lucky enough to be included among this select—and dwindling, it seems—group of seniors, there are a few things you should know about the situation:
Finally, don’t forget that private-sector employers are under no obligation to offer retiree health insurance. Also, most of those that do decide to provide them to employees can cut or eliminate those plans at any time—unless, of course, they have made specific promises (in writing) that they will maintain them in any specific ways or for a set period of time.
A far more likely health-insurance-related situation than the one above for most American seniors is that they may retire early—at, say, the age of 55—and then find themselves in need of health insurance between then and when they turn 65, which is when they’ll become eligible for Medicare.
Although employers sometimes will help fill this gap by extending a person’s job-based health insurance until he or she turns 65 and becomes eligible for Medicare, a more typical scenario is that the senior in question will have to purchase this temporary coverage on his or her own, and usually via the federal health insurance marketplace or the related state “exchanges.”
A couple of notes related to this course of action:
Once you turn 65, though, you’ll probably drop any marketplace plan you may have picked up in the preceding years in favor of some form of Medicare, which is the federally backed health insurance program for seniors who are older than 65 and who spent at least 10 years working full time. (It also supports some younger people who receive Social Security disability benefits.)
Here’s where things can get a bit complicated, unfortunately. That’s because there isn’t just a single policy or product related to Medicare. Instead, it’s divided into four parts that usually are referred to as Part A, Part B, Part C, and Part D. And just to add even more confusion to the situation, there’s a related form of coverage known as Medicare supplement insurance, or “Medigap.”
As difficult as it may be to wrap your head around all of these Medicare-related options, you’re going to want to give it your best shot, as Rachel Kenselaar, co-founder of eCaregivers.com, says that “the first step in selecting a health plan is understanding the difference between Medicare and Medicare Advantage plans.”
Speaking of which, here is some additional information about both of those health insurance options and more:
Also commonly referred to as “hospital insurance,” Medicare Part A covers many of the costs associated with in-patient hospital stays, care that’s provided in skilled-nursing facilities, hospice care, and some instances of home health care.
There are some limits placed on this coverage, of course, but it’s hard to complain about that fact when you consider that it’s made available to most people free of charge.
By the way, if you’re receiving Social Security benefits when you become eligible for Medicare (which is a seven-month period that surrounds your 65th birthday), you’ll be automatically enrolled in Medicare Parts A and B.
This form of Medicare often is called “medical insurance,” which makes sense given that it covers all sorts of outpatient medical services like doctor’s visits, “durable” medical equipment and supplies (think blood sugar monitors, CPAP devices, hospital beds, walkers, and wheelchairs), laboratory and diagnostic tests, mental health care and treatment, various kinds of preventative care (such as flu and pneumonia vaccinations), and more.
Unlike Medicare Part A, Part B usually isn’t free and has both monthly premiums and small deductibles associated with it (although private Medigap insurance can pick up some or all of the latter).
Also, while Part B is considered optional (you’re automatically enrolled in Part A when you apply for Medicare), if you decide to opt out of it—because you or your spouse still have health insurance through an employer or a union—when you first enroll in Medicare but later decide you’d like to buy the coverage, your premium probably will be higher than it would’ve been otherwise due to a penalty that’s imposed on people who are actively working and receiving health insurance from an employer fail to purchase it.
When contemplating Medicare Parts A and B, Kenselaar says, remember that neither of them “cover most dental care, dentures, eye exams related to prescription glasses, hearing aids, prescription drugs, or long-term care.”
So, she adds, it’s important to understand what supplemental policies exist—such as Medicare Part D and Medigap, both detailed below--and the alternatives offered through Medicare Advantage plans.
These “Medicare Advantage” plans basically serve as an alternative to or substitute for Medicare Parts A and B.
They’re offered by private insurance companies who contract with, and receive compensation from, the federal government.
Other than that, the main differences between Medicare Advantage plans and the coverage associated with Medicare Parts A and B are that people who choose the former option:
At long last, we’ve come to Medicare Part D. These plans help people who are enrolled in Medicare Parts A and B pay for prescription medications, a cost that isn’t covered by the aforementioned forms of Medicare.
Although they’re approved and regulated by federal government, they’re provided to members of the public by private insurance companies. Also, like Medicare Advantage plans, and unlike Medicare Parts A and B, Part D coverage isn’t standardized. That means that different plans will cover different medications to different extents.
As for Medigap (or Medicare supplement insurance) policies, they’re also sold by private companies.
They exist to fill the coverage gaps that are left open by Medicare Parts A and B. Specifically, Medigap plans can help people pay some of the co-insurance costs and deductibles related to their care.
Four things to keep in mind if you’re thinking of purchasing this kind of coverage:
For more information on this kind of coverage, read our “Medigap Insurance Policy FAQ.”
When choosing a supplemental policy provided by a private insurer, eCaregivers’ Kenselaar and Sarah O'Leary, CEO and founder of Exhale Healthcare Advocates, suggest putting a bit of time into the following:
Ask yourself, "What are my current and anticipated medical needs, and what policy is the best value for me?" For instance, O'Leary says, “If a patient is in need of a hip replacement in the next year, he should bear that in mind when considering his supplemental plan choice for the upcoming year.”
Adds Kenselaar: “Everyone’s financial situation and health condition are different so write down what coverage is important to you and ask lots of questions before enrolling in a health plan.”
Get objective advice when choosing or changing your supplemental policy. “AARP, for example, recommends a United Healthcare supplemental policy for its members,” she shares. “Most members don't realize that AARP is paid for that endorsement based on how many AARP members enroll in the program. This makes the advisement less than unbiased. Further, most insurance brokers are paid by insurance companies and may have a compromised point of view.”
As for what O’Leary would recommend instead, that would be for seniors to do “careful, objective research on their own. Family members who have the ability to understand the complexities of the Medicare system may be of help, and professional independent advocates can be extremely helpful, too.”
Kenselaar also recommends roping family and friends into the situation, as well as “[going] to the local senior center and [finding] out about their experiences with Medicare and Medigap plans.”
This health insurance program, unlike Medicare, is administered by individual states—although it was set up, and is partially funded, by the federal government.
Also, rather than being an entitlement program (people are entitled to it because they helped pay for it through taxes) like Medicare, Medicaid is provided to those in need.
In particular, it’s provided to various segments of the population—including seniors, children, pregnant women, and people with disabilities--who have limited incomes and resources.
One of the peculiarities related to Medicaid is that many seniors have to “spend down” the bulk of their assets before they can benefit from its assistance—which can be summed up by saying it pays for many of the same services that tend to be covered by Medicare as well as the majority of the costs associated with long-term care provided by skilled-nursing facilities, hospice care, and some home health services.
That’s an overly basic look at what Medicaid can provide to seniors, though, as the services covered by the program varies from state to state. To learn more about how Medicaid works where you live, go to State Medicaid & CHIP Profiles.
Here are a few final words of wisdom courtesy of Colonial Life’s Gail Cavanaugh, eCaregivers’ Rachel Kenselaar, and Exhale Healthcare Advocates’ Sarah O'Leary.
Kenselaar and O'Leary already mentioned this piece of advice in regard to choosing a Medigap policy, but Cavanaugh suggests it also should be heeded when contemplating the other forms of health insurance likely to be considered by seniors.
“Health insurance contracts are very complicated,” she says, and “insurance agents are trained in helping to interpret them and in meeting compliance issues.”
“Seniors absolutely should review their health plans each year,” Kenselaar suggests, “and for one simple reason: our health is unpredictable and seniors’ needs can change from one day to the next.”
As part of this annual review, she recommends asking yourself the following questions:
O’Leary is another proponent of such reviews, especially for seniors who are enrolled in a Medicare Advantage, Medicare Part D, or Medigap plan.
“The drug formularies—the list of drugs included in one's policy--and plan benefits of privately insured Medicare plans change constantly,” she says. “The drug that was covered last year might not be this year, and the breadth of coverage can change.”
Another reason you should give your plan a thorough look every year when open enrollment seasons rolls around, O’Leary adds: doing so “can save [you] thousands in the long run.”
“Most people, seniors included, don't look to negotiate the price of their non-emergency care, medical devices, and prescription drugs prior to the receipt of their services, devices, and drugs,” O’Leary says.
If that describes you, reconsidering your non-negotiable stance could save you a lot of money. “The mark-up on hearing aids is over 100 percent in some areas, and that price can be negotiated,” she explains. “Shopping around the price of prescription drugs can also lead to big savings.”
A “common and dangerous” misconception many seniors have is that “the cost of hiring a caregiver for custodial care--assistance with personal hygiene, meal preparation, running errands--is covered by Medicare,” Kenselaar says.
Unfortunately, it isn’t—yet 70 percent of Americans over 65 are expected to need some sort of long-term care in their lifetime, according to MetLife’s 2012 Market Survey of Long-Term Care Costs.
Seniors could avoid some of the expenses that are related to long-term care--and typically aren’t covered by the health plans discussed throughout this article--if they planned ahead and purchased a long-term care policy or added a long-term care rider to their life insurance policies, she adds.
Cavanaugh also calls for more seniors and their loved ones to consider this form of insurance, especially if they have a significant estate. “Many seniors overlook long-term care coverage for [these] expenses,” she says, despite the fact that “plans are less expensive at younger ages.”
For more information about this type of insurance, check out our “Long-Term Care Insurance FAQ.”
That’s another of O’Leary’s suggestions, who says that “seniors owe it to themselves to appeal any denial of claim or service by the government or their private insurer.”
The typical claim denial will be overturned after just a few attempts, she adds, “so it's important to keep appealing denials. Help from a loved one or professional advocate can help this process become less of a burden on the senior.”
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