A Full Guide for Getting Health Insurance Options for Seniors

Published on October 07, 2024By Laura M. (Contributor)

For the year 2018, as you are nearing your retirement age as a senior, getting the proper health insurance that is affordable while also covers one or more of your needs is an impending decision. There are a variety of options to choose from and knowing the differences between plans like Medicare, Medigap and Medicare Advantage can help you make an educated decision. In this post, we will go through those options along with tips of your own to make sure you are getting the best coverage.

Medicare: The Basics

Medicare is a federally administered health insurance program available to those aged 65 and older. Medicare has different parts that each cover certain areas of healthcare:

• Part A (Hospital Coverage) — Inpatient care, hospital care, limited home health aide services Part A (hospital insurance) is premium-free for most people who've worked and paid Medicare taxes at least 10 years.
• PART B. Covers dr visit, outpt care, some home health svcs & other med srvs or items that Part A doesn't cover Cost: Part B has a premium, with the cost varying by income.
• Part D (Prescription Drug Coverage): At your local pharmacy or through mail-order, Part D helps pay for prescription drugs. These plans are administered by private insurers so they also differ in cost and what different prescriptions they cover, which is why it's a good idea to compare your options based on the drugs you're currently taking.

Medigap: Filling the Gaps

On the other hand, Medigap (also called Medicare Supplement Insurance) is coverage in addition to Original Medicare and is intended to help people fill the amount of money they have to pay out-of-pocket, like copayments, coinsurance or deductibles (cost-sharing amounts). This way, if you are likely to use a lot of health services it can provide some financial peace of mind. These are policies offered by private insurers, which can help reduce unexpected healthcare costs.

What Does Medigap Cover?

• Deductible for Part A and B services.
• Emergency medical care on trips abroad.
• Medicare does not pay for hospital stays longer than a limited number of days

Also keep in mind that Medigap plans do not cover drugs. To do so, you would have to sign up with another Part D plan.

Medicare Part C (Medicare Advantage): The All-in-One Medicare Solution

Private insurance companies offer Medicare Advantage, which is an all in one alternative to the Original Medicare Plan (Part A and Part B). This plan typically offers everything you would get with Part A & B plus other benefits, such as dental, vision and hearing. Most Medicare Advantage plans offer Part D prescription drug coverage as well.

Pros of Medicare Advantage:

Additional Benefits: Most plans also offer services that are not covered by Original Medicare.

Cost Share: Lower Out-of-Pocket Costs — Typically, has lower premiums or copayments than Original Medicare and Medigap.

Cons of Medicare Advantage:

Network Restrictions — most plans require your doctor to be in-network

Variability in Coverage: different plans will cover different things, so you need to look over the coverage details very carefully.

Medicaid for Seniors

Medicaid, in some cases, can be a lifeline for low-income seniors, as it covers services that Medicare may not. If you qualify, Medicaid may pay for certain costs like nursing home care or long-term support services. Each state runs the program differently so you will want to seek out your local specific requirements and guidelines as to what is covered etc.

Choosing the Right Plan

Consider the following when you are choosing a health insurance plan as a senior:

• Health: Evaluate Your Current And Potential Future Healthcare Needs Many individuals find themselves visiting the doctor regularly or taking prescription medications,…
• Check your income- how much you are earning, and the expenses. While Medicare Advantage plans can provide lower premiums, Original Medicare with Medigap generally will save you more on out-of-pocket costs if your care utilization is known to be frequent.
• Your Doctors and Networks: If you have a provider that you like, confirm that they accept the plan you are about to sign up with, especially with Medicare Advantage plans.

Medicare Enrollment: Important Dates

You will need to know the best time for you to sign up to prevent penalties. The first azure panel launch period will run for seven months: the three months before you turn 65, your birthday month and then a three-month extension afterward. Not taking advantage of this opportunity can lead to increased premiums.

If you are thinking of getting a Medicare Advantage or Medigap plan, the best time to apply is during your initial enrollment period (IEP) and the fall open enrollment period (OEP), which runs from October 15th - December 7th each year.

Extra Help with Drug Costs

Seniors who have trouble with the cost of medications may qualify for Part D added coverage and copayment support through programs such as Medicare's Extra Help. Only those people with very limited income are able to apply for Extra Help, but this can massively reduce the cost of medication.