Health Insurance for Seniors
Your healthcare needs are changing. Do you know what your options are?
Health Insurance for Seniors
Your healthcare needs are changing. Do you know what your options are?
What Health Insurance options do senior citizens have?
As you approach retirement, you face many decisions when it comes to your healthcare. Your health needs—and your spouse’s—may also be changing. In addition, you may need to transition from your employer-sponsored insurance to Medicare and supplemental insurance.
Tezana Insurance wants to help you successfully navigate this transitional part of your life. Let’s take a closer look at Medicare and what your
options are.
What is Medicare?
Medicare is a government insurance program offered to people 65 years or older to younger people with specific diseases or disabilities. Seniors are eligible to enroll in Medicare up to three months before turning 65, but there are some things you should know about the enrollment process.
Who is eligible for Medicare?
Most people over the age of 65 are eligible for Medicare, and many pay little to nothing out-of-pocket for certain types of care. In fact, if you or your spouse worked for a minimum of ten years and had Medicare taxes withheld from your paychecks, then you are automatically eligible for Medicare when you turn 65.
US residents and recent immigrants who do not have this work history can still become eligible for Medicare. However, knowing how to enroll can be confusing, and many may not realize that they have options regarding their Medicare coverage. In addition, there is often some confusion about the differences between Medicare and Medi-Cal (or Medicaid in other parts of the US).
How does Medicare work?
You may have noticed that Medicare is divided into Parts. Understanding these parts is crucial to ensuring you get the healthcare coverage you need.
Medicare Parts Explained
A
Medicare Part A
Hospital Coverage – This insurance covers hospital expenses, hospice care, skilled nursing facility stays, rehabilitation facility stays, and also includes certain home healthcare services.
It does not guarantee that everything will be paid long term. There are restrictions that limit the length of time these services will be covered, if at all.
Medicare Part A Includes:
- Inpatient care in a hospital
- Skilled nursing facility care
- Nursing home care (inpatient care in a skilled nursing facility that’s not custodial or long-term care)
- Hospice care
- Home health care
B
Medicare Part B
Medical Coverage – Medicare covers medical services, including doctor’s visits, ambulance services, clinical research, durable medical equipment, mental health services, and limited outpatient prescription drugs.
This can be broken down into two sections: Medically necessary services & Preventive services.
Medicare Part B Includes:
- Clinical research
- Ambulance services
- Durable medical equipment (DME)
- Mental health services
- Inpatient services
- Outpatient services
- Partial hospitalization
- Limited outpatient prescription drugs
C
Medicare Part C
Medicare Advantage – This alternative to Original Medicare (Part A and B) is offered by private insurance companies in agreement with the federal government.
It includes the same coverage as Medicare with additional supplemental benefits at a higher monthly premium in comparison to the Original Medicare.
D
Medicare Part D:
Prescription Drug Coverage – This is a separate program that only covers prescribed drugs. Thus, it is important to select the best program for your needs.
- Tier 1—lowest copayment: most generic prescription drugs
- Tier 2—medium copayment: preferred, brand-name prescription drugs
- Tier 3—higher copayment: non-preferred, brand-name prescription drugs
- Specialty Tier—highest copayment: very high cost for prescription drugs
Who qualifies for Medicare Part D?
- Any person age 65 or older
- People under the age of 65 with certain disabilities
- People with End-Stage Renal Disease (ESRD), which is permanent kidney failure (either required to do dialysis or a kidney transplant)
What is the difference between Medigap and Medicare Advantage?
For many, Medicare Parts A and B do not cover all of their healthcare needs. When this happens, seniors can choose between a Medigap policy or Medicare Advantage, also known as Part C.
Medicare Advantage offers private insurance that can include the prescription drug coverage offered in Part D, as well as vision and dental coverage. Rather than buying a plan for each healthcare need you have, you can get everything you need that Medicare does not cover, in a single plan.
Medigap plans are another way to get the coverage that Medicare doesn’t provide. You are able to choose between multiple plans that offer different benefits depending on your healthcare needs and budget. However, you may still need to purchase private insurance for certain types of care or pay out-of-pocket.
For some seniors, Medigap plans are more cost-effective. For others, a Medicare Advantage plan makes more sense. You need an insurance partner to help you determine what works best for you. At Tezana Insurance, we are here to help. Let’s work together to find the plan and level of coverage that will protect you and your spouse in this new phase of life.
When to Enroll in Medicare
The Initial Enrollment Period (IEP) for Medicare starts 3 months before you turn 65 and ends 3 months after your 65th birthday. After the IEP, there is an open enrollment period every year for seniors who wish to make changes to their Medicare Coverage.
- While everyone is not obligated to enroll into every part of Medicare, late fees can accumulate as time goes on for those who do not sign up on time.
- Part A Late enrollment penalty – Some have to purchase Part A because they do not meet the requirements to qualify for premium-free Part A. If you do not enroll when you are first eligible, your monthly premiums can increase by up to 10%.
- Part B Late enrollment penalty – If you did not enroll in part B when you are first eligible, your monthly premiums could increase by as much as 10% for each 12-month period. In most cases these penalties will be included for as long as you have the plan.
- Part D Late enrollment penalty – This late enrollment penalty that will be permanently added to your Medicare drug coverage premium for as long as you have coverage.
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