Health insurance for seniors may be difficult to get above and beyond the standard Medicaid or Medicare coverage. Medicare is the federal health insurance program that covers most people aged 65 and older while Medicaid is the federal insurance program used to cover those who are disabled no matter what their age.
There are some people who are younger than age 65 and who are disabled or who have end-stage renal disease who are also eligible for coverage under Medicare. However, as with all other health insurance policies, Medicare does not cover everything. Therefore many seniors look for other health insurance coverages that may cover the services which Medicare does not.
Medicare covers most acute medical conditions or conditions that the patient will recover from, but does not cover most care that is given at home, in assisted living facilities or in nursing homes. That gap may be covered by Medicaid.
Medicare benefits are provided in four different parts called parts A, B, C and D. Medicare part A is premium free for most people and will help to pay for inpatient hospital care as well as some skilled nursing facilities and hospice. Most people do pay a monthly premium for part B which is the part that helps to pay for doctors, outpatient hospital care and other therapies such as physical and occupational therapy.
Medicare part C allows for a variety of HMOs and PPOs to insure individuals with Medicare beneficiaries. By federal law they must provide the same benefits that the original Medicare plan provides but are allowed to offer additional benefits such as dental and vision care. To control costs these plans are allowed to limit a patient’s choice of practitioners to those who are specifically in network. In that respect Medicare part C operates much the same as an HMO does.
Medicare part D provides prescription drug benefits through private insurance companies and people must pay an extra premium each month which can vary from state to state and company to company.
Although Medicare does provide for different parts of their insurance coverage, to attempt to cover the majority of individuals and their needs there continues to be a gap in what is covered and what needs to be covered for our aging population. This gap is usually covered by something called supplemental Medicare insurance which is offered by a private company. There are 12 standardize plans that are defined by federal law but not all states offer all 12 plans.
As if this isn’t confusing enough, Medicare also offers more than 40 booklets to help people understand the program and answer their questions.
One way to help you choose a supplemental insurance plan is to pick it up at the age of retirement. As you grow older the price will increase incrementally each year but it will grow to a lesser degree if you have been a customer of the company since the day after your retirement.
All of these supplemental plans should work in addition to your current benefits with Medicare or your primary care company, and not as the primary source of your health insurance coverage. At some time seniors must see specialists for particular health problems, and while Medicare does not cover those necessities, many of the supplemental health insurance policies will.
Many of the supplemental health insurance policies cover anywhere from 50 percent to 80 percent of the balance remaining after a Medicare has paid their part. There are many variables with the different Medicare plans and it’s very hard sometimes to determine which option is best for the individual to use. Sometimes, it can seem that supplemental insurance policies are not worth the extra money so the differences between a policy that costs $100 per month must be weighed against the cost of prescription and physician benefits in order to determine whether or not the supplemental plan fits the needs of the senior.
Texas Health Options: Health Insurance Information for Seniors
Alabama Department of Insurance: Medicare Supplement Insurance and Long-term care Insurance Information
USA.gov: Senior Citizens Resources