General

Senior Healthcare Coverage: What You Need to Know

Our advisors help 300,000 families each year find the right senior healthcare coverage. This article covers the most common questions and concerns we hear from our clients.

The most important thing to remember is that there’s no one-size-fits-all solution when it comes to senior health insurance. Whether you’re an aging adult, a family caregiver, or an advisor helping a client, it’s critical to take the time to consider the unique health needs and financial circumstances of the individual you’re working with.

Medicare

Medicare is a federal program that provides health Go to page care for seniors. To qualify for Medicare, a person must be age 65 or older and have paid into the system through their taxes for at least 10 years. Individuals who are disabled can also become eligible after receiving Social Security disability benefits for two years. Medicare consists of hospital insurance, medical insurance for doctors and outpatient services, and prescription drug coverage. It requires a monthly premium and copays, as well as deductibles and coinsurance.

In addition to Medicare, private insurers offer supplemental coverage for seniors. These policies, which are called Medigap, provide secondary coverage to help pay for some of the costs that Medicare doesn’t cover, including co-pays and deductibles. They can also be used to pay for long-term care services like home health, hospice and nursing homes.

For those who choose to enroll in Original Medicare, they can purchase a separate Medicare Part D plan for prescription drug coverage. This isn’t necessary for those who opt for a Medicare Advantage plan, as most of them include prescription drug coverage in their plan. If you’re not happy with your current Medicare Advantage or supplemental insurance policy, it is possible to switch during the annual open enrollment period.

Some of the most commonly reported reasons why seniors don’t switch plans involve a belief that they did their homework when selecting their initial plan and do not want to go through the hassle of revisiting their decision. Others cite a fear that a change in plans could disrupt their ongoing medical care or result in higher costs.

A relatively small number of seniors in our focus groups stated that they would be willing to change their plan in response to a major modification in their personal health care needs or, in the case of Medicare Advantage and Part D, a big increase in drug prices or provider networks. It is critical for individuals to compare various plans annually to ensure they have the best possible coverage and the most affordable rates. If you’re concerned about high medical costs, you may be able to reduce your monthly payments by choosing a lower-tier plan or switching providers altogether.