If you’ve been working your whole life, you probably haven’t had too much to worry about when it comes to insurance. You’ve also been paying a hefty portion of your earnings to the Medicare program ever since you first started working and are interested in recovering that investment. Now that retirement approaches, it’s time to move from employer-provided healthcare to seniors health insurance options.
Why It’s Hard to Choose
Seniors health insurance options can be tricky to navigate, and having the right information is key to choosing a plan that provides everything you need. The good news is there are options out there; the bad news is those options are sometimes hidden behind a wall of confusing terminology. Don’t let the terms confuse you. You can find a plan when you follow these steps to making the right choice among your seniors health insurance options.
5 Ways to Get the Best Seniors Health Insurance for 2019-2020
1. Understand What You Already Have
In some cases, your group health insurance through your employer can be extended to cover you after you retire. This is not always an option, and the costs may change dramatically. In most cases, you will only qualify if you’ve worked for the same company for many years.
If your employer offers workshops or literature with information about your health insurance options, carefully make use of these, so you understand what’s available to you. Of course, your employer may not have a retiree health plan, but you may be able to continue under COBRA. It’s important to understand if you can, how long that’s allowed, and how much it would cost.
What Is COBRA?
COBRA is an acronym for a law passed by Congress called the Consolidated Omnibus Reconciliation Act. Its original purpose was to provide insurance during the gap in coverage for those who have been laid off. COBRA allows you to continue your health insurance through your employer’s group plan, though you pay the entire premium yourself plus a 2% administration fee.
In some cases, if you’re retiring a little early and are not yet eligible for Medicare, you may be eligible under COBRA regulations and can stay on your old health plan for up to 18 months.
2. Educate Yourself About Medicare
If you’re approaching 65 and will soon be joining Medicare, things can get confusing. Take a little time to understand the options before you. There are two primary types of Medicare: Original Medicare and Medicare Advantage.
Original Medicare is provided by the government and is essentially a fee-for-service plan. There are two parts, labeled A and B. Part A is hospital insurance, while Part B is much like traditional medical insurance.
With both of these types of Medicare, you pay a deductible, and then Medicare kicks in to pay up to the approved amount. If you incur expenses beyond the approved amount, you’ll have to pay them either yourself or through a coinsurance plan if you have one.
Original Medicare also has an optional Part D. If you’re willing to pay an added premium for this part, you can get help with your prescription drug coverage. If you are entering retirement and you already know that you have significant prescription drug costs, it may be a good idea to sign up for part D.
What Original Medicare Covers
In general, and assuming you seek care where Medicare is accepted, original Medicare Parts A and B will cover hospitalization, some home healthcare, skilled nursing care, outpatient services, and doctor visits, lab tests, preventative care, physical and occupational therapy, and some mental health care and medical supplies.
What Original Medicare Doesn’t Cover
Original Medicare parts A and B do not cover prescription drugs, dental or vision, alternative treatments such as acupuncture, cosmetic surgeries, routine foot care, or long-term care.
Medicare Advantage plans are offered by private insurers who contract with Medicare to offer original Medicare plus extra services and coverage, depending on the plan you choose. Which Medicare advantage plan is open to you will depend in part on which state you live in and your unique healthcare challenges and goals.
3. Talk To An Agent
The next step in choosing among the many seniors health insurance options out there is to talk to an agent. While it is possible to call all the private insurers yourself and talk to them one by one, you’re going to have a much better experience and avoid wasting money overpaying for what you don’t need by getting some professional help.
You want to talk to a health insurance agent who specializes in health insurance for seniors. They will know the right questions to ask to find out what you need and will be knowledgeable about which plans will best fit your unique needs.
Questions Your Agent Will Ask
As you talk to your agent, consider these questions they will ask and how best to answer them:
- What kind of medications do you take now?
- Who is your current doctor, and how important is it that you stay with them?
- Do you have any chronic conditions?
- Do you intend to travel often?
- Do you have any coinsurance in place already?
- Is it more important to you to keep monthly premiums low and deductibles high, or vice versa?
Questions You Should Ask
Once you start looking at plans and talking with your agent, you should have some questions also:
- Do doctors and healthcare providers take new patients on this plan?
- Do I get any coverage for visits outside the network?
- Where am I covered? Do I get any coverage for care outside the service area?
- What is the annual maximum out-of-pocket cost?
- What are copayments like, and what do I need to pay copayments for?
- What does the plan cover that original Medicare doesn’t cover?
- How does the plan deal with prescription drugs?
- Am I able to continue using my current pharmacy?
4. Choose a Medigap Plan
When you and your agent have asked and answered all the important questions, you should have a good idea of what’s most important to you and what you need. Your agent should be able to help you navigate the sometimes complicated process of enrolling in Medicare plans and can help you understand the Medigap plans you should consider.
Medigap plans are offered by private insurers as a supplement to original Medicare. Here’s what you need to know about these policies:
- To be eligible, you must have Medicare part A and part B
- These are not the same as a Medicare advantage plan; they are only supplements
- They are guaranteed renewable no matter what health problems may arise in the future
- They do not cover prescription drugs; only Medicare part D can do that
- If you already have a Medicare Advantage plan, it’s illegal for anyone to sell you a Medigap policy
- All Medigap policies are standardized by federal and state law, though not every insurer has to sell all available policies
- Medigap policies are standardized differently in Massachusetts, Wisconsin, and Minnesota
Why Do I Want Medigap?
There are quite a few Medigap policies available because everyone wants different things. The various policies can cover important gaps in coverage, like hospital costs, for up to a year after your Medicare benefits are used up. They will also cover all, or at least part, of your copayment for hospice care under original Medicare Part A.
Some will give you extra coverage for skilled nursing facility care coinsurance and help you pay your Part B excess charge. Some will also cover foreign travel, and all will pay at least something to cover the first 3 pints of blood you may require in a transfusion.
The different plans have different deductibles and premiums. As with all insurance plans, the higher the monthly premiums you pay, the lower your deductible. If you keep your monthly premiums lower, you’ll need to pay a higher deductible before coverage kicks in.
5. Buy At the Right Time
If you buy a policy during your six-month open enrollment period, which begins the month you turn 65, and you are enrolled in Medicare part B, you’ll be able to choose any policy sold in your state no matter what health problems you might have. If you wait until the open enrollment period is over, insurers can deny you coverage for a pre-existing condition or can charge you higher rates for coverage.
Choosing the Right Seniors Health Insurance Option
There are many options out there for seniors health insurance policies. Choosing the right one can certainly be confusing, but if you think carefully about what you need, take time to understand the basics of Original Medicare, and talk to an insurance agent who specializes in seniors health insurance, you’ll be able to get the coverage you need when you need it.
Visit the Seniors Solutions Group today and talk with an expert who can take you through the process step-by-step from start to finish. Get the peace of mind for your future that you deserve so you can enjoy a long and happy retirement.