Health insurance has become one of the most difficult things to navigate in modern life. Since the Affordable Care Act, things have only become more complicated; yet for many on an employer’s insurance, things don’t change much: until you get ready to retire. The real difficulty comes when you have to switch over to insurance for elderly subscribers. If you’re approaching age 65 and are trying to navigate the Wild West of Medicare, consider these tips for finding the best policy.
6 Tips for Successfully Navigating Insurance for Elderly Citizens
1. Learn When You Can Enroll
Open enrollment takes place every year from October 15 to December 7, and during this time, you can freely change your coverage. What’s important to understand about open enrollment is that so long as you change your plan during this period, you cannot be denied coverage no matter what pre-existing health conditions you bring to the table. If you wait until open enrollment is over, insurers can elect to deny coverage or can charge you extra to cover a pre-existing condition.
During this time, you can make changes to your original Medicare Part C or Medicare Advantage plan and your Medicare Part D prescription drug plan. Whatever you choose, it will go into effect on January 1 of the following year. This time is also sometimes called the annual election period, or AEP. Open enrollment is only for people who already have a Medicare plan. If this is your first time to go on Medicare, you will have a different enrollment period.
Special Enrollment Periods (SEPs)
Special enrollment is available if you need to make a change to your health plan because of a qualifying event. If one of these qualifying events happen to you, you can make changes to your plan or choose a new plan without any penalties, just as during the open enrollment period.
One of the most common qualifying events is losing your healthcare coverage from an employer or a spouse’s employer. This only counts as a qualifying event if you or your spouse were actually employed at the time you lost coverage. If you are using your employer’s group plan under COBRA rules or private insurance, you can’t use the special enrollment period.
If you’ve never used Medicare before, you have your own unique initial enrollment period. The total amount of time you have to enroll is seven months, and this begins three months before the month you turn 65. For the next seven months, you can choose your Medicare plan without any penalties or restrictions about pre-existing conditions.
If you already claim Social Security, you will be automatically enrolled in Original Medicare when you turn 65. Note that if you miss your initial enrollment period, your premiums for Medicare Part A and Part B will be higher.
Medigap Insurance Enrollment
Medigap is extra coverage designed to help you pay copays, coinsurance, and out-of-pocket expenses with Original Medicare. Medigap has its own special enrollment period. You can’t apply for a Medigap plan unless you are already enrolled in Original Medicare, both Part A, and Part B.
Once you are enrolled in both parts of Original Medicare, you have six months to choose a Medigap plan. If you choose one during these periods, insurers must take you regardless of pre-existing conditions and for the standard rate. If you get your plan after the six-month period, or you want to change it at some other point in the year, you can: but insurers do not have to accept you, or they may accept you only at a higher cost.
2. Always Review Your Annual Notice of Change
If you are already on a Medicare plan, your insurance provider has to send you an annual notice of change no later than September 30 of each year. This notice must clearly explain all changes that will go into effect the following January. This includes any changes to costs, coverage, or service areas where your Medicare coverage applies.
It’s important to review your annual notice of change so you can make a smart decision about which plan to choose during open enrollment. If there have been significant changes to the plan you are currently on, it may be in your best interest to change. It’s especially important to check your plan’s drug formulary to ensure that all the medications you need will be covered in the following year and whether you will be paying more for them out of pocket.
3. Don’t Forget About Disenrollment
If you have chosen a Medicare Advantage plan during open enrollment or initial enrollment and decide that it’s not in your best interest to keep it, there is an official disenrollment period from January 1 to February 14. During this time, you can adjust your coverage.
4. Learn About Your Options
Original Medicare (the Basics)
Original Medicare is available to any citizen or permanent resident of 5+ years who are over the age of 65. It’s also available to anyone who has been on Social Security disability for at least 24 months. Original Medicare has three parts: A, B, and D. These are provided by the government.
Part A covers room and board in a hospital or your time in a skilled nursing facility. Part B covers your outpatient services, such as lab work, surgeries, or doctor visits. Part D is your drug coverage and basically consists of a special card that allows you to purchase prescriptions at lower prices.
Original Medicare costs will vary depending on your income and ZIP Code. Your costs will be based on your income tax returns from the last two years, but if your income has decreased since that time, you can file for reconsideration. It’s also important to know that while Medicare Part D is optional, Medicare Part A and B are really not. You won’t be allowed to buy any supplemental insurance unless you have A and B already or unless you’re still actively working for an employer.
Medicare Advantage (Part C)
Medicare also has a slightly unusual and optional Part C, which works differently than the other three parts. Part C, also known as a Medicare Advantage plan, is designed to be a replacement for Medicare that covers more; but they are also designed to be more affordable than Medigap (which we’ll talk about in a moment).
Part C Medicare plans cover all that Medicare does, plus more. They’re offered by private insurers and operate similarly to an HMO. When you see in-network healthcare providers, you have smaller copays. These plans cost less than Medigap because you are paying copays in exchange for lower premiums.
In other words, if you already have significant healthcare costs, this might not work well for you. If you are healthy and rarely need healthcare services, this could be a smart choice that allows you to pay a lower premium and only pay more when you actually need a service.
Medigap (Medicare Supplement Plans)
Medigap plans are something you choose after you’ve enrolled in Medicare, and they are designed to fill in the coverage “gaps” that can cost you too much out-of-pocket with Medicare. For example, if your Medicare plan will cover 80% of your skilled nursing care stay, you would normally pay the remaining 20% out-of-pocket unless you have a Medigap plan that would cover the missing 20%.
There are many different Medigap plans available, but they are standardized across all insurers. However, the costs may change depending on which state you live in. Other advantages of Medigap plans are that several offer coverage outside of the United States, and all of them allow you to see any healthcare provider that participates in Medicare. Some plans will also cover vision and dental care that isn’t covered by Medicare or Medicare Advantage.
5. Take Time to Think About Your Big Picture
The right plan for you will depend on your age, income, lifestyle, health condition, how many prescriptions you take, and any supplemental insurance you might already have. Before you make your choice, assess your current medical expenses and estimate where they’ll be in the coming year. Be sure to give yourself plenty of time to research your options, talk to your doctors, and ask plenty of questions.
6. Meet With a Medicare Specialist
Because Medicare is so complicated, and there are so many choices, most people benefit from meeting with an insurance agent who specializes in insurance for elderly clients. These specialists work for you, and their job is to find the best plan for your healthcare needs. They can walk you through all the options for insurance for elderly and senior clients and have experience in helping people estimate retirement risk, final expenses, and other issues that could affect your choice.
Get the Best Insurance for Elderly and Senior Citizens
You’re not alone in trying to navigate the confusing world of insurance. To get the help, you need to understand your options and choose the best plan, visit the Senior Solutions Group today. Senior Solutions Group will be with you at every step and won’t stop until you have the coverage you need.