Senior Health Insurance: How to Get the Best Benefits

What are my options for senior health insurance?

For many seniors, finding an affordable and comprehensive health insurance plan is a major priority. However, there are so many options for healthcare benefits available, how can anyone know what the best option is? 

To get to the bottom of this important question, let’s first walk through many of the health insurance options that are currently available to seniors.

Original Medicare (Medicare Parts A and B)

When most seniors reach the age of 65, they become eligible for a basic health insurance plan that is regulated and managed by the U.S. federal government. This health insurance is known as Medicare.

While it may come as a surprise to many, Medicare health insurance coverage is actually made up of four main parts. The first two parts, Medicare Part A and Medicare Part B, are also known as Original Medicare. These two parts of Medicare provide hospital insurance and medical insurance to millions of American seniors, meaning that basic healthcare needs like hospital stays, surgery, and doctor’s visits are typically covered under Original Medicare.

That said, there are many instances where Original Medicare alone will not be enough to cover other vital healthcare needs like prescription medication, vision needs, dental needs, hearing needs, transportation needs, and more.

Seniors who require this type of coverage will likely benefit from enrolling in Medicare Part C, also known as Medicare Advantage, or occasionally other coverage options like Medicare Part D or a Medigap supplemental plan.

Medicare Advantage (Medicare Part C)

Medicare Advantage (Medicare Part C) plans offer additional Medicare benefits beyond what is available under Original Medicare. Often, these additional benefits can include coverage for needs like eyeglasses, contacts, dentures, hearing aids, and travel to and from appointments. With Medicare Advantage, your Original Medicare coverage is included as well.

It is important to know that Medicare Advantage plans, while still regulated by the federal government, are offered by private insurance companies. This not only means that different plans include different benefits, but it also means that senior health insurance costs can differ between plans as well. In addition, there are only certain times of the year where you can enroll in Medicare for the first time, or make changes to an existing plan. These times of year are known as enrollment periods.

Also, some Medicare Advantage plans may include coverage for prescription medication, though this coverage may also be offered as a standalone option. This part of Medicare is called Medicare Part D.

Medicare Part D: Prescription Drug Coverage

As stated, Medicare Part D is the portion of Medicare that is responsible for covering outpatient prescription drugs. Like Medicare Advantage, Medicare Part D is offered by private insurance companies, meaning costs like deductibles, copays, and premiums can vary.

Part D plans will also provide coverage for most vaccines that are not already covered under Medicare Part B. Please note that some drugs, like those used to treat weight gain or weight loss and other over-the-counter drugs, are excluded from Medicare coverage by law.

Medigap Supplemental Plans

Medigap supplemental plans are health insurance options that can be used to pay for some medical services that Original Medicare does not cover, or only partially covers. Again, Medigap supplemental plans are offered by private insurance companies, but they are not the same as Medicare Advantage plans.

The cost of a Medigap supplemental plan typically depends on the specifics of the coverage provided, as well as the insurance carrier offering the plan. Keep in mind that Medigap plans are only available to those who have Original Medicare.

Federal regulations require that every private insurance company offering a Medigap supplemental plan provides the same benefit coverage across all states, ensuring that seniors receive the same level of benefits regardless of where they live.

Medicaid

Like Medicare, Medicaid is also a government-managed health insurance program. However, Medicaid is managed jointly by both the federal and individual state governments, rather than the federal government alone.

Medicaid is designed to assist certain low-income individuals in paying for healthcare expenses, including nursing home care, personal care, transportation to and from medical appointments, some home and community-based services, and dental, vision, and hearing services.

Keep in mind that Medicaid coverage can vary from state to state. In order to be eligible for Medicaid coverage in a given state, you must be a resident of that state and a U.S. citizen (or possess qualified immigration status) and you must be considered a limited-income individual.

What can I do to ensure I am getting the best senior health benefits?

Deciding which senior health insurance option is truly the best for you can depend on multiple factors, including your exact healthcare needs, your income level, and your preferred network of doctors, hospitals, and other healthcare providers.

For seniors and caregivers who are looking to find the best possible health insurance options for themselves or their loved ones, there are a number of important things you should do before settling on any one senior health insurance option.

Courtesy of Nursing Home Reviews, you can learn more about the important steps you need to take by reading below.

Create a list of your required or preferred healthcare needs.

Before deciding on any given senior health insurance option, you should first make a comprehensive list of the healthcare treatments and services you require or want to have coverage for. 

This way, you can narrow down plans in your area based on your personalized healthcare criteria, and make an informed decision about which options may be best for your lifestyle.

Don’t be afraid to shop around and compare different plan benefits and prices.

All across the United States, there are countless options for senior health insurance plans. Many of these plans are specifically tailored to certain individuals. While one plan may not be ideal for you, another may offer exactly what you need.

Pricing for these plans can vary quite dramatically as well, so you should always consider your financial status and your physical condition and budget your health insurance accordingly. There is no shame in shopping around for the best possible coverage.

Consider which plans offer your preferred providers as in-network options.

Another important aspect to consider when choosing a health insurance plan is whether a certain plan includes your preferred healthcare providers as in-network providers, which are simply the hospitals, doctors, and healthcare professionals that the insurance plan has agreed to cover.

For certain plans, you may find that going out of network for medical care will not be covered or will only partially be covered, meaning that a greater responsibility for out-of-pocket costs may fall to you. Choosing a plan whose preferred providers align with yours can prevent this potential issue.

Don’t hesitate to ask for professional assistance.

It’s no secret that navigating the world of senior health insurance can be complicated. For this reason, you should never hesitate to seek out professional assistance when it comes to researching and comparing your health insurance options.

Luckily, there are many great resources available, like MedicareInsurance.com for example, that employ friendly, experienced, and licensed professional agents whose main goal is to satisfy your healthcare needs at a price you can afford. Don’t hesitate to ask for help today if you feel you may need it!