Learning about insurance coverage requires time, consideration and patience, as most people have already discovered prior to retirement. Understanding the nuances of Medicare or Medicaid, as well as Medicare Supplement Insurance or additional supplemental coverage plans, becomes even more important in a person’s later years, when they may need to rely more heavily on healthcare coverage. Unfortunately, many people often find out the most about their insurance or health care plans or those held by a loved one while in the midst of needing its benefits.
To help prevent this emergency experience from happening to you or to start the process of exploring available insurance options for seniors, both you and close family members (especially individuals in the role of health care proxy) can benefit from learning about Medicare and other supplemental insurance options now. As a support for you in this process, we’ve compiled this basic overview which includes a list of pre-search reflection topics, basic information about Medicare Supplement Insurance and other supplemental insurance selections that you may want to consider to determine the best options for your needs.
Medicare Supplement Insurance: Reflection Prompts for Planning
To assist with long-term care planning, reflecting on the following prompts will contribute to establishing a baseline for your insurance coverage needs. In thinking about each item, be sure to account for current circumstances and potential future care. For example, if other family members have needed memory care, it may be important to include this possibility in your healthcare needs assessment. Additionally, it may be useful to create a computer file or designate a notebook for this important health care planning information.
Conduct a Healthcare Self-Assessment
The kind of Medicare or other supplemental insurance that you may need will depend on your health status. In addition to assessing your current healthcare needs, consider family history and prescription necessities to plan for care now and the potential for more healthcare support in the future.
Research Current Coverage and Eligibility
Review existing insurance plans to understand what coverage is currently provided and what costs exist that you may be covering independently. Remember to explore both the services that you are using and those that you may have not yet utilized. If you haven’t already done so, also explore your eligibility for Medicare and Medicaid. As you’ll see, age, income, Social Security benefits and location may impact coverage timeline and access.
Understand your budget now and anticipate how it may change in the future. This evaluation will help you determine a monthly financial plan, which will provide better clarity with regard to how much can be put toward insurance premiums, copayments, long-term care coverage, etc. Knowing your finances will also help you assess which supplemental coverage options you may need in addition to the primary coverage from Medicare or Medicaid.
Explore Providers and Networks
If staying with a preferred healthcare team, such as specific doctors or select hospitals, is preferable, explore what insurance is accepted by those providers. As you narrow down your Medicare Supplement Insurance options or other plans, be sure to revisit whether or not these practitioners and locations are still accessible with your coverage. As long as the doctor or healthcare facility accepts Medicare, you should not have any out-of-network concerns, and any Medicare supplemental insurance selections should also be available for use.
Investigate the Enrollment Process
While enrollment may not be imminent, being aware of any timelines or requirements for accessing policies or coverage can help with planning. For example, to buy Medicare Supplement Insurance, having Original Medicare (Part A & Part B) is typically necessary. It is strongly recommended to acquire a supplemental insurance plan in addition to Medicare during the Medigap Open Enrollment period, which includes the month you turn 65 and the 5 months that follow when you first have Medicare Parts A and B.
As a quick investigation of the more comprehensive Medicare.gov and “Medicare & You” handbook will reveal, there are many details to consider in senior care planning. Use of these prompts is one way that you can be more aware of the position from which you are beginning this process. In addition to these helpful online resources, another beneficial option may be to consult with a reputable licensed and certified insurance agent or a Medicare counselor who specializes in senior insurance.
What is Medicare Supplement Insurance?
Medicare Supplement Insurance or Medigap is extra insurance that you buy from a private insurance company. As suggested by the latter name, the purpose of this insurance is to help you pay for gaps in coverage by Original Medicare. Instead of paying out-of-pocket, this supplemental insurance helps cover costs associated with expenses, such as copayments and deductibles. However, Medigap doesn’t cover all potential care needs, and the level of coverage varies with each different plan.
What types of Medicare Supplement Insurance plans are available?
As of Jan. 1 2020*, newly eligible Medicare participants have eight different supplemental insurance plans to choose from. Each of these plans are available in most states, and each plan is designated by letter (e.g., Plan A or Plan M). These plans are standard**, so the benefits that accompany each plan will be the same from state to state and from any insurance provider. However, insurance companies are not required to offer all 10 plans nor are they required to offer plans at the same price. Therefore, after you determine which plan is right for you and which insurance company offers it, make sure to do a cost comparison.
* Two additional plans (Plan C and Plan F) exist but are only available to individuals who were eligible for Medicare before Jan. 1, 2020.
** In three states (MA, MN, WI), Medigap policies are standardized differently. In some other states, another type of Medigap plan, Medicare SELECT, may be available.
What is the difference between each Medigap plan?
Basically, plans differ in price and scope of benefits. In comparing the plan benefits, some plans only cover a percentage of the copayments or coinsurance while others cover the entire cost or don’t cover those costs at all. There are also some significant differences in coverage when it comes to deductibles and excess charges, as well as out-of-pocket limits.
What else may determine which Medigap plans are available to me?
In addition to factors like existing cut-off dates, personal health care needs and primary plan selection, some supplemental plans may not be able to be used without another supplemental plan in place or in connection with other insurance programs. Some people may also prefer to start their plan selection by seeing which supplemental insurance plans are available in their state. For those who are considering relocating upon retirement or to be closer to family, plan availability may impact those decisions. Investigate your options using this policy search tool. However, final availability, costs or quotes will need to be addressed with the specific insurance policy provider.
Are there any other types of supplemental insurance?
In addition to supplemental insurance provided through one of the Medigap plans, Medicaid or a Medicare Advantage, you may want to explore your eligibility or interest in these other options:
- Employer or union plans: Group health coverage through these former organizations may still be available to seniors and provide benefits to supplement other existing coverage.
- Long-term care insurance policies: Eventually, you may require extended in-home care or nursing home care. This insurance can help with these expenses or with assisted living costs. Medigap plans don’t typically cover these costs.
- Veterans’ benefits: Veterans and their spouses may be eligible for aid through the Department of Veterans Affairs. For those who qualify, this benefit can help with assisted living or in-home care coverage.
- Vision, hearing or dental coverage: These wellness considerations are not accounted for in Medicare coverage, in its supplemental insurance Medigap or in the Advantage plan. To maintain eye and ear health, including hearing aids, additional insurance will be needed. Oral health, from cleaning to major dental work, will also become an out-of-pocket expense without a supplemental dental plan.
- Hospital insurance: Although hospital stays are often covered by Medicare or Medicaid, there may be hospital-related expenses that aren’t included. For example, staying an extra day in the hospital while follow-up nursing home care is arranged may not be covered. This insurance can help with those costs.
- Cancer or critical illness insurance: Some policies specifically offer financial support if cancer is diagnosed, while others may pay a lump sum to help cover expenses associated with this illness or others like heart attacks.
- Travel insurance: The arrival of retirement may come with the additional opportunity to travel more. For those planning to take that celebratory trip to Greece or increasing their annual trips to tropical locales, this insurance can cover unexpected medical costs that may occur when out of the country.
- Prescriptions: Original Medicare (Part A and Part B) does not contribute to prescription drug costs. There are a few Medicare, Medigap and Medicare Advantage options to help with these expenses, but it may also be helpful to start looking into prescription discount cards – most of which can be used prior to Medicare eligibility.
While staff members at Arbors of Hop Brook may be able to answer general questions about insurance coverage in relation to assisted living care, each community member’s needs and circumstances will vary. However, like the thoughtful consideration and selection of a Medicare supplement or other supplemental insurance plan, becoming a resident in our comprehensive care community is another meaningful step in ensuring your own long-term care or that of your loved one. To talk with us about senior living including our health services or see what our community has to offer, schedule a tour today!