September 30, 2016

Understanding Health Insurance Options Available to Seniors

For years, seniors approaching the age of 65 had limited choices for health insurance.  The traditional choice for most people has been Medicare part A and part B.  These plans assured reasonable coverage for hospital, inpatient and outpatient services, clinical tests and physician services. Many other seniors have selected a Medicare Supplement to cover deductibles and co-pays. For those who met eligibility guidelines, MassHealth was the answer; it assured virtually all medical expenses were covered.  As time went on, however, a variety of managed care options became available for Medicare and MassHealth. Additionally several drug plans came into play.
Now, with the Affordable Care Act, there are many different care models and insurance options that have emerged, making the choices for seniors even more complicated. This is why it is more important than ever to learn about your options and make plans in advance. It is not uncommon for seniors and their families to postpone such planning until a crisis occurs, but this often leads to critical health choices being made without knowing coverage details.
Here are some quick tips to help you understand the health insurance options available to seniors:
Know your existing coverage.
Many seniors approaching age 65 already have health insurance benefits as retirees. Often, the nature of coverage can change when you turn 65. So, it is important that you check with the person or company who administers your benefits to learn about your options and to stay informed of upcoming changes.
Know what’s included in basic coverage.
Once you learn about your existing coverage – and  even if you do nothing else – you will likely become covered by Medicare part A when you turn age 65.You will also have the opportunity to purchase Medicare part B. While part B is optional, these are typically the “default” plans. Furthermore, you will also have the opportunity to purchase Medicare part D, which covers the cost of prescription drugs.
Know the benefits of Medicare supplements.
Supplements offered by many insurance companies have a variety of added benefits. The primary benefit is to cover deductibles and co-pays. Without a supplement, these bills can mount up very easily. For example, a person receiving Skilled Nursing Facility care that is covered by Medicare for 30 days can end up with a bill of $1,610. This is due to the $161 daily co-pay that begins on the 21st day of care. There is also an additional 20% co-pay on most other medical services. Not all supplements are alike so it is important to learn the cost of the plan as well as the benefits offered.
Consider planning for MassHealth.
In considering coverage plans that meet your needs, you should consider whether MassHealth can be an option. MassHealth has a variety of programs that are available to those who are eligible, but applying and determining eligibility can be a cumbersome process. There are separate eligibility requirements for each program they offer, and there are special provisions for married persons compared to those who are single, widowed or divorced. One of the first things I suggest you do is a little financial planning. During the years leading up to an application for MassHealth, it is good practice to retain receipts for large expenditures and to consolidate bank and investment accounts whenever possible. During the application process, you will be required to provide verifications of bank statements and large transactions going back 5 years. Making pre-paid funeral arrangements is permitted and, in fact, encouraged. Proof of birth, marriage, death of a spouse and a variety of other documents are required. If you qualify, in conjunction with the Medicare benefit, you will be in a position to cover virtually all your health expenses. MassHealth is the primary source of payment for most nursing home stays.
Consider managed care options.
With both Medicare and MassHealth, there are countless options for managed care. With managed care, there are usually benefits like lower cost premiums, but patient choices can sometimes be limited. Managed care options include Medicare Advantage programs, PACE programs, and Senior Care Options (SCO), which are Medicare-MassHealth partnerships. Hospitals and physicians are also developing Accountable Care Organizations (ACO) which participate with the patient on a variety of healthcare management options. 
The information above should be considered as a basic introduction to the challenging landscape of insurance choices facing seniors. Keep in mind that this landscape is always changing. That’s why it’s a very good idea to find an advocate to help you. This will ensure that you make sound timely decisions. Most hospitals, nursing homes, and home health agencies have someone in the business office or a social worker who can help provide direction. Aging Service Access Points such as Mystic Valley Elder Services and North Shore Elder Services are also excellent resources, especially for seniors living in the community. These senior service organizations have professionals who administer the SHINE program, which can help broaden your knowledge regarding all of your health insurance options. You can learn more about SHINE at the following link:
For other resources, you can also visit:
This blog is courtesy of Ed Stewart, Executive Director for the Chelsea Jewish Nursing Home in Chelsea, MA.