Navigating the System: When You’re a Senior (65+)

Medicare

Medicare is a US government health insurance program provided for Americans who are age 65 or older. It is also available to certain younger people (eg, those with disabilities and certain medical conditions). Medicare is paid for by taxpayers, and premiums are deducted from Social Security checks. While Medicare helps with the cost of healthcare, it does not cover all health expenses. The costs you pay include coinsurance, co-payments, and deductibles. There is also a range of services that Medicare does not cover at all. These added costs are referred to as “gaps” in Medicare coverage.

Most people age 65 or older who are citizens or permanent residents of the United States are eligible for Medicare. Medicare has four parts:

• Hospital insurance (Part A): a service that helps pay for inpatient hospital care, care in a skilled nursing facility following a hospital stay, and some home health and hospice care
• Medical insurance (Part B): a service requiring a monthly premium that helps pay for doctors’ services and some other medical services and supplies not covered by Part A
• Medicare Advantage (Part C): a service requiring a monthly premium that provides more choices and extra benefits than Part A and Part B
• Prescription drug coverage (Part D): a service requiring a monthly premium that helps pay for prescribed medications

In addition to healthcare from illnesses or emergencies, Medicare covers many preventive services, which can help find problems early, when they are most easily treated. These services include:

• One-time “Welcome to Medicare” physical exam
• Cardiovascular screening
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• Bone mass measurements
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Talk to your doctor about the types of preventive services you need and how often you need them.

Supplemental Health Insurance

There are supplemental healthcare policies, called Medigap plans, which pay for some of the costs Medicare does not cover. It is up to you to decide whether you want to buy the supplemental coverage, because it is not provided as part of the basic Medicare coverage.

However, there is a plan provided by the government at an additional cost called the Medicare Advantage plan. If you enroll in it, you may not need a Medigap plan, since Medicare Advantage Plans provide many of the same benefits as Medigap plans.

Medigap plans are sold by private insurance companies. There are standardized types of Medigap plans (A to L), each filling in different “gaps” and offering different benefits. Medigap plans may pay for extra days in the hospital, hospital deductibles, Medicare Part B deductibles, foreign travel emergencies, as well as other services not paid for by Medicare. Talk with a private insurance agent to find out what each Medigap plan offers. Study the plans carefully to decide if you need a plan, and if so, which one. For further guidance in this process:

• Medicare provides a comprehensive online guide to choosing a Medigap policy. Section 4, “Steps to Buying a Medigap Policy,” provides worksheets to help you figure out which type you need, as well as how to find out which insurance companies offer policies in your state and how to contact and compare them.
• Or call 1-800-MEDICARE (1-800-633-4227) to speak with a Medicare customer service representative.

None of the Medigap plans cover long-term care, vision or dental care, hearing aids, eye glasses, or private nursing. If you need this type of coverage, talk to your insurance provider about other insurance options that will cover these services.

Health Services for Seniors

The Administration on Aging (AOA) provides information on a variety of community-based programs aimed at meeting the needs of older Americans. The AOA can help direct you to a variety of health related services, including:

• Home healthcare—Home healthcare is an alternative to hospitalization or nursing home care for patients who do not need around-the-clock supervision. Additional information can be obtained from the National Association for Home Care and the Visiting Nurse Associations of America.
• State Health Insurance Counseling and Assistance Programs (SHIP)—SHIP programs have counselors in every state who provide free one-on-one help for Medicare beneficiaries with Medicare question or problems.
• Services for caregivers—The National Family Caregiver Support Program provides information and assistance about services that complement the care given by the caregiver (usually a spouse). These supplemental services include home modifications, equipment and supplies, and transportation. In addition, there are support groups available for caregivers.
• Support for Alzheimer’s disease patients and their families—Many communities have day care programs for Alzheimer’s patients, as well as family support groups, physical and speech therapy, nutrition counseling, and home care services.