Health care becomes more and more important as we age, when the risk of developing a variety of medical problems rises. But figuring out what kind of health care is available and necessary after you reach age 65 can be daunting. It is important to know the basics about Medicare and other health insurance plans for seniors, and to identify which types of health care services are available.
Medicare is a U.S. government health insurance program provided for Americans who are age 65 or older. It is also available to certain younger people (e.g., 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 health care, 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:
In addition to health care from illnesses or emergencies, Medicare covers many preventive services, which can help find problems early, when they are most easily treated. These services include:
Talk to your doctor about the types of preventive services you need, and how often you need them.
To find out more about Medicare, its limitations, costs, and how to enroll, see our full-length article, Medicare 101 .
There are supplemental health care policies, called Medigap plans, which pay for some of the costs Medicare does not cover. It is up to the individual to make a decision as to whether he or she wants 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 10 standardized types of Medigap plans (A to J), 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(s). For further guidance in this process:
None of the Medigap plans cover long-term care, vision or dental care, hearing aids, private nursing, or all prescription drugs. If you need this type of coverage, talk to your insurance provider about other insurance options that will cover these services.
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:
Finally, for more information on your long-term care options, see our full-length article on long-term care facilities .
Administration on Aginghttp://www.aoa.gov/
Alzheimer’s Resource Roomhttp://www.aoa.gov/alz/
Centers for Medicare and Medicaid Serviceshttp://www.cms.hhs.gov/
National Association for Home Carehttp://www.nahc.org/
National Family Caregiver Support Programhttp://www.aoa.gov/prof/aoaprog/caregiver/caregiver.asp
State Health Insurance Assistance Programhttp://www.medicare.gov/contacts/static/allstatecontacts.asp
Visiting Nurse Associations of Americahttp://www.vnaa.org/vnaa/gen/html~home.aspx
Medicare. Social Security Administration website. Available at: http://www.ssa.gov/pubs/10043.html . Accessed June 26, 2006.
Medicare plan choices. Medicare website. Available at: http://www.medicare.gov/choices/overview.asp . Accessed June 26, 2006.
Prescription drug coverage: basic information. Medicare website. Available at: http://www.medicare.gov/pdp-basic-information.asp . Accessed June 26, 2006.
Services for seniors. Administration on Aging website. Available at: http://www.aoa.gov/eldfam/service_options/service_options.asp . Accessed June 26, 2006.
Supplemental plans (Medigap). American Association of Retired Persons website. Available at: http://www.aarp.org/health/medicare/supplemental/ . Accessed June 26, 2006.
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