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What Is the Best Health Insurance for Seniors on Medicare

HealthPlans of NC

Upon turning 65, many seniors opt to enroll in Medicare. Medicare is federal health insurance coverage designed to support individuals over 65, who have eligible disabilities, or who have End Stage Renal Disease. While Medicare offers multiple parts and is considered quality healthcare, it isn’t comprehensive enough for everyone. So what is the best health insurance for seniors on Medicare?

For most Americans, medical insurance can be quite costly. Finding affordable health insurance alongside Medicare that covers basic needs, emergency care, long-term care, prescription drug coverage, and dental can be quite challenging. Some private insurance companies can raise monthly premiums as you age, making it very difficult to pay for the coverage you need.

The purpose of this article is to explore health insurance options for seniors on Medicare, and to help them find the best option available. For more information about health insurance options in the state of North Carolina, explore our website today. 

The Importance of Health Insurance for Retirees

Many Americans decide to retire around the age of 65. While social security is designed to financially support seniors as they age, it can be difficult to afford daily living expenses without a job. 

As we age, quality medical insurance becomes a necessity. Although Medicare can offer a lot of financial support, it isn’t perfect. That’s why getting additional support from private insurance companies is a major help.  

Seniors have cited that the most important factors when considering additional healthcare are: 

  • Monthly premiums

  • Out-of-pocket costs

  • Access to desired providers

  • Familiarity with the name of the company

  • Access to prescription drug coverage

  • Adequate coverage for their needs

  • A positive experience with an insurance company representative

One form of insurance that can be added to your Medicare coverage is called Medicare supplement insurance, or Medigap. Medicare supplement insurance is designed to fill in the gaps that Medicare doesn’t cover. These plans, offered by an insurance company rather than a federal program, can assist with coinsurance, copays, out-of-pocket costs, and more. 

About 25% of people in the United States with traditional Medicare had a Medigap plan in 2015, according to the Henry J. Kaiser Family Foundation. However, only around 5% of enrolled people under the age of 65 years had a Medicare supplement insurance plan. 

It’s important to note that Medicare supplement insurance plans do not cover some elements of care. Examples include long-term care, dental care, eyeglasses, private-duty nursing, and hearing aids. Also, several states have Medicare waivers, including Massachusetts, Minnesota, and Wisconsin. This means that companies do not have to offer the standard Medigap plans in these states. 

Health insurance for seniors

Getting Affordable Monthly Premiums and Out-of-Pocket Costs

For seniors, two of the most important elements when considering healthcare are affordable monthly premiums and reasonable out-of-pocket costs. If you are a senior living off social security, quality healthcare may be difficult to find. 

With this in mind, it’s important to know that monthly premiums tend to go up as we age. This means it’s best to get medical insurance as early as possible.

Access to Desired Providers

A major benefit of Medicare and Medicare supplemental plans is that they have a massive network of doctors and hospitals. This is a major factor that seniors consider when it comes to healthcare. Private insurance companies often have a smaller network, making it difficult for seniors to find healthcare professionals that meet their specific needs. This is why many seniors turn away from private insurance companies and opt for Medicare and Medigap.

Adequate Health Care Coverage

As we get older, we become more susceptible to chronic illness and serious health conditions. When we’re younger, we may not need comprehensive medical insurance. But as seniors, having adequate and affordable coverage is a must.

Health Plans with Prescription Drug Coverage

Having prescription drug coverage becomes increasingly necessary as we age. Prescription drug plans keep medications affordable and easy to access. 

Coordination of Benefits from Existing Health Insurance

If you are seeking Medicare supplement insurance, it’s important to understand the payment details. Having two types of medical insurance requires a “coordination of benefits.”

This means that one of your insurers will pay for medical services first. This is known as the primary payer. Then, the other insurer pays whatever cost is left, which is known as the secondary or supplemental payer. The primary payer will pay what it owes, followed by the secondary payer. If there is still money owed, you will likely have to cover those out-of-pocket costs. 

Insurers decide who the primary and secondary payers are based on the type of private insurance and the particular insurance company.

How Medigap Policies Benefit Seniors on Medicare

Those with Original Medicare often need additional assistance. Therefore, Medicare supplement insurance, or Medigap, is designed to help cover a multitude of out-of-pocket costs. If you have Medicare Part A and B through Original Medicare, Medigap can help with deductibles, coinsurance, and copays not covered by Medicare. In most cases, private insurance companies offer these medical insurance supplemental plans. Monthly premiums may vary based on location, health status, age, and more. 

Medicare Supplement Plan (Medigap): The Key Benefits of a Medicare Supplement Plan

Some of the benefits of Medigap include:

  • You get to choose your physicians and hospitals. Anyone that accepts Medicare will accept Medigap

  • You won’t need to wonder about out-of-pocket costs throughout the year

  • Your plan will automatically renew at the end of the year, even if your health condition has changed

  • You don’t need a referral to see a specialist

Make the Right Decision with Your Health Coverage

It’s important to educate yourself before deciding on your health coverage. Medicare supplement insurance can be a major asset to those that need additional insurance. Finding the right plan starts with knowing who to trust. Health Plans of North Carolina has a team of highly qualified insurance agents that can guide you toward the plan that’s right for you. Get a quote and explore our website today. 

When considering your options it’s important to be clear about your needs:

  • How much financial assistance do you need? Supplemental insurance isn’t free, so it’s smart to weigh the pros and cons

  • Do you travel out of the country often? Will you need a foreign travel emergency healthcare plan?

  • Do you need a nursing facility or hospice care? Not all supplemental plans will support these needs

It’s possible that Medicare supplemental plans aren’t for you. There are also plenty of Medicare Advantage plans that provide more comprehensive benefits. In fact, extended benefits were the most common reasons cited for choosing a Medicare Advantage plan. About one in four (24%) Medicare beneficiaries enrolled in a Medicare Advantage plan cited its additional benefit. Meanwhile, one in five (20%) pointed to a limit on out-of-pocket spending as the main reason for their choice. 

Additionally, a larger share of people with the lowest incomes (below 100% of the federal poverty level) cited additional benefits. This was greater than those with the highest incomes (over 400% of FPL), which was 36% vs. 20%, respectively. And, a smaller share of dual-eligible beneficiaries (low-income adults enrolled in both Medicare and Medicaid) cited the out-of-pocket limits. Relatively, this was 8% vs. 22%. This was their main reason for choosing Medicare Advantage over traditional Medicare. 

Greater choice in providers was the most frequent reason for choosing traditional Medicare. This was true for beneficiaries who supplement their coverage with a private insurance company as well as those who don’t supplement. However, beneficiaries with supplemental coverage cited provider choice as the primary reason at two times the rate of those without it (50% vs. 22%). 

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Blue Cross Blue Shield Medicare Supplement Insurance Pros and Cons

Medigap, offered by Blue Cross Blue Shield, is a popular form of supplement insurance. Here are some of their pros and cons. 

  • Pros: It’s highly flexible. Their program “Blue to Blue” makes it easier and less expensive to change plans over time. Every state in the country offers plans, including Washington, D.C.

  • Cons: Much like any other insurance company, prices, plan types, extras, and customer service varies depending on location and other specifics. Some plans are pricey, more than 50% more expensive than the market’s best prices. Lastly, the best-priced plans have network restrictions. 

Finding the Best Health Insurance on Medicare with Trusted Agents

Having quality health insurance is especially important for seniors. Thankfully, you don’t need to navigate the world of health insurance by yourself. 

For seniors living on social security, struggling financially, and needing comprehensive, affordable healthcare, there are insurance agents that can help. Whether you need to find a plan that gives you access to your favorite doctor or affordable prescription drug coverage, we are here to help. The health insurance agents at Health Plans of North Carolina are ready to serve. Get a quote from one of our experienced agents today.

Frequently Asked Questions

Can I drop my Medicare Advantage Plan and go back to my original Medicare?

You can drop your Medicare Advantage Plan (with or without prescription drug plans) and switch to another Medicare Advantage Plan. Also, you can drop your plan (with or without prescription drug plans) and go back to Original Medicare. You must also have Medicare Part A and B to utilize Original Medicare.

Is it necessary to have supplemental insurance with Medicare?

It is not necessary to have supplemental insurance. For those struggling financially or living strictly off of social security, supplemental insurance may be too expensive. 

Are Advantage plans good for seniors?

Advantage plans are a great option for seniors. Depending on your specific plan, they may offer prescription drug plans, vision, dental, and other services that go beyond Original Medicare.

What percent of seniors choose Medicare Advantage?

Roughly 45% of those on Medicare chose Medicare Advantage.

Why is the Medicare supplement better than Advantage Plan?

Medicare supplement plans and Advantage plans have different benefits and purposes. Medicare supplemental plans are meant to assist Original Medicare with out-of-pocket expenses. Meanwhile, advantage plans offer additional benefits such as prescription drug plans, vision, and dental.  

What Insurance Can Help With My Out-of-Pocket Expenses?

Medicare is a form of federal health insurance designed to help people over 65, who have disabilities, or have End Stage Renal Disease. It has many benefits, but it isn’t fully comprehensive. Supplemental insurance can assist those with Medicare with certain out-of-pocket expenses. Additionally, supplemental coverage and advantage plans offer more benefits than Original Medicare alone but can be more expensive. Those with little income or who are dependent on social security payments may not be able to afford additional healthcare.

Do you need help finding an affordable health insurance plan that meets your needs? Or, do you already have Medicare and want to maximize your benefits? Our qualified agents are ready to help. Get a quote today and get started.

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