Elderly Health Insurance

Medicare which is the most widely used health insurance by the elderly was developed in 1965 by the social security act. To qualify a person must have worked for at least ten years. Those who don’t meet this requirement may be asked to pay a monthly premium. Medicare covers most of the medical services needed with the exception of prescription drugs and long term care. Services may be subject to out-of-pocket costs. These may include an inpatient hospital deductible, deductible or co-pay incurred from a skilled nursing facility, and other imposed fees. Medicare recipients may also be required to pay a monthly premium to use the Part B program.

In 1997 the Balanced Budget Act was passed by Congress to allow for more types of health insurance plans to serve Medicare recipients. By 1999, 97 plans either withdrew or reduced their service areas which affected more than 934,000 Medicare applicants. In the latter part of 2000 Congress passed the Benefits Improvement and Protection Act in hopes of increasing payments to plans and making an effort to stop health service providers from withdrawing. Though change was appreciated it seems that Medicare and Congress are always in turmoil.

More often, the elderly are initiating alternatives to accompany their Medicare plan. These may be applied from an Employment-Based Retiree Health Insurance. However, employers are under no obligation to provide any retiree health benefits unless a retiree can prove that it was documented otherwise. Individually purchased Medigap Policies are also an option. In later years, purchasing health insurance of this type to supplement Medicare was difficult. Currently, it can be more easily done. Premium costs for these policies vary largely by state.

Elderly Pharmaceutical Insurance Coverage or the EPIC Program was introduced in New York State. It’s a cost sharing program developed to reduce the costs of prescription drugs. The deductible plan is based for seniors with an annual income of over 20,000. Almost all prescription drugs are covered in this program and most pharmacies take part actively in it. It can be used in conjunction with other prescription drug plans allowing for lower co-payments. Currently Medicare provides prescription drug coverage through prescription drug plans such as EPIC. This allows for seniors to save much more. Therefore, EPIC recommends that seniors join both plans. Extra help is also available for those enrolled in EPIC. Those approved for this aid will have their EPIC fees waived if they join a Medicare drug plan. They will not be asked to pay a deductible or premium and their co-payments will be significantly lowered for drugs which are covered by the Medicare plan.

There are also several other Medicare Advantage Plans. These include: Medicare Special Needs Plans (SNP), Medicare Medical Savings Account Plans (MSA), Private Fee-For-Service Plans (PFFS), Preferred Provider Organizations (PPO), or Health Maintenance Organizations (HMOs). HMOs and PPOs are the most widely used. There are some types of Medicare Health Plans which include prescription drug coverage but they are not included in Medicare Advantage. With these specific plans, you usually get all your Medicare covered health care through that plan. These include: PACE (Programs of All-inclusive Care for the Elderly), Demonstrations/Pilot Programs and Medicare Cost Plans. As you near retirement, familiarize yourself with the many options available for your later years. Being prepared will help eliminate the frustration of presenting your senior health care unaware.