When you think about retirement, perhaps you picture yourself relaxing on a beach or touring the country in a recreational vehicle. Although it's great to think about enjoying your time as a retiree, it's also important to consider how you'll cover the cost of health care.
According to the CDC, 85% of Americans over the age of 65 have at least one chronic health problem. Health insurance covers medications, lab tests and other services, making it easier to manage your health and avoid complications. Before you move to our assisted living community in Creve Coeur, take time to explore your coverage options.
Medicare is a federal health insurance plan that makes it easier for seniors to access health care. To enroll, you must be at least 65 years old or have a disability that makes you eligible for Social Security Disability Insurance payments. When you become eligible, you have the option of enrolling in Original Medicare or Medicare Advantage.
Original Medicare is administered by the federal government, so it comes with a standardized set of benefits. Part A, known as Hospital Insurance, covers your inpatient medical expenses. For example, if you have to stay in the hospital for a few days, Part A pays for the services you receive while you're there. Part B, known as Medical Insurance, covers your outpatient medical expenses. This includes laboratory tests, X-rays and doctor visits.
Medicare Advantage, also known as Part C, allows you to get your Medicare benefits through a private insurance company. Each participating company must be approved by Medicare and provide the same Part A and Part B benefits you'd get with Original Medicare. The difference is that Medicare Advantage providers may offer additional benefits, such as coverage for hearing aids, glasses or dental care.
Another difference between Original Medicare and Medicare Advantage is that Original Medicare doesn't come with prescription coverage. Unless you want to pay the full cost of each medication out of your own pocket, you'll need to sign up for a Medicare Part D prescription plan. If you enroll in Medicare Advantage, you don't need Part D, as almost all Medicare Advantage Plans bundle prescription coverage with their Part A and Part B benefits.
Medicaid is a health insurance program for Americans with limited financial resources. To qualify, you must meet strict income and asset guidelines. Although the federal government provides funding for Medicaid, each state sets its own eligibility criteria, so the income and asset limits vary from state to state. For example, Alabama's Medicaid program has an income limit of $934 per month for a single person who needs standard coverage. In contrast, Indiana has an income cap of $1,215 per month. These cost estimates are current as of July 2023.
Under federal law, every Medicaid plan must pay for these mandatory benefits:
Some states also provide optional benefits, giving you access to a broader range of health care services. For example, Florida's Medicaid program covers basic dental services. Every state also offers some level of prescription coverage, but you may need to obtain prior authorization or make a co-pay for each drug. Connecticut's Medicaid program has some of the most comprehensive prescription coverage, as there are no co-pays and no coverage limits.
If you don't qualify for Medicare and Medicaid, private health insurance is another option. For seniors who are still working, one of the easiest ways to get this type of insurance is to sign up for a group health plan. If you're not working or your employer doesn't offer health insurance, consider signing up for a health plan via the Health Insurance Marketplace. Thanks to the Patient Protection and Affordable Care Act, insurance companies can't deny you for having a preexisting health condition, so it's easier to obtain coverage on the open market.
Before you enroll in a health insurance plan, it's important to understand your cost-sharing requirements. Many plans have a deductible, which is the amount of money you must pay out of your own pocket before your insurance provider starts covering your health care expenses. For example, if you have a deductible of $500, your insurance company won't cover anything until you pay that $500.
It's also common for health insurance plans to have co-pays and coinsurance requirements. A co-pay is a flat fee you pay each time you receive a covered service. If you have a co-pay of $10 for primary care visits, then you have to pay $10 every time you visit your PCP. Coinsurance is a specific percentage of the cost you must pay out of your own pocket. For example, if your plan has a 70/30 coinsurance split, you have to pay 30% of each covered service.
At Autumn View Gardens, we strive to help residents maintain their health and independence. Whether you need memory care or standard assisted living services, we're always available to answer questions and make sure you feel comfortable about the next stage of life. You may even be able to use your insurance benefits to cover some of your living expenses, making assisted living more affordable than you anticipated.
