Senior Health Insurance Options

So you've finally retired. You're ready to face a whole new list of challenges, but you know you have to get your senior health insurance in order so you don't have to worry about a health crisis derailing your plans.

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But hold on just a bit. First you've got a little more work to do. Because if you've reached the age of 65, you're ready for Medicare. And figuring out all the options and complexities of Medicare health insurance for seniors can be a full-time job. Just unraveling the names can give you a headache. Medicare, Medigap, Parts A & B, Supplemental, Medicare Advantage, Part D Drug Plans, Parts E and F and G through L -- it's a regular alphabet soup and each plan is different.

Senior Health Insurance: Medicare Overview

Medicare is a government program designed to guarantee that senior U.S. citizens and legal residents have access to affordable health care. When you reach 65, you automatically become eligible to enroll. The two main components of Medicare are Parts A and B. The first is free; the second is not free, though the premiums are fairly low.

  • Medicare Part A is hospital insurance. It pays for in-patient services you get in a hospital, for care in a skilled nursing facility after a hospital stay, for some home health care and for hospice care. If you need blood, it also pays for all but the first three pints received in one calendar year. There is a deductible and for some services a co-pay is required for Part A coverage.
  • Medicare Part B is medical insurance. It covers doctor visits, lab tests, outpatient hospital care, ambulance services, and many health services and supplies. For most of these services, you pay 20% and Medicare pays the other 80% after a fairly small annual deductible has been met.

Many people have only Medicare Parts A & B. But that 20% co-pay can add up to some big money as you get older and need more frequent and more expensive doctor visits and treatments. Also, you may need services that are simply not covered at all. That can leave a gap in your safety net.

Senior Health Insurance: Medigap

Since those co-pay, co-insurance and deductible "gaps" in Medicare coverage can sink you, Medigap Insurance was invented. It's also called Medicare Supplemental Insurance. Unlike Parts A and B, this insurance is not provided by the government. It's sold by private insurance companies, but it is regulated by the Medicare program.

These policies are lettered "A" through "L" and are standardized. In other words, no matter what company you buy Medigap coverage from, it has to offer the same basic services and features as every other company offering the same lettered policy. The only difference is usually the price. You must have both Parts A and B of Medicare to be eligible to buy Medigap insurance.

Senior Health Insurance: Medicare Part D -- Prescription Drug Plans (PDPs)

If you thought Medicare was complex and confusing, you're really going to have some fun now.

Medicare doesn't cover the cost of prescription drugs, and if you've had to fill any prescriptions lately, you know that the total cost can run into the hundreds of dollars or more per month. Prescription Drug Plans, or PDPs, are designed to take the brunt of that blow by covering all or part of the cost of your meds, both generic and name-brand.

These plans aren't run by the government. They're offered by private companies approved by Medicare. The variation in the plans can be pretty mind-boggling. It's important that you sit down with the details of several plans and a list of prescription drugs you take regularly to figure out which plan will serve you best.

To join a Medicare Prescription Drug Plan, you must first have Medicare Parts A and B. Once you've joined a PDP, the company will send you a membership card. You use that card every time you have a prescription filled. You might have to pay a deductible, a co-payment or both.

Senior Health Insurance: Medicare Advantage

As a senior eligible for Medicare, an Advantage plan is the closest thing to the standard health insurance you've probably had for most of your life. Though approved by Medicare, these plans are offered by private insurance companies. They're sometimes called "Part C" or "MA Plans."

Once you enroll, Medicare pays the company a set fee for your coverage. The insurance company then covers all your Part A and Part B benefits plus any other plan benefits they offer, usually including prescription drug coverage. They all must cover emergency and urgent care.

Medicare Advantage Plans are offered by many companies and in many forms, including:

  • Preferred Provider Organization (PPO) Plans
  • Health Maintenance Organization (HMO) Plans
  • Private Fee-for-Service (PFFS) Plans.
  • Medical Savings Account (MSA) Plans
  • Special Needs Plans (SNP)

There will probably be co-payments, co-insurance and deductibles on your Medicare Advantage plan.

Insurance companies want your business and competition is fierce, so many Advantage plans include extra benefits. You might find coverage for vision and glasses, hearing, dental, and health and wellness programs. With some, you'll be limited to using doctors and services that are part of the provider's network. With others, you have your choice of doctors. Some require referrals to see a specialist, others don't.

It's important to shop around and look at a lot of different Advantage Health plans before you decide which one is right for you. Compare benefits and premium quotes from several companies. It's easy to do online at a site such as

Exiting the Maze, Insurance in Hand

You don't need to be lost in the Medicare maze. There's always a way out once you've seen the map. The secret to getting to the heart of Medicare is twofold.

First, consider you personal needs -- your general health, your medical history, what prescription meds you take regularly as well as your personal finances and how much you can afford to pay. Next, begin researching health insurance companies for the best combination of features and benefits, services, premium prices and out-of-pocket expenses. Get insurance advice from several companies and study them.

You'll probably feel like you've gone back to school -- or never retired. But eventually, you'll find the perfect plan that will keep you healthy, keep you covered, and give you the security and peace of mind to enjoy your retirement without worrying that a health crisis will wipe you out.

To learn more about health insurance and get free individual health insurance quotes, visit

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