WPS Health Insurance Blog

The 65+ crowd has lots of health insurance options

Posted by Ryan Kanable

Aug 20, 2013 9:00:00 AM

Seniors have health insurance choicesMedicare Part A. Medicare Part B. Medicare Advantage. Medicare supplement plans. Prescription drug plans. An employer’s group health plan. A retiree plan from a previous employer. The health insurance choices for people age 65 and older can seem daunting. How do you sort them all out? Which plan or combination of plans is best for you? There are lots of questions, but WPS is here to help.

Original Medicare

Let’s start with Medicare. When you turn 65, you’re automatically eligible for Medicare Part A and Part B.

Part A covers costs related to hospitalization, such as acute care, inpatient rehabilitation, long-term care, mental health care, and more. Generally speaking, there is no premium for Part A, as you have been paying for it through your paychecks your entire working career.

Part B, on the other hand, covers costs related to physician care, such as a surgeon’s fee for surgery, doctors’ fees for procedures that don’t require hospitalization, visiting the doctor when you’re sick, and preventive visits to your physician. Premiums for Part B in 2013 are $104.90 per month unless you make more than $85,000 a year as an individual or more than $170,000 a year filing jointly with your spouse.

Medicare Advantage

Medicare Advantage plans, sometimes called Part C or MA plans, take the place of Medicare Parts A and B, although you still must pay your Part B premium. These special plans, offered by insurance companies rather than the federal government, give you coverage that is equivalent to Medicare. Some MA plans also offer other benefits, such as prescription drug coverage. These plans can charge different

Health or prescription drug costs that you must pay on your own because they aren’t covered by Medicare or other insurance.

">out-of-pocket costs and have different rules for how you get services (like whether you need a

A written order from your primary care doctor for you to see a specialist or get certain medical services. In many Health Maintenance Organizations (HMOs), you need to get a referral before you can get medical care from anyone except your primary care ">referral

to see a specialist or if you have to go to only doctors, facilities, or suppliers that belong to the plan for non-emergency or non-urgent care). Plans operate on year-to-year contracts with Medicare and can decide to change the rules or stop offering plans with each new year.

Medicare supplements

Medicare supplement plans, or Medigap plans, are special health plans that provide extra coverage for the things that Parts A and B don’t cover, such as deductibles, copays, the percentages of costs beyond what Medicare covers, and other services. Most of these plans require you to have Medicare Parts A and B.

In general, these plans don’t cover drugs, so you may want to consider pairing a Medicare supplement plan with a Medicare Part D plan.

Medicare Part D

Prescription drug plans, also called PDP or Medicare Part D plans, are optional plans that help you pay for your prescription drugs. These can vary from one insurer to another. Each plan has its own list of drugs it will cover, called a formulary.

If you have a Part D plan, you can also have a Medicare supplement or MA plan. However, you cannot pair a Part D plan with a Medicare Advantage plan that includes prescription drug coverage, known as an MA-PD plan. Because both of these plan types offer drug coverage, you may only have one of them at a time. This is important because if you sign up for a Part D plan and you have an MA-PD plan, you will be automatically disenrolled from your MA-PD plan and put back on regular Medicare.

Employer health plans

All employer plans are different and rules for these plans vary based on how many people are employed. Check with your employer to see which options are available to you.

Retiree health plans

If you are a retiree and your previous employer provided you with a health plan in your retirement, this plan will supplement your Medicare benefits. Generally, Medicare pays first and your retiree health plan pays second.

What’s best?

Back to the original question: which plan or combination of plans is best for you? Everyone’s situation is different and you should explore all of your options.

WPS offers many coverage options for those 65 and older, such as Medicare supplement plans and prescription drug plans. The health plan consultants at WPS are also Certified Senior Advisors®, or CSAs, who can help you weigh your options so you can make the right decision, even if your best option is a plan we don’t offer.

S5753-25938-021-1307 Pending CMS approval

Topics: health insurance