Health Insurance for Seniors

Health insurance for seniors is an important part of maintaining a healthy lifestyle. Without proper health care coverage, your aging parents may not be able to obtain timely expert health care advice and services.

This article covers:

• Overview
• Canada
• USA

Overview

It is important to ensure your aging parents have adequate health insurance for seniors. Although most seniors are covered by government programs that provide medications and surgical procedures that are usually covered 100%, there is still a huge gap in coverage for seniors living on a fixed income.

Some health care services are not covered by government health insurance for seniors and it's important seniors plan ahead to ensure they can obtain the services they may need in the future.

Purchasing additional health insurance for seniors is paying against a calculated risk, the greater the expected risk, the higher the cost of the policy. As seniors age, they become more susceptible to disease, ailments such as arthritis and rheumatism, and diabetes.

Canada

Canadian Provinces are responsible for delivering health care services to all its citizens. The Canadian Health Act was passed in 1984 and it established the criteria and conditions related to insured health care services that provinces and territories must meet in order to receive money from the federal government.

While the government provides medical care for its citizens, coverage for all health care needs is not available.

Each province offers residents various coverage basics. Medical expenses that are not covered by the provincial plan must either be paid in full by the individual or can be partially paid by a supplemental health insurance for seniors plan.

Supplemental Insurance

The federal and provincial governments fail to provide coverage for the following health care needs:

• Preferred hospital accommodation (i.e. private room)
• Private nursing care
• Cosmetic surgery
• Physician testimony in court

However, provinces provide partial or full coverage for a variety of services outside of the Canadian Health Act, including:

• Dental services
• Chiropractic and other alternative health care services
• Prescription drugs
• Ambulatory services

The extent of these services varies from province to province.

Supplemental health insurance for seniors is for individuals who prefer more protection for themselves (other than government health insurance). The supplemental health insurance for seniors is a means of extending your coverage and reducing your out of pocket costs.

Supplemental insurance coverage can include:

• 365 days of hospital care
• 3 pints of blood
• Provincial coverage deductibles
• Provincial coverage co-payment
• Prescription drugs
• Dental coverage
• Foreign travel emergency
• At home recovery
• Preventative care
• Skilled nursing co-insurance

USA

Medicare is the American federal health insurance for seniors program that covers most people age 65 and older. Some younger adults are also eligible, such as those who are disabled or who have End-Stage Renal Disease (permanent kidney failure).

Seniors covered by Medicare are called beneficiaries. Medicare pays for most of their health care, but not 100%. It covers most acute medical conditions - conditions from which a patient usually recovers. However, it does not cover: most care given at home, in assisted living facilities/nursing homes, for seniors with chronic disabilities and lengthy illnesses. In addition, there are large gaps in Medicare's prescription drug plans.

The benefits are divided into 4 parts: A, B, C and D.

• Part A - Helps pay for inpatient hospital care, some skilled nursing facilities, hospice care, and some home health care. It is premium-free for most seniors.
• Part B - Most beneficiaries pay a monthly premium to be covered under Part B. It helps pay for doctors, outpatient hospital care, and some other care that Part A doesn't cover, such as rehabilitation therapy (such as physical and occupational therapy).
• Part C - Allows various HMOs, PPOs and similar health care organizations to offer health insurance plans to seniors covered by Medicare. At a minimum, the health care organizations must provide the same benefits that the Original Medicare Plan provides under Parts A and B. Part C organizations are also permitted to offer additional benefits (such as dental and vision care). However, Part C plans are allowed to limit choice of doctors, hospitals, etc., to just those who are part of their networks. This can be a major disadvantage if the seniors favorite doctor or hospital is not part of the network.
• Part D - Provides prescription drug benefits through various private insurance companies. Like Part B, most seniors have to pay additional premiums each month to be covered for prescription drugs under Part D. Premiums

Most seniors are covered by the Original Medicare Plan, which requires them to pay for some of their health care in addition to their monthly Part B and Part D premiums. Those additional amounts are called deductibles and coinsurance. All premiums, deductibles and coinsurance amounts change every year on January 1st.

Seniors can purchase additional insurance policies to cover: part or all of Medicare's deductibles and coinsurance amounts or to cover health care that it is not covered by Medicare. These include:

• Supplemental Medicare insurance
• Employer or union coverage
• Long-Term Care insurance
• Other kinds of insurance

Seniors do not need to buy Supplemental Medicare insurance if they are covered under Medicaid or if they have enrolled in a Part C plan (such as Managed Care Plan, Private Fee-for-Service Plan, Medical Savings Account and Religious Fraternal Benefit Plan).

Supplemental Insurance

Health insurance for seniors supplemental plans work in addition to your benefits, not as a primary source. They cover additional doctor visits above and beyond the allowance of whatever Medicare policy you may currently have.

They may also cover visits to specialists for particular health problems. Very often the secondary insurance policy will pay anywhere from 50-80% of the balance remaining on any special procedures.

The medication prescribed for these special procedures costs hundreds of dollars and may not be covered by Medicare. This is dependent on the diagnosis, prescription, and how long the drug has been on the market. Supplemental plans can be worthwhile as although they can cost over a hundred dollars per month, they can cover prescription and doctor's costs of over one thousand dollars a month.

It is recommended that you enroll in supplemental plans just before retirement as the younger you are at the beginning of the policy, the less expensive the plan will be.