NAVIGATING HEALTH INSURANCE AS A SENIOR

Selecting a health insurance plan is no easy task.

Seniors turning 65 typically turn to Medicare for their insurance needs. However, with the advent of Advantage plans, there are more choices than ever. This can be difficult to navigate, and understanding the differences can lead to the best choice for an individual.

First, the basics
Most insurances pay for medical services, covering a large portion—usually 80 percent. The remaining 20 percent is often covered by a supplemental or secondary policy. If someone does not have a secondary policy, that portion’s responsibility falls on the patient. Sometimes insurances won’t pay the full amount of a medical bill, and that portion could also be the responsibility of the patient.

In-network and out-of-network
This could be important depending on the type of insurance you have. Certain insurance plans known as PPO, or Preferred Provider Organization, could cost more but allow more options for care, as it has broader coverage. HMO, or Health Maintenance Organization, is typically a cheaper option but limits your care to only those physicians, hospitals, and other services that participate in that specific HMO. For an HMO, having In-Network care allows for the most cost-effective option but limits where you can go for your care. PPOs provide greater flexibility, but your premium could be higher.

Deductibles
Most insurances have a deductible, or an initial portion a patient is responsible for before the insurance coverage starts. This is also true for Medicare at the first of each year. Regardless of insurance type, most plans have a deductible structure, so make sure you are aware of your out-of-pocket responsibility.

EOB, Explanation of Benefit
We get questions about EOBs, or Explanation of Benefits, from time to time. These are complex documents provided by the insurance company to patients, explaining the care received. For any questions regarding an EOB, always ask for an explanation from your insurance carrier or healthcare provider, as this is unique to the specific care provided.

What should you choose?
Health insurance, like any other insurance, is a necessary part of life. There are unique and personal considerations you should factor into deciding the type of insurance that is right for you—but always read the fine print. Specifically for seniors, HMOs or Medicare Advantage plans may seem attractive initially, but often have limitations when services and medications are needed. We have found that straight Medicare with a supplemental plan provides the best coverage for our patients. Lower initial premiums often do not mean lower out-of-pocket costs. Consult your physicians to make the most informed decision regarding your health insurance.

Hansa Medical Groupe has offices at 5250 Old Orchard Road, Suite 300, in Skokie, and in Chicago, 847-920-0902, hansamedicalgroupe.com.