Health Insurance Articles
Health Insurance And Aging Family Members
2010-07-06
Aging family members are one of the groups in our society that are most likely to need medical services. Thus, access to dependable health insurance for this group is a vital concern, not just for the aging family members themselves, but for all members of the family who love and care for them.
For most senior citizens, Medicare is the starting point for their health insurance coverage. When people have paid into Social Security over a working career, they and their spouses are entitled to be covered for hospital stays under Medicare Part A. Medicare Part B, which covers doctor visits and other out-patient services, is optional and requires a monthly contribution from the retired worker. Similarly, the Medicare Part D prescription drug program is optional and requires an additional contribution from the insured person.
Traditional Medicare is based on an indemnity model where Medicare pays 80 percent of medical expenses and the insured person is responsible for the remaining 20 percent. There are also annual deductibles that must be met before Medicare will begin to pay its 80 percent. This model leaves many senior citizens with large medical bills, despite Medicare's coverage.
Two basic alternatives exist to assist aging family members with the healthcare expenses that Medicare does not reimburse: supplement plans and HMO plans (often called Medicare Advantage). Supplement plans typically pick up the 20 percent of expenses that Medicare does not pay. HMO plans replace traditional Medicare with a managed care system. With HMO plans, aging family members will be responsible for a co-pay at the time of a doctor visit, but no other expenses will be billed. For hospital visits, the HMOs typically require a deductible of several hundred dollars; however, once again, no other expenses will be billed to the patient.
For some aging family members, supplement plans are the better alternative. These plans allow seniors to make their own choices about doctors and medical specialists. However, the claim process can be cumbersome, and the amount of paperwork can overwhelm some aging family members. For others, the HMO model works best. There are usually no claims to be filed, and the co-pays are much easier to understand. However, with HMO plans, the patient is usually limited to doctors within the plan's network, and visits to specialists typically require a referral from the primary physician and prior authorization from the HMO. This can be a significant hurdle when a person needs specialty care with little time to spare.
For all of us, it is important to become familiar with the health insurance options for our aging family members. By doing so, we will be in a better position to assist them with their healthcare needs.
