Navigating the System: When You’re a Senior (65+)
Healthcare becomes important as we age and the risk of health problems rises. It can be hard to figure out what kind of healthcare you need after 65. Older adults need to know the basics about Medicare and other health insurance plans. They also need to be able to identify which healthcare services are available to them.
Medicare is a US government health insurance program for Americans who are age 65 or older. It is also available to certain younger people, such as those with disabilities and certain health problems. Medicare is paid for by taxpayers. Other funding includes income taxes paid on Social Security benefits, interest earned on trust fund investments, and Medicare Part A premiums from people who aren't eligible for premium-free Part A. Medicare helps with healthcare costs, but it does not cover all health expenses. Costs to you may include coinsurance, co-payments, and deductibles. There is also a range of services that Medicare does not cover at all. These added costs are referred to as “gaps” in Medicare coverage.
Most people 65 years of age or older who are citizens or permanent residents of the United States are eligible for Medicare. Medicare has four parts:
- Hospital insurance (Part A) helps pay for inpatient hospital care, care in a skilled nursing facility after a hospital stay, and some home health and hospice care
- Medical insurance (Part B) requires a monthly premium that helps pay for doctors’ services and some other medical services and supplies not covered by Part A
- Medicare Advantage (Part C) requires a monthly premium that provides more choices and extra benefits than Part A and Part B
- Prescription drug coverage (Part D) requires a monthly premium that helps pay for prescribed medicines
In addition to healthcare from illnesses or emergencies, Medicare covers many preventive services. This can help find problems early when they are most easily treated. These services are:
- Annual physical exams
- Cardiovascular screening
- Tests for breast, cervical, vaginal, colorectal, and prostate cancers
- Flu, pneumonia, and Hepatitis B shots (for people at risk)
- Bone mass measurements for people at risk for osteoporosis
- Diabetes screening and self-management
- Glaucoma testing
Talk to your doctor about the types of preventive services you need and how often you need them.
Supplemental Health Insurance
Supplemental healthcare policies called Medigap plans can pay for some of the costs Medicare does not cover. You will need to decide whether you want to buy the supplemental coverage. It is not provided as part of the basic Medicare coverage.
There is another plan provided by private companies that is approved by the government at an additional cost. It is called the Medicare Advantage plan. If you enroll in it, you do not need a Medigap plan. Medicare Advantage Plans have many of the same benefits as Medigap plans.
Medigap plans are sold by private insurance companies. There are standardized types of Medigap plans (A to G and K through N). Each fills in different gaps and offers different benefits. Medigap plans may pay for extra days in the hospital, hospital deductibles, Medicare Part B deductibles, foreign travel emergencies, as well as other services not paid for by Medicare. Talk with a private insurance agent to find out what each plan offers. Study the plans carefully to decide if you need a plan and which one works best. For more information:
- Medicare has an online guide to help you choose a Medigap policy. Section 4, “Steps to Buying a Medigap Policy,” has worksheets to help you figure out which type you need. It also lets you know how to find out which insurance companies offer policies in your state and how to contact and compare them.
- Call 1-800-MEDICARE (1-800-633-4227) to speak with a Medicare customer service representative.
None of the Medigap plans cover long-term care, vision or dental care, hearing aids, eyeglasses, or private nursing. If you need this type of coverage, talk to your insurance provider about other insurance options that will cover these services.
Health Services for Seniors
The Administration for Community Living (ACL) provides information on community-based programs for older Americans. The ACL can help you find health related services, such as:
- Home healthcare—Home healthcare is an alternative to hospitalization or nursing home care for people who do not need around-the-clock care. Contact the National Association for Home Care and Hospice and the Visiting Nurse Associations of America to learn more.
- State Health Insurance Counseling and Assistance Programs (SHIP)—SHIP programs have counselors in every state who give free one-on-one help to people with Medicare who have questions or problems.
- Services for caregivers—The National Family Caregiver Support Program provides information and help on services in addition to the care given by the caregiver (usually a spouse). These supplemental services include changes to the home, equipment and supplies, and transportation. There are also support groups for caregivers.
- Support for people with Alzheimer disease and their families—Many cities and towns have day programs, family support groups, physical and speech therapy, nutrition counseling, and home care services.
Administration for Community Living
2021 choosing a Medigap policy: a guide to health insurance for people with medicare. Medicare website. Available at: https://www.medicare.gov/media/9486. Accessed October 20, 2021.
Drug coverage (Part D). Medicare website. Available at: https://www.medicare.gov/drug-coverage-part-d. Accessed October 20, 2021.
How is Medicare funded? Medicare website. Available at: https://www.medicare.gov/about-us/how-is-medicare-funded. Accessed October 20, 2021.
Medicare. Social Security Administration website. Available at: https://www.ssa.gov/pubs/EN-05-10043.pdf. Accessed October 20, 2021.
Medigap: Your supplemental insurance. AARP website. Available at: http://www.aarp.org/health/medicare-insurance/info-01-2011/understanding_medicare_medigap.html. Accessed October 20, 2021.
Your Medicare coverage choices. Medicare website. Available at: https://www.medicare.gov/what-medicare-covers/your-medicare-coverage-choices. Accessed October 20, 2021.
Last reviewed October 2021 by EBSCO Medical Review Board