Senior Healthcare Options: Navigating The Murky Mess That Is The US Healthcare System

photo credit: Hamed Saber

It never occurred to me that the health care system for seniors in this country was so dire until my FIL became ill. To have every door closed to us because of a pre-existing condition, age and lack of continuing insurance blew my mind. So what options do seniors have when it comes to health care? Here’s what we found:

Group Insurance

Wikipedia:

Group insurance is an insurance that covers a group of people, usually who are the members of societies, employees of a common employer, or professionals in a common group.

Group insurance may or may not be converted to individual coverage. As group insurance gets big business for an insurance company with minimum operational expenses (under one master policy issued to an employer, union or any recognised group), it is usually less expensive than individual policies.

Now if you’re retired and battling a major illness which prevents you from working and obtaining group health insurance, what are your options?

Exactly, same questions we were faced with. Again, this is something we never thought about until now because we always assumed that Medicare or Medicaid took care of this sort of thing. He isn’t yet 65 and while his income qualifies him for Medicaid, he would still be living with us and they would count our income as I understand it which would make him ineligible. It’s like one frustrating merry go around that just seems so unfair to this section of our population. Don’t get me started on the cost of prescription drugs out of pocket.

Individual Insurance

After a comprehensive internet search we found a few plans that might be worth considering with the only issue being cost. Given his pre-existing conditions (diabetes and high blood pressure) we want a plan whereby he can see a specialist in a network, no deductible, no more than $50 per office visit to the PCP or specialist and emergency room coverage all for less than $300 month. What turned me off was the eagerness and shady behavior of the insurance agents who started calling 10 minutes after submitting the application. I don’t like being rushed into anything and so I had to tell one agent to back off while we get together and make a decision. After all, it isn’t final as to whether or not his stay here will be permanent OR if he will be returning to NJ and if so what level of independence will that mean for him?

It goes without saying that individual plans are more expensive than group plans because group plans get a larger discount for bigger business. This is our primary barrier to getting the best insurance as our preferred plan will run around $515 per month.

Medical Discount Plans

Medical Discount Plans are not insurance. This is a type of plan sometimes underwritten by insurance companies where you pay a set fee as which entitles you to plan benefits similar to that of regular health insurance. I am a bit wary of these plans as Ive never used them and not sure how binding the plan benefits are given that the company we interviewed could not guarantee for us how much they would cover after seeing a specialist. She kept on saying up to 70%, even with telling her he would be seeing a renal specialist and/or endocrinologist. Granted, they do have an advocate but what good does that do if the insurance company’s decision is final?

So, this isn’t a full health insurance policy and does not give one the same benefits and I am not sold in this plan. It merely gives a discount and boasts a large provider listing but what if they aren’t near? Well, we found out none of the 250,000 providers were near us and we live in the DC metro area, come on now. So this plan is a no go and that is final. And about the discount? This can get expensive if you need surgery or need to see a specialist, the latter of which is a reality for us at this time.

I am still waiting for the administrators of the Maryland Senior Health Insurance Assistance Program program and Maryland Health Insurance Plan (MHIP) to call me back to discuss health insurance options. Hopefully, they may be able to provide some information and insight into our options moving forward.

Have you been faced with a similar situation? If so, what were your options and how did you obtain insurance for a senior or edlerly person in your care?

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