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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BK (8 comments.) | May 5, 2008 | Reply
I’ve been here.. and I would be curious to hear what you get back from MHIP and Senior Health Insurance Assistance.. My mother didn’t have any pre-existing conditions which was very fortunate for me. When forced into early retirement and she couldn’t find a job she decided to retire after talking with me and help me take care of my children. What I would have paid in daycare monthly I put towards her medical insurance and monthly living expenses. Her insurance costs me just about 1K every 3 months. I went through my SF agent because I trusted her after doing all of my research and she was very honest about EVERYTHING to me. I brought in the info I had received from others and we went through it together and she even told me one of the plans was actually better than what she could offer BUT after further research there was a clause in there I didn’t like so I decided to go with SF. I pay it quarterly and it includes medical, vision and prescription. Dental was overly expensive to add and a lot of the dentists in my area offer “cheaper” rates to seniors. She will qualify for her medicare benefits in a year so that will be a huge help. I was also able to enroll her in a few county programs in which she gets a lot of her screenings free. I’ll check but I think they are only for women but if not, I’ll forward that info to you since I believe we live in the same county.
Good luck Ginger.. I know its trying but your husband is very lucky to have you by his side during this time.
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Bill | May 12, 2008 | Reply
Medicaid applications would consider the total income/assets of a married couple, but not other relatives.
The biggest issue is look-back on asset transfers - now a full 5 years.
Medicare becomes available 24 months after one qualifies Social Security disability - sooner in some cases - have you applied for that?
see the Medicare section here: http://www.socialsecurity.gov/pubs/10072.html
Kimberly (1 comments.) | May 24, 2008 | Reply
I’m on disability and lived for a brief time with my parents before Social Security kicked in. I was declared my own household for food stamps, which wasn’t much, but every little bit helps. If he has a private phone at your residence, he may qualify for Lifeline, which will decrease his phone bill.
Check out http://www.benefitscheckup.org , which is an assessment tool that will guide you to resources, including prescription assistance programs, based on information you provide. It’s a confidential tool offered by the National council on aging.
More stuff is on my blog, but I haven’t worked on it much, so info is limited. Gotta get back to it. Good luck.
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Kimberly | May 25, 2008 | Reply
One more thing: If he is in End Stage Renal Failure, when he gets Social Security, there is no waiting period for Medicare, as opposed to waiting two years otherwise.