As healthcare costs rise, paying for medical expenses has become a primary concern for all Americans, but especially seniors. After all, they are the group most likely to need expensive medical procedures or skilled care in a nursing home. The Bureau of Labor Statistics reports that the average household headed by a person 65 years or older spent an average of $7,540 on healthcare in 2022. Still, that amount can vary wildly depending on factors like location and care needs. With the median income for adults 65 and over being $50,290, even annual medical expenses of $10,000 or less would represent a significant financial burden for most people, which is why most seniors will require some form of healthcare coverage.
Today, the team at Slutsky Elder Law has a rundown of healthcare coverage options for seniors so you can be better educated about your choices.
Private Insurance
Even working seniors may be able to get healthcare coverage through their employer. Private plans may provide more coverage than public health plans but also have higher premiums. Of course, not all private health insurance plans are created equal, and some more affordable plans come with high deductibles, limited coverage, and high out-of-pocket maximums. Private insurance is also usually tied to employment, so it may not be an option for retired seniors and those who can’t work because of disability or other health concerns.
Medicare
Every U.S. citizen is eligible for Medicare when they turn 65, and you may be able to sign up earlier if you have certain health conditions. Medicare is composed of different parts that provide various types of coverage. Part A covers inpatient hospital stays and can provide limited coverage for skilled nursing facility stays, hospice care, and even home health care. Part B covers outpatient care, including doctor visits, specific medical equipment, preventative services, and more. Part D provides coverage for prescription drugs.
Medicare Advantage Plans
Medicare is a great program, but it does have its limits. Private insurance companies offer plans that fill in the gaps not covered by Medicare. Known as Medicare Part C or Medicare Advantage, these plans are standardized and heavily regulated. The coverage they offer varies by the specific plan, but it offers the same coverage as Medicare Parts A, B, and D. It may also include coverage for vision, dental, and hearing services.
Medicaid
Even with the subsidies they provide, Medicare and Medicare Advantage may not be affordable for those with limited financial resources. Those people can apply for Medicaid, which offers many of the same benefits as Medicare as well as assistance with paying premiums and other costs. Medicaid can also give you coverage for long-term nursing care, making it a great option for lower-income individuals who need to stay in a nursing home.
Unfortunately, it can be difficult to qualify for Medicaid. If your application is rejected, you will have to go through a waiting period before you can reapply (although you can appeal the decision). Generally speaking, your income must be below 138% of the federal poverty level to qualify for certain types of Medicaid long-term care benefits. In 2024, that would be $20,782 for an individual. Other factors will be considered, such as non-monetary assets, medical needs, and any money transfers that were made in the past five years. Qualifying for Medicaid can be extremely difficult and time-consuming, so it’s a good idea to speak with an attorney specializing in elder law before you apply.
Medicaid Asset Protection Attorney in Pennsylvania
If you have questions about Medicaid, Robert Slutsky is highly qualified to answer them. He has specialized as an elder law attorney for more than 30 years, so you can be sure he knows the ins and outs of government programs for senior healthcare coverage and private coverage options. Contact us today if you need a Medicaid attorney in Chester County, PA, or anywhere else nearby.