Private Health Insurance

Many senior citizens will purchase private health insurance even if they are eligible for Medicare because Medicare covers a limited portion of health care costs. The high co-payments and short coverage periods of Medicare have developed what is known as the “Medigap.” Private health insurance helps to cover those gaps in coverage.

Some businesses offer to continue the health insurance plan for their retirees. If the plan is a good one and the cost is not unreasonable, staying with this plan might be the best health insurance option available.

Medicare and HMOs

HMOs are allowed to enroll Medicare beneficiaries into their plan. However, there are certain rules that Medicare recipients must follow. For coverage in an HMO, those with Medicare must be enrolled in the Part B plan and live within the area that is serviced by the HMO. Usually by subscribing to an HMO plan, the patient is required to use the HMO for all care, except in emergency situations.

The advantages to joining an HMO include preventative health care (which is not provided by Medicare), access to dental and eye care, and broader coverage than what is usually provided by the typical Medigap coverage. The disadvantages to joining an HMO include limited choices of care providers, needing to live in the HMO’s coverage area to receive full benefits, and limited services covered by the HMO.

Considerations When Choosing an HMO

The senior citizen will need to decide what the most important medical issues are when choosing an HMO. No two seniors will have the same health care needs, but there are some basic services that the HMO should cover.

When purchasing an HMO, the senior citizen should investigate its coverage of physical examinations, dental exams, eye care and glasses, hearing tests and hearing aids, and hospital stays. For senior citizens who know they will spend a good deal of time outside of their home town, such as regular travelers or those who enjoy extended visits with out-of-town relatives, will want to know how the emergency services of the HMO work. Is there a fee for using a service provider outside of the HMO’s network? Is there the opportunity to pay into a plan that has extended coverage? Because good mental health is important for senior citizens, the HMO should have some type of mental health plan in place.