Affordable health insurance coverage for retirees under age 65, seniors age 65 and over, and the elderly, is possible. Low cost medical plans with guaranteed approval and comprehensive benefits can be purchased from most of the large reputable companies. We help you select the best plan, by comparing all available options, so it’s easy for you to apply or enroll, and get covered quickly. Medigap Supplement, Advantage, and Marketplace policies are offered. Prescription plans (Part D) are also offered.
We review the least expensive policies, the companies that underwrite these contracts, and when is the best time to purchase or enroll in these plans. Our quote engine at the top of the page will provide instant pricing and comprehensive descriptions of each option offered to you. Whether you are a senior citizen, or much younger, we shop and research, so you save time and money. We also show you the 65+ plans endorsed by AARP in your area, and determine if the options are worth considering. Other major carriers, such as Cigna, Humana, Blue Cross, Aetna, and UnitedHealthcare, offer plans in most parts of the US.
Subsidized Marketplace Plans (Must Be Under Age 65)
The older you are, the larger the potential financial assistance you may be eligible for through your State or the Federal Exchanges. Although premiums are higher for someone in their 60s vs. an applicant in their 40s, the potential subsidy often offsets the age difference. The largest federal subsidies are awarded to persons between the ages of 61 and 64, and often the savings is more than $6,000 per year. Depending on your Federal Poverty Level, the subsidy could be more than $10,000.
For example, residents of St. Louis, like all cities, are eligible for substantial reductions. A 62 year old earning $35,000 per year will pay less than $130 per month for the least expensive Bronze-tier plan (Cigna US-MO Connect 6650). Income of $27,000 results in a monthly premium of only $11. Low rates are available in many other areas. For example, in Columbus, Ohio, a married couple (age 30) with $40,000 of household income, will pay only $173 month for the least expensive plan (Medical Mutual Market HMO 7150).
In all states, there are several major reputable companies that offer Exchange policies. Of course, the selection will vary, depending where you live. For example, New York, Ohio, Texas, Michigan, Wisconsin, and Arizona have at least 11 insurers that offer Exchange policies to state residents. However, residents of West Virginia have only one available carrier, while just two companies operate in Wyoming, Vermont, Hawaii, Delaware and Alaska. Parts of Arizona actually had NO available companies for a short period.
Although Open Enrollment typically occurs for only three months (November to February), you can purchase coverage at any time of the year if you qualify for a “Special Enrollment Period” (SEP). These special life changes allow you to qualify for a subsidized plan with pre-existing conditions covered. A set of “qualifying life events” provides many exceptions and allows up to 60 days to shop and compare before enrolling. During this time, companies must offer all available Marketplace policies.
Some of the most commonly-used SEP exceptions for Seniors include having a large change in income, obtaining citizenship, or becoming a legal resident of the country, changing residences outside of your current service area, and losing prior coverage (group or individual). These situations allow you sign up for a plan regardless if you need benefits for a few months or 10 years. Becoming ineligible for Medicaid also qualifies as an exception.
Unsubsidized Marketplace Plans (Must Be Under Age 65)
Plan availability and pricing is very similar to the “subsidized” group of policies we just discussed. However, because your household income is more than 400% of the Federal Poverty Level, you aren’t going to receive a subsidy to help pay the premium. Since you pay “full price” for your policy, often choosing catastrophic or high-deductible plans will keep premiums affordable. Maximum out-of-pocket expenses must also be considered. Currently, the highest allowed deductible is $7,150.
For example, in most areas, although you can purchase an “Obamacare” plan from at least one of the large carriers, such as Aetna, UnitedHeathcare, Blue Cross, Humana, or Cigna, you can also enroll for coverage regardless of your income. Whether your household income is $25,000 or $250,000, quality policies are offered that contain the 10 mandated “Essential Health Benefits.” However, it is possible, that by 2019, new less-expensive options may be available that eliminate often unneeded benefits such as maternity.
“Unsubsidized” also means that you don’t utilize the .gov Marketplace website. You purchase your coverage directly through the insurer. Of course, our website provides those options to you when you request your free personal quote. The available single and family plans closely mirror “on-Exchange” contracts, although the provider network is often bigger with more available specialists, primary-care physicians, and medical facilities. Many companies offer different “tiers” of network coverage.
You can also compare gap insurance quotes if you aren’t quite eligible for Medicare yet. Perhaps you retired early and only need coverage for a few years. During this period of transition, you don’t have to sacrifice quality healthcare benefits. Your situation is a bit unique so we will show you the specific options that are the most cost-effective. “Short-term” plans can be considered if you need coverage less than three months. But benefits may be limited, and chronic illnesses and diseases are typically not properly covered. Although an existing short-term policy can be renewed (typically once), your insurability will have to be proven, and an application denial is possible.
NOTE: “Medigap” policies are different than “gap” policies. If you qualify for Medicare, the combination of original and supplementary benefits will pay most expenses. “Gap” plans are designed to protect you during periods of time that you are either uncovered, or waiting for Medicare or Medicaid benefits to commence. They also provide numerous options for persons that forgot to sign up before Open Enrollment ended.
You certainly can’t beat the price! It’s cheap and when you reach age 65, you become eligible for a variety of benefit options. The program is mostly managed by the Centers for Medicare and Medicaid Services (CMS). If you’re under age 65, you can still qualify for benefits if you meet specific disability requirements or have End-Stage Renal-Disease.
NOTE: Open Enrollment always occurs between October 15th and December 7th. During this time period, consumers can change to a different plan. Prescription (Part D) coverage can also be changed. If your health or other circumstances change throughout the year, it is advisable to review all options. Also, if you receive an ANOC (Annual Notice Of Change), it’s important to review the changes and understand if your current plan is still the best option. Your carrier may no longer offer coverage in your service area, or there may be benefit and price changes.
Parts A, B, And C
Medicare consists of several major benefits including Part A (hospitalization), Part B (office visits, outpatient care etc…), and prescription drugs (generic and non-generic). Since it is not considered a Marketplace plan, federal subsidies are not offered. However, most of the cost is paid by the government through your contributions to social security during your working years.
Part A is the major medical (hospitalization) coverage including inpatient and skilled nursing benefits. However, it is not designed to replace separate private long-term care plans. Part B includes outpatient services and physician charges. Also, many therapy expenses that are considered medically necessary are included in benefits.
Part C (Advantage Plans) allows you to purchase coverage privately through an insurer that provides PPO or HMO plans. Original Medicare benefits are included along with several extras offered by some carriers. These include dental, vision and prescription options. Typically, the premium is much less than buying a standard Medicare Supplement/Medigap plan. Often, the entire premium is paid by the providing carrier.
You may dis-enroll from these types of plans from January 1 to February 14th. If you elect this option, you can return to standard Medicare benefits.
Supplements And Medigap Plans
If you have existing coverage already, such as a private Marketplace plan if you’re under age 65, or Medicare if you’re 65 or older, there are always going to be gaps that leave you paying copays, coinsurance or deductibles out of your own pocket. It could be as little as a few hundred dollars per year or potentially $10,000 or more, depending on the size of your family. Customizing a policy to fit your specific needs can save thousands of dollars in potential out-of-pocket expenses.
Under Age 65 Supplements
The most common gap-fillers if you are not yet eligible for Medicare are accidental injury and critical-illness contracts. Since these two situations become more common as you enter your senior ages, and represent a major unexpected expense, supplement coverage is often purchased.
Accidental injury riders can pay thousands of dollars of medical bills, and sometimes provide reimbursement for lost wages. They are not intended to replace long-term or short-term disability plans. These riders can often be purchased as stand-alone policies. It is important to understand all terms, including any waiting period (or elimination period).
Critical illness coverage (sometimes referred to as dread disease benefits) pays for medical expenses directly attributed to specific major medical diseases, such as cancer, stroke, or heart attack. Additional conditions which may be included (depending on carrier and policy) are Parkinson’s disease, kidney failure, Alzheimer’s disease, and multiple sclerosis.
Limited Benefit Plans are generally issued by lesser-known carriers and can be expensive. And, as its name implies, benefits can be very limited compared to traditional options. An application fee of approximately $50-$200 is often not refundable, so these contracts should be viewed with caution. Although a major carrier may be mentioned in the sales pitch, they rarely offer much more than use of network providers for LB policies.
Also, they are not considered compliant with the Affordable Care Act guidelines, so although securing very basic limited benefits will be accomplished, you’ll be liable for paying a tax penalty at the end of the year if you use this plan is your primary source of coverage.
Over Age 65 Supplements
Medigap coverage (also referred to as Medicare Supplements) is written by private insurers. During Open Enrollment (typically October 15th-December 7th), you can purchase or change plans without medical underwriting. Also, when you reach age 65, you have a six-month window that also allows you to buy a policy regardless of any existing conditions. Availability may depend on where you live. For example, many companies offer specific plans in certain counties, and prices may vary.
To qualify for these types of plans, you must be enrolled in Medicare Parts A and B. Each applicant owns their own policy so there are separate deductibles and/or copays to meet. The contracts are always renewable, regardless of any changes in health. However, if you move, you may have to re-enroll in a policy that is offered in your area. At any time you can terminate your policy, although you may have to wait until January 1 to be covered again.
Medicare Advantage Plans
An Advantage plan is not issued by the federal government. Rather, a private insurer provides coverage, and typically at rates much lower than a conventional Med-Supp contract. Your Part A and Part B benefits are included in the plan, and often drug/prescription is also included. However, contracts vary, depending upon the carrier. Rates are typically low, with several carriers offering $0 premium options. Additionally, dental and vision benefits are often included with free preventative vision and dental exams.
MA contracts come in all shapes and sizes, including HMO. PPO, PFFS, and SNP (Special Need Plans). Also available is a high-deductible MSA version (Medical Savings Account) that allows you to add a special tax-deferred savings portion. This option consists of two separate contracts, with annual deposits from Medicare deposited into the funding portion. These funds can be used to pay for out-of-pocket expenses you incur, before the plan deductible is met. NOTE: MSA plans do not cover Part D prescription drugs.
During Open Enrollment, you can purchase an Advantage plan. If you are already covered under an existing MA policy, it will terminate when you switch to the new contract. You can also change back to Medicare and consider a traditional Medigap policy. It’s also important to determine if the contract offers prescription drug benefits. If not, a separate Part D plan can be purchased. NOTE: If you have End-Stage Renal Disease (ESRD), standard Medicare is usually the best option.
Medicaid (Under age 65)
If your income is low, you don’t have private medical coverage, and the financial resources you have are limited, Medicaid may be available at little or no cost. And you won’t have to wait for an Open Enrollment Period to qualify. Premiums are paid with federal and state-sponsored funds, and the network of available physicians, hospitals, and ancillary medical facilities is large.
There are no medical requirements, although you must be a US citizen or have legal permanent status. If your household income is under 100% of the Federal Poverty Level (FPL), you will likely qualify for Medicaid. In many states, income up to 133% of the FPL will qualify for new Medicaid expansion. In these states, you may be eligible if you make approximately $16,243 (single person) or $33,465 (family of four).
CHIP, which is available in all states, can help children of Seniors in low-income households. Pregnant women and parents can also get CHIP benefits (in some states) if Medicaid-ineligible. Some of the most popular covered benefits include routine check-ups and office visits, immunizations, prescriptions, ER, lab tests and x-rays, dental/vision, and of course hospitalization. It is possible to purchase a conventional plan, even if you are CHIP-eligible. However, you would not be eligible for financial aid or tax credits, and thus, the premium would be higher.
Senior health insurance rates don’t necessarily have to be expensive, if you shop, research, and compare the right way. That’s our job and the end result is affordable healthcare for consumers. Regardless of your income or medical conditions, during designated times throughout the year, quality low-cost benefits are available.
The American Medical Association (AMA) is concerned with the recent proposed mergers of Aetna and Humana, and Anthem and Cigna. The number of offered Medicare Advantage plans is likely to reduce, which would reduce availability, and possibly increases rates. More than 150 Metropolitan areas could potentially be impacted.
The AMA stated that the reduced competition would help neither doctors or their patients. Currently, the three biggest insurers already have more than 80% market share in most states.
Medicare Open Enrollment has begun and persons 65 and over have until December 15th to make changes to coverage. More than 50 million persons are eligible this year and about a third will receive up to a 50% increase in Part B premiums.
Bigger costs are likely if your household income is high, you are not currently receiving SS benefits, or you just applied for Medicare for the first time. Another factor in the rising costs is that there is no COLA (Cost Of Living Adjustment) for Social Security in 2016. This is the third year out of the last six years that there has been no increase in benefits.