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.
2022 Medigap Supplement, Advantage (MA), and Marketplace policies are offered. Prescription drug plans (Part D) are also available. Copays, deductibles, coinsurance, and other out-of-pocket expenses, can be covered by supplementary policies. Personalized and free counseling and consultations from SHIP (State Health Insurance Assistance Program) are available to help review and explain benefits. If you are currently receiving Social Security benefits, Parts A and B will become effective the first day of the month you reach age 65. If you choose to not enroll in Part B, there may be a penalty later when you do enroll.
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 and other organizations in your area, and determine if the options are worth considering.
Other major carriers, such as Cigna, Humana, Blue Cross, Transamerica, Mutual Of Omaha, Physician’s Mutual, Aetna, Colonial Penn, Manhattan Life, and UnitedHealthcare, offer plans in most parts of the US. Lesser-known companies also feature competitive prices in many states, including Bankers Fidelity, Medico, Everence, Globe Life, Philadelphia American, Thrivent, Greek Catholic Union, New Era Life, United American, and United World Life. BCBS plans are popular in most areas, and provide large network coverage. Many states have more than one Blue Cross company, including Pennsylvania (Independence Blue Cross, Capital Blue Cross, and Highmark).
Subsidized Marketplace Plans (Must Be Under Age 65)
Applicants ages 50-64 may qualify for larger financial assistance through State or 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 instant tax credits are awarded to persons between the ages of 61 and 64, and often the savings is more than $8,000 per year. Depending on your Federal Poverty Level, the subsidy could be more than $10,000.
Deductibles for cost-sharing eligible Silver-tier plans can also substantially reduce, often from $8,700 to less than $1,000. However, many areas do not offer “Platinum” tier options. Maximum out-of-pocket expenses are currently capped at $8,700 per person, and $17,400 per family. There are many $0 deductible plans offered, although coinsurance and out-of-pocket expenses are high. typically, catastrophic and Bronze-tier plans have deductibles between $6,000 and $8,700.
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 $0 per month for the least expensive Bronze-tier plan (WellFirst Bronze Copay Plus 8650X). The least expensive Silver-tier plan (Ambetter Balanced Care 30) costs only $141 per month. A 62 year-old earning $40,000 per year will pay $17 per month for the Medica Bronze Value plan and $208 per month for the Ambetter Balanced Care 30 plan.
Low rates are available in many other areas. In Columbus, Ohio, a married couple (age 30) with $50,000 of household income, will pay only $46 month for the least expensive plan (Oscar Bronze Simple) and $48 per month for the Oscar Bronze Classic plan. However, many carriers have ceased offering private individual plans, including Premier, Humana, UnitedHealthcare, and Aetna in the Buckeye State. Many Co-ops have also left other states.
In most states, there are several major reputable companies that offer Exchange policies. Of course, the selection will vary, depending where you live. States with the most participating carriers are New York (12 companies), California and Wisconsin (11 companies), Ohio and Texas (8 companies), Colorado, Michigan, and Massachusetts (7 companies), and Virginia (6 companies).
States with the fewest participating carriers are Alaska, Delaware, Iowa, Mississippi, Nebraska, Oklahoma, South Carolina, and Wyoming (1 company), and Alabama, Arizona, Connecticut, District Of Columbia, Hawaii, Indiana, Kentucky, Louisiana, Maine, Maryland, Nevada, North Carolina, North Dakota, Rhode Island, South Dakota, Utah, Vermont, and West Virginia.
During the first year of the Marketplace, states with the most participating carriers were New York (16), Wisconsin (13), Ohio (12), California, Oregon, Texas (11), and Colorado and Massachusetts (10). States with the fewest participating carriers were New Hampshire and West Virginia (1), Alabama, Nebraska, Delaware, Hawaii, Maine, Mississippi, North Carolina, Rhode Island, Vermont, and Wyoming (2).
Although Open Enrollment typically occurs for less than two months (November and December), 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 purchase 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. You can also choose to purchase cheaper temporary plans, that typically exclude existing medical conditions from being covered.
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, if 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 $8,700. Catastrophic and Bronze-tier plans typically use this amount for their maximum out-of-pocket expenses.
You can purchase an “Obamacare” plan regardless of your income. Whether your household income is $15,000 or $250,000, quality policies are offered that contain the 10 mandated “Essential Health Benefits.” However, it is possible, that in 2023, new less-expensive options may be available that eliminate often unneeded benefits such as maternity. New high-deductible catastrophic plans may become available to all applicants (instead of under-30 only), with lower premiums, and basic benefits. Note: Medicaid-eligible applicants can purchase an Exchange plan without utilizing the subsidy. However, in most situations, it is not advisable.
“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 12 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. “Short-term” plans can be utilized to fill temporary gaps, although pre-existing conditions are not covered and only increments of three months can be purchased without re-applying.
This Federal program is constantly improving, 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. Unlike under-65 private plans, typically, you can utilize almost every doctor, specialist, and medical facility, since most meet enrollment requirements. However, you will need to verify they are accepting new patients.
Although Supplement plans generally allow you to use any doctor, specialist, or hospital, Advantage plans are more restrictive. The network provided by the insurer must be used, and depending upon the carrier and your location, your physician or specialist may not be “in-network.” This could result in higher out-of-pocket expenses. However, Advantage contracts often provide additional benefits, including prescription drug, dental, vision, or hearing coverage.
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. Deductibles and the maximum out-of-pocket expense may also change.
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. The longer you work, in most situations, the higher your monthly SS income. And the longer you delay receiving benefits, the higher your monthly payment becomes.
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. The current deductible is $1,556. The coinsurance for hospital stays (60-90 days) is $389 per day. Up to 60 lifetime reserve days are available after the 90th day has been used. A $778 coinsurance per day is applied.
20 days of skilled nursing facility benefits are provided at no cost. However days 21-100 cost $185.50 per day. After the 100th day, coverage terminates. A separate policy can be purchased to provide additional 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. Out-of-pocket expenses are often covered with low copays.
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. The annual deductible for Part B recipients is $233. Also, if you are receiving Medicare benefits, but not Social Security benefits, your Part B premium payment is $170.10. This amount increases to $238.10 if your income is more than $91,000 and less than or equal to $114,000 on an individual tax return. For joint tax returns, the range is $182,000 and $228,000. The amount further increases to $340.20 if your income is more than $114,000 and less than or equal to $142,000 on an individual tax return. For joint tax returns, the range is $228,000 and $284,000.
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. Plans are often issued by large and small carriers, and prices will differ from one state to another.
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. They can be attached to short-term or indemnity contracts, or purchased as stand-alone plans.
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). Occasionally, major credit cards offer basic accidental coverage. The benefit range is typically $5,000 to $100,000.
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. Stand-alone policies are available through several major companies, including UnitedHealthcare. Documentation of the specific disease is required.
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.
The cancellation rate is very high on this type of plan, and large hospital bills typically result in huge out-of-pocket obligations for consumers. Surgeries and inpatient hospital charges are only partially-covered, and several additional procedures are subject to major limitations.
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. Multiple surgeries with long periods of confinement can result in large out-of-pocket expenses. Note: Effective with the 2019 tax year, the requirement of of purchasing qualified coverage ended. Therefore, the 2.5% non-compliant tax penalty was terminated two years ago.
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 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. Blue Cross, Aetna, Humana, Cigna, Manhattan Life, Medico, Equitable, and AARP-UnitedHealthcare are popular carriers.
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 Supplement plans are available in all states. Offered/current plans are A, B, C, D, F, F (HD), G (HD), K, L, M, and N. Prices and covered benefits vary from one plan to another. However, since coverage is standardized, comparing carrier quotes is much easier than comparing private Marketplace plans for persons under age 65. The Plan F and PLan G high-deductible options feature a $2,370 deductible, which provides a low-cost option. Once out-of-pocket yearly limits and the Part B deductible, benefits are covered at 100%. This type of plan is often popular with persons that rarely utilize their policies.
2022 Medicare Advantage Plans (MA)
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. Urgent care and emergency care coverage is always included, although “medically-unnecessary” treatment is typically excluded. If benefits are denied, an appeal process is available.
MA contracts come in all shapes and sizes, including HMO. PPO, PFFS, and SNP (Special Need Plans). Maximum out-of-pocket expenses can vary, along with deductibles and premiums. 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.
Advantage plans (HMO or PPO with prescription drug coverage) offered by major carriers in the largest US states are listed below. Additional options are also available.
California – AARP Medicare Advantage SecureHorizons, AARP Medicare Advantage SecureHorizons Plan 1, AARP Medicare Advantage Freedom Plus, Aetna Medicare Choice Plan, Aetna Medicare Plus Plan, Aetna Medicare Select Plan, Anthem MediBlue Dual Plus, Anthem MediBlue Plus, Anthem MediBlue StartSmart Plus, Anthem MediBlue Value Plus, Blue Shield AdvantageOptimum Plan, Blue Shield Inspire, Blue Shield Coordinated Choice Plan, Blue Shield 65 Plus, Brand New Day Classic Care II Plan, Health Net Healthy Heart, Health Net Jade, Health Net Ruby Select, Health Net Sapphire Premier, Health Net Amber II, Humana Gold Plus, Imperial Senior Value, Imperial Traditional, Imperial Dynamic Plan, Imperial Traditional Plus, Kaiser Permanente Senior Advantage Basic, and UnitedHealthcare Medicare Advantage Assure.
New York – AARP Medicare Advantage Patriot, Aetna Medicare Credit Plan, Aetna Medicare Eagle Plan, Aetna Medicare Value Plan, Aetna Medicare Elite Plan, BlueShield Freedom Station, BlueShield Freedom No Rx, BlueShield Freedom Value, Centers Plan For Medicare Advantage Care, CDPHP $0 Medicare Rx, CDPHP Flex, CDPHP Vital Rx, EmblemHealth VIP Part B Saver, EmblemHealth VIP Rx Saver, Empire Mediblue Core, Empire MediBlue Core Select, Empire MediBlue Health Plus, Fidelis Medicare $0 Premium, Fidelis Medicare Advantage Flex, Healthfirst 65 Plus Plan, Healthfirst Coordinated Benefits Plan, Healthfirst Signature, Humana Gold Plus, Humana Honor, HumanaChoice, MVP Medicare WellSelect With Part D, UnitedHealthcare Medicare Advantage Patriot, UnitedHealthcare Medicare Advantage Choice Plan 1, WellCare Absolute, WellCare Patriot, WellCare Value, WellCare Summit, and WellCare Imperial.
Texas – AARP Medicare Advantage Choice, AARP Medicare Advantage SecureHorizons, AARP Medicare Advantage SecureHorizons Plan 1, AARP Medicare Advantage SecureHorizons Plan 2, Aetna Medicare Choice, Aetna Medicare Dual Complete, Aetna Medicare Premier, Aetna Medicare Prime, Aetna Medicare Value, Aetna Medicare Choice II Plan, Allwell Medicare, Allwell Medicare Nurture, Allwell Medicare Complement, Amerivantage Classic, Amerivantage Classic Plus, Amerivantage Select, Amerivantage Choice, Amerivantage Select Plus, Blue Cross Medicare Advantage Choice Plus, Blue Cross Medicare Advantage Value, Blue Cross Medicare Advantage Choice Premier, BSW SeniorCare Advantage, Care N’ Care Choice, Care N” Care Choice Plus, Care N’ Care Choice Premium, Care N’ Care Classic, CFHP Medicare Advantage with Part D Standard Plan, Cigna Preferred Medicare, Cigna True Choice Medicare, Clover Health Choice, Clover Health Classic, Devoted Heallth Core San Antonio, Devoted Health Prime San Antonio, Humana Gold Plus, Humana Gold Choice, HumanaChoice, Imperial Insurance Company Traditional, Imperial Insurance Value, Molina Dual Options, Molina Medicare Complete Care, UnitedHealthcare Chronic Complete, UnitedHealthcare Dual Complete, UnitedHealthcare Medicare Advantage Choice, UnitedHealthcare Medicare Gold, WellCare Dividend Prime, WellCare Guardian, WellCare Rx Plus, WellCare Value, WellCare Compass, and WellCare TexaxPlus Classic.
Florida – AARP Medicare Advantage Choice, AARP Medicare Advantage Choice Plan 2, AARP Medicare Advantage Patriot, Aetna Medicare Credit, Aetna Medicare Premier, Aetna Medicare Premier Plus, Aetna Medicare Select, AvMed Medicare Access, AvMed Medicare Choice, AvMed Medicare Circle, AvMed Medicare Premium Saver, BlueMedicare Classic, BlueMedicare Premium, BlueMedicare Saver, BlueMedicare Value, Bright Advantage Health Dollars, Bright Advantage Part B Savings, CareFree, CareOne, Devoted Health Care Broward, Devoted Health Essentials Broward, Humana Gold Plus, HumanaChoice Florida, Medica HealthCare Plans MedicareMax, MMM Elite, MMM Extra, Optimum Gold Rewards Plan, Optimum Platinum Plan, Simply Extra, and Simply Level.
Pennsylvania – AARP Medicare Advantage Choice Plan 2, AARP Medicare Advantage, Aetna Medicare Advantra Credit Value, Aetna Medicare Advantra Value, Aetna Medicare Elite, Aetna Medicare Gold, Allwell Medicare, BlueJourney Essential, Cigna-HealthSpring Advantage, Cigna-HealthSpring Alliance, Clover Health Choice, Clover Health Choice Value, Community Blue Medicare HMO Signature, Community Blue Medicare PPO Signature, Gateway Health Medicare Assured Ruby, Geisinger Gold Classic 360 Rx, Geisinger Gold Classic Essential Rx, Health Partners Medicare Simple, Humana Gold Plus, Humana Honor, Keystone 65 Basic Rx, Keystone 65 Focus Rx, Keystone 65 Select Medical Only, Personal Choice 65 Prime Rx PPO, Personal Choice 65 Medical Only, UnitedHealthcare Dual Complete, UPMC for Life HMO no Rx, UPMC for Life HMO Deductible with Rx, and UPMC for Life PPO High Deductible with Rx.
Ohio – AARP Medicare Advantage Plan 6, AARP Medicare Advantage 7, AARP Medicare Advantage Walgreens, Aetna Medicare Premier, Aetna Medicare Value, Aetna Advantra Medicare Silver, Allwell Medicare, Allwell Medicare Essentials, Anthem MediBlue Essential, Anthem MediBlue Preferred, Anthem MediBlue Access, Bright Advantage, Bright Advantage Access, Bright Advantage Flex, Buckeye Health plan MyCare Ohio, CareSource Advantage Zero Premium, Humana Gold Plus, Humana Honor, MediGold Southwest OH Essential Care, MedMutual Advantage Classic, MedMutual Advantage Choice, MedMutual Advantage Select, Molina Medicare Complete Care, SummaCare Medicare Amber, SummaCare Medicare Topaz, SummaCare Medicare Ruby, SummaCare Medicare Saphire, SummaCare Medicare Garnet, WellCare Essential, and WellCare Plus.
Illinois – AARP Medicare Advantage Access, AARP Medicare Advantage Walgreens, Aetna Medicare Prime, Aetna Medicare Value, Allwell Medicare, Ascension Complete Illinois Reward, Ascension Complete Illinois Secure, Blue Cross Medicare Advantage Basic, Blue Cross Medicare Advantage Basic Plus, Bright Advantage Assist, Cigna-HealthSpring Advantage, Cigna-HealthSpring Preferred, Cigna-HealthSpring Premier, Cigna-HealthSpring Essential, Community Advantage, Humana Community Select HMO, HumanaChoice, Humana Gold Plus, IlliniCare Health, Lasso Healthcare, Sunrise Advantage Plan, WellCare Advance, WellCare Essential, WellCare Value, WellCare Rx, and WellCare Plus.
Georgia – AARP Medicare Advantage Walgreens, AARP Medicare Advantage Plus Plan 1, Aetna Medicare Basics, Aetna Medicare Essential, Aetna Medicare Plus, Aetna Medicare Freedom, Allwell Medicare, Allwell Medicare Premier, Anthem MediBlue Access Basic, Anthem MediBlue Plus, Cigna-HealthSpring Preferred, Cigna-HealthSpring True Choice, EON CHOICE, EON SELECT, EON SILVER, Humana Gold Plus, Humana Honor, HumanaChoice, Kaiser Permanente Senior Advantage Basic, UnitedHealthcare Medicare Advantage Essential, UnitedHealthcare Medicare Silver, UnitedHealthcare Dual Complete, WellCare Advance, WellCare Dividend, WellCare Focus, and WellCare Value.
North Carolina – AARP Medicare Advantage Essential, AARP MedicareAdvantage Plan 1, AARP Medicare Advantage Plan 2, AARP Medicare Advantage Walgreens, Aetna Medicare Core Plan, Aetna Medicare Premier Plan, Aetna Medicare Premier Plus Plan, Blue Medicare Essential Plus, Blue Medicare Medical Only, Blue Medicare Choice, Blue Medicare PPO Enhanced, Cigna-HealthSpring Advantage, Cigna-HealthSpring Preferred, Cigna-HealthSpring True Choice, Health Team Advantage Plan 1, Health Team Advantage Plan 2, Humana Gold Plus, HumanaChoice, Lasso Healthcare, Liberty Advantage, Liberty At Home, Liberty Advantage Gold, PruittHealth Premier, UnitedHealthcare Dual Complete, and UnitedHealthcare Nursing Home Plan.
Michigan – BCN Advantage HMO-POS Basic, Covenant Advantage, Covenant Advantage Plus, HAP Senior Plus, HAP Senior Plus Option 1, Humana Choice, Humana Value Plus, Medicare Plus Blue PPO Essential, Medicare Plus Blue PPO Vitality, Medicare Plus Blue PPO Signature, Medicare Plus Blue PPO Assure, Principle, PriorityMedicare Key, PriorityMedicare Ideal, PriorityMedicare Value, PriorityMedicare Merit, Priority Medicare Edge, PriorityMedicare Select, Sparrow Advantage, Sparrow Advantage Plus, WellCare Essential, WellCare Elite Smile, and WellCare Explore.
New Jersey – AARP Medicare Advantage Plan 1, Aetna Medicare Credit Value, Aetna Medicare Explorer Elite, Aetna Medicare Prime Premier, Aetna Medicare Prime Value, Amerivantage Classic, Amerivantage Balance, Clover Health Choice, Clover Health Choice Value, Erickson Advantage Liberty With Drugs, Horizon Medicare Blue Advantage, Horizon Medicare Blue Choice w/Rx, Horizon Medicare Blue, Horizon Medicare Blue Select, HumanaChoice, WellCare Compass, and WellCare Value.
Virginia – AARP Medicare Advantage Walgreens, AARP Medicare Advantage Plan 1, Aetna Medicare Choice Plan, Aetna Medicare Prime Plan, Anthem MediBlue Care On Site, Anthem MediBlue Plus, ApexBold, ApexAscend, Erickson Advantage Liberty With Drugs, Erickson Advantage Guardian, Erickson Advantage Freedom, Humana Gold Plus, Innovation Health – Aetna Medicare Connect, Innovation Health-Aetna Medicare Voyager, Kaiser Permanente Medicare Advantage Value VA, Kaiser Permanente Medicare Advantage High VA, Optima Medicare Value, Optima Community Complete, Reflections, Sunrise Advantage Plan, Sunrise Advantage Community Plan, and Virginia Premier Advantage Elite.
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.
The Basic Health Program (BHP) provides coverage for lower-income households that qualify for Marketplace benefits. However, often their income dramatically changes, resulting in sporadic eligibility of CHIP and Medicaid. Other eligible applicants include legally-present citizens and non-citizens whose income is between 133% and 200% of the Federal Poverty Level (FPL). They also must not meet CHIP and Medicaid guidelines. The 10 required essential health benefits will be included, and participating states receive federal funding for the program.
The monthly cost of coverage will not be higher than available Exchange plans in that state. 95% of premium tax credits are paid to the state from the federal government. A blueprint is the required form to request certification. Compliance and operational details must be submitted for approval.
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) was 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. However, neither merger was completed, although additional smaller mergers will likely be proposed.
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.