ARE HEALTH INSURANCE CHOICES IMPACTING YOUR LIFE?

It’s no secret that as we age, our health needs can become more complex. Not everyone will experience significant complications, but many will. Doctor visits may increase, more prescriptions may be required, and medical costs often rise, impacting not only your physical and emotional well-being but also your retirement budget.

One of the most critical challenges we see with our clients is the health insurance choices they’ve made along the way. 

Understanding Medicare and Your Options

At age 65, you become eligible for Medicare, the federal health insurance program for older adults. But Medicare alone does not cover everything. It typically pays 80% of approved medical costs, leaving you responsible for the remaining 20%.

That’s where Medigap (Supplemental Insurance) comes in. Medigap policies help cover the remaining 20%, and prescription drug coverage requires a separate plan altogether.

The Most Important Enrollment Window

The best time to purchase a supplemental insurance policy is during your 6-month Medigap open enrollment period, which begins the month you turn 65 and enroll in Medicare Part B.

• During this period, you have guaranteed issue rights, you can’t be denied coverage or charged more due to pre-existing conditions.

• If you wait until after this window, insurance companies can medically underwrite your policy, potentially deny your coverage or significantly increase your premiums.

The Medicare Advantage Trap

Many adults are drawn to Medicare Advantage Plans (often marketed with appealing benefits like dental or gym memberships). These plans are offered by private insurance companies like UnitedHealthcare, Aetna, and others. But here’s what you need to know:

• These companies manage your Medicare dollars.

• This can translate into restricted provider networks, required referrals, and limited flexibility in care.

• Home health services are limited or unavailable due to network constraints.

• In an emergency, you must be taken to the closest hospital, and you find out it is not covered by your insurance plan.

• If your insurance plan doesn’t cover certain rehab centers, your options for post-hospital care may be severely limited.

You may not notice the drawbacks until your health changes.

Had you chosen traditional Medicare with a supplemental plan, you'd likely have more flexibility, choice, and fewer delays in care.

The Impact on You and Your Family

When care needs escalate, decision-making becomes harder, and stress rises; particularly when health insurance limitations and financial consequences weren’t part of the original retirement plan.

Ask Yourself or a Loved One:

1. Do I understand my health insurance coverage options?

2. Do I have a trusted health insurance specialist to consult?

3. Have I enrolled in Medicare Part B and chosen supplemental insurance by age 65?

4. Do I understand prescription coverage and the associated costs?

5. Do I know the difference between Medicare + Medigap vs. Medicare Advantage?

6. If finances are limited, do I understand the trade-offs of having chosen a Medicare Advantage plan?

Final Thoughts

This is a critical issue that we have faced with clients. Health insurance choices made in the early stages of Medicare eligibility can have lasting impacts on quality of care and financial stability.

We encourage everyone to ask hard questions, engage with trusted professionals, and make informed choices, before a crisis occurs.

Don't wait until open enrollment catches you off guard. Be proactive. Be prepared.