Medicare v. Medicaid

If you are around 64 years of age, you have likely received invitations to attend informational sessions on Medicare options. This is because it is Medicare Open Enrollment Season. You can only change plans once a year, unless there are changes in your family situation necessitating a change. While I’m not a licensed insurance agent, and I don’t sell Medicare plans, we can certainly refer you to people who will advise you on the Medicare plans. I will however enlighten you on the different options available for Medicare. There are two ways to go about doing Medicare, one of which is traditional Medicare and the other is the Medicare Advantage plan. 

Medicare Traditional Plan

For Traditional Medicare Part A and B, you get hospitalisation and doctor’s visits. Depending on your income, there are some premiums for Part B. Unfortunately there are gaps in the coverage, so you may need to add a policy. Commonly referred to as a Medigap policy, it is designed to fill the gaps in coverage where Part A and B don’t pay, or leave you with heavy copayments. You can purchase this policy from a private insurance company. In addition, you also have to buy a Part D policy, which is your prescription drug coverage. This all forms part of a Traditional Medicare Plan.

The biggest advantage is that you can use it anywhere in the country, and is suited to those who travel. Provided the doctor you wish to see accepts Medicare, you can go to a doctor’s office or hospital and receive care. While the premiums can be a little pricey, traditional Medicare plans provide good coverage. 

Medicare Advantage Plan

The other way to do Medicare is with an Advantage Plan, which is Part C. It is a partly funded Medicare policy, offered by a private insurance company. Medicare is shifting some of the costs and the administration of these policies and policyholders to private insurance companies. There are all different types of Advantage plans, and all the different insurance companies offer them. Advantage plans have pros and cons, but many of these plans include gym memberships and wellness bonuses. One of the shortfalls with the Advantage plan, is that these are managed care plans and they’re usually set up as an HMO or PPO. They have a network of providers, but some of these networks are very expensive. 

Get Trusted Advice

Many people choose Advantage plans, although it is not always clear whether traditional Medicare or an Advantage Plan is the better option. That is why we recommend chatting with advisors who will talk you through your options. One of the companies that we work with is MediConnect, who are the region’s largest Medicare broker. They will help you pick the plan that makes the most sense for you. Families trying to do this on their own, are likely going to make mistakes, because the plans are complicated. It is important that people get trusted advice. 

We are all led to believe that when we reach the age of 65, we will have health insurance in our senior years with Medicare. Many people work to the age of 65 because they need the employers health insurance plan to get their healthcare benefits when they retire. However, Medicare does not pay for the single biggest health care expense that retirees face, which is custodial long term care (residential facilities, personal care homes, assisted living facilities or skilled nursing facilities). If you heed the recommendations of various organizations, such as Parkinson’s and the Alzheimer’s Association, a significant portion of the baby boomer generation may need long term care.

Paying for Long Term Care

This means you have three options. You can either pay privately, or you can buy long term care insurance. Alternatively, you can look at other government programs like the Veterans Administration and Medicaid. Paying privately for most middle-class families is cost prohibitive, as most nursing homes in Pennsylvania now cost $170,000 a year. Unfortunately, middle class families are mostly affected, because wealthy people are not worried about paying for the nursing home. For those who are indigent, they’re immediately eligible for Medicaid to pay for long term care. Not many people buy long term care insurance because it is also costly, with high premiums. If you do get sick and file a claim, you will get more than your premium dollars back, but if you don’t need long term care, the insurance companies score.

There are a few different programs that veterans could consider. Known as the Improved Pension, or ‘Aid and Attendance’, this program pays the veteran cash to pay for care. Unfortunately, nursing home beds for veterans are on a waiting list and it is tough to get in to a nursing home. As a result, many veterans end up in the civilian system. 

We Teach You About Medicaid

Medicaid is something we talk about in our Three Secrets Workshop. If you are concerned about the risk of long term care, and want to become eligible for Medicaid, you need to understand how the system works. Medicaid is the only government program that will help you pay for care in a nursing home. Therefore, it is important that you know the rules. This is why we provide education to our clients. If this resonates with you, we encourage you to register to attend our Three Secrets Workshop HERE.

Estate planning is not just about answering the question of who gets your stuff when you pass away. When done properly, you can protect your stuff from this system that requires you to go broke if you have Alzheimer’s disease. We know you want to leave a legacy, and by doing asset protection, we can help you to ensure there is stuff to leave to your family when you pass away.