Being optimistic about your health is important, but so is preparing for the unexpected. So take the time to learn about your options and budget for health care before you actually need it. You will be happy you took charge of your future!
Medicare
Medicaid
Paying for Long-term Care
Retiree Health Coverage
Association-based Coverage
Using Your Personal Resources
For Veterans
Order Resources
Helpful Links
Medicare
Medicare is a federal government program that provides health care coverage if you are 65 or older, or have a disability. If you paid into the program during your working years, you are eligible to receive Medicare, regardless of your income. Keep in mind that you will pay a monthly premium once you start receiving Medicare, and that there are various deductibles.
Medicare is divided into three parts: Part A, Part B and Part D.
- Medicare Part A covers in-patient care at hospitals and nursing facilities. It also pays for hospice and home health care.
- Medicare Part B covers almost all reasonable and necessary medical services-including visits to the doctors, laboratory and x-ray services, equipment like wheelchairs and hospital beds, ambulance services, outpatient hospital care, home health care, blood transfusions and medical supplies.
- Medicare Part D covers prescription drugs, but only through Medicare private drug plans or Medicare private health plans.
Medicare DOES NOT cover long-term care, such as extended stays in a nursing home-which is why planning ahead for health care costs, is so important. For more information and details on Medicare, visit the helpful links (below) or order free educational resources by clicking here.
Medigap: Medicare Supplement Insurance
Medigap policies are specifically designed to supplement the Original Medicare Plan and pay for some of the "gaps" that the Original does not cover, like deductibles. A Medigap policy only works with the Original Medicare Plan and is only available through private insurance companies.
Medicare Advantage Plans
Medicare Advantage Plans are managed care versions of Medicare, often providing extra benefits and even prescription drug coverage (although each plan varies). When you join an Advantage Plan, your health care is paid for and managed by a private insurance company. If you are considering an Advantage Plan, check to see if it has a network and if your doctors, hospitals and clinics are included.
Prescription Drug Coverage
You don't need us to tell you that prescription drugs are expensive! Through Medicare Part D, you can get prescription assistance. Medicare drug plans vary in cost, the prescriptions they cover and which pharmacies you can use. And be careful as most Medicare drug plans also have a coverage gap, known as the "donut hole." This means that once you've received a certain level of assistance, you will have to pay out of pocket for your prescriptions. Then, once you reach a second threshold, the coverage picks back up.
Some individuals are eligible to receive assistance in paying for their prescription coverage through what is called Low Income Subsidy. Based on your income and assets, Medicare may pay all or part of your monthly premium and deductibles, and individual drug costs range from $2 to $5.
In addition to what Medicare offers, the Partnership for Prescription Assistance brings together pharmaceutical companies, doctors, health care providers, patient advocacy organizations and community groups to help qualifying patients get the medicines they need by connecting them with public and private programs. For more information, click here or see the helpful links at the bottom of this page.
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Medicaid
Medicaid helps low-income individuals cover medical costs, including premiums, co-payments and deductibles. Medicaid does not send you checks, but rather sends payments directly to your health care providers. You can have both Medicaid and Medicare at the same time. Talk to an attorney or someone at your state Medicaid office to find out if you qualify. For more information, see the helpful links at the bottom of this page.
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Retiree Health Coverage
Count yourself lucky if you have retiree health care coverage through your former employer, as individuals aren't the only ones feeling the pressure of rising health care costs. Companies are also affected. And with increasing costs, many are reconsidering their retiree coverage programs, or even canceling them. It's important to understand that your previous employer can, at any time, cancel or change your benefits and premiums. So follow the old adage, "expect the best, plan for the worst."
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Association-Based Health Coverage
You may be able to get health coverage through your trade organization or professional group, even if you are no longer working. Many professional, community and religious organizations offer group insurance for members-just ask the group's leader.
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Using Your Personal Resources
If you planned ahead, you could use your personal funds to help pay for health care. By drawing from your checking and savings accounts, stocks, bonds, investments, life insurance policies and pensions, you will avoid having to rely solely on insurance plans and government programs to cover the cost of health care. A financial advisor can help you evaluate your resources and make a plan to pay for health care.
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For Veterans
The Veterans Health Administration oversees many programs for veterans and their families. The Department of Veteran's Affairs is required by law to provide eligible veterans with hospital and outpatient care services that are "needed" to promote, preserve and restore health-including treatment, procedures, supplies or services.
If you were a member of the U.S. Armed Forces and suffered a service-related injury or meet other eligibility requirements, you may also be able to get in-home care or placement at a VA nursing home. For more information, see the links below.
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Paying for Long-term Care
Long-term care is different from health care, although both are vital for your well-being. Health care is provided by physicians, nurses and other medical professionals and focuses primarily on diagnosis, treatments and procedures. However, long-term care is more focused on providing help with daily living activities like bathing, dressing, or moving around. Trained assistants, family members and nursing homes provide most long-term care.
There are three ways to pay for long-term care:
- Medicaid Coverage. Most people do not realize that Medicare does not normally pay for long-term care. When it comes to government assistance, Medicaid is the program that covers long-term care. But, as you may know, Medicaid is limited to those with low incomes and minimal assets.
- Private Savings. Those who are not eligible for Medicaid usually use their own savings to pay for long-term care, which can be very expensive. Look into home and community care costs and options before you need them. Planning ahead helps alleviate stress and gives you time to make a financial plan.
- Long-term Care Insurance. If you're under 70, consider long-term care insurance. Premiums vary depending on your age, health and the type of coverage you want. The younger you are when you purchase, the lower your premium will be-so it's better to take action sooner rather than later. You may not need care now. But if you do in the future, you'll be happy you planned ahead. For more in-depth information on long-term care insurance, click here to visit the Insurance page of this website.
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Order Resources
Click here to order resources on paying for health care.
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Helpful Links
Benefits Check Up
Center for Medicare & Medicaid Services
Medicare Rights Center
Partnership for Prescription Assistance
Texas MedicareRX
Texas Medicaid Program
Veteran's Health Care Benefits
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