By Amita Connor-Williams
Exploring your options for healthcare coverage can open up a world of possibilities. From health insurance and Medicare to long-term care plans, there are solutions designed to fit different needs and life stages. Knowing the basics of each type can help you make clear-headed decisions for yourself or a loved one.
This guide provides a simple, high-level look at the most common types of insurance. Think of it as your starting point. Our goal is to help you understand the purpose of each plan so you can feel more confident as you plan for your healthcare needs.
Health Insurance: Your Go-To for Everyday Health
This is the type of insurance most of us are familiar with. Health insurance is designed to cover your routine medical needs. This includes visits to the doctor, stays in the hospital, prescription medications and preventive care like check-ups and screenings.
If you are younger than 65, you likely have coverage through your job, a spouse’s plan or a state health marketplace. Every plan is different, with its own network of doctors and hospitals, as well as varying costs. It’s always a good idea to review your plan’s details to understand what’s covered before you need to use it.
Medicare: Coverage for 65-plus and Certain Disabilities
Medicare is the federal health insurance program for people 65 or older. It also covers some younger individuals who have specific disabilities. Medicare is broken down into different “parts,” each covering different services.
• Part A (Hospital Insurance): Helps cover care you receive in a hospital, skilled nursing facility care after a hospital stay and some home health services.
• Part B (Medical Insurance): Helps cover outpatient services. This includes doctor’s appointments, lab tests and preventive screenings.
• Part D (Prescription Drugs): This part helps pay for your prescription medications.
• Part C (Medicare Advantage): These are all-in-one plans offered by private companies that contract with Medicare. They bundle Parts A, B, and often D. Many also include extra benefits that Original Medicare doesn’t cover, like vision, hearing or dental care.
Medicaid: Support Based on Income
Medicaid is a program run jointly by the federal government and individual states. It provides health coverage to people with limited income and resources. Depending on your circumstances, Medicaid can work with Medicare or as your primary insurance.
For instance, some older adults qualify for both programs. In this case, Medicaid can help cover out-of-pocket costs that Medicare doesn’t, such as copays and deductibles. It can also cover services not typically included in Medicare, like personal care at home or extended stays in a nursing home.
Long-Term Care Insurance: Planning for Future Needs
Unlike traditional health insurance, long-term care insurance is specifically for services you might need over an extended period. This could mean help with daily activities like bathing and dressing at home or care in a long-term community such as St. Ann’s.
It’s an important tool for future planning because Medicare generally does not cover long-term “custodial care.” So, what does that mean?
• Custodial Care: This is non-medical help with personal tasks, such as eating, bathing or getting dressed. It’s about assistance with daily living, not treating a medical condition.
• Extended Care: This refers to the need for these services over a long period, which can last for months or even years.
Because these needs can arise unexpectedly, looking into long-term care insurance before you need it is a wise step. Your age and health when you purchase a plan will affect the cost.
Supplemental Insurance: Filling the Gaps in Medicare
Supplemental insurance, often called “Medigap,” is an extra policy you can buy from a private company. Its purpose is to help pay for some of the healthcare costs that Original Medicare (Parts A and B) doesn’t cover. This can include your deductibles, copayments and coinsurance.
These plans can provide peace of mind by making your medical costs more predictable. It’s important to know that Medigap plans supplement or “add to” your Medicare coverage — they don’t replace it.
This article is just a brief overview to get you started. The right insurance plan or combination of plans depends on your age, health, financial picture and future care needs. There is no single answer that fits everyone.
Amita Connor – Williams is an admissions professional at St. Ann’s Community. She can be reached at AConnorWilliams@mystanns.com or by calling 585-697-6000.