Insurance for Senior Citizens: What Covers What

Insurance for senior citizens usually starts with Medicare: Part A for hospital care, Part B for doctors and outpatient care, and Part D for prescriptions, or a Medicare Advantage plan that bundles them. Many people add a Medicare supplement (Medigap) plan, and some also qualify for Medicaid or veterans coverage. The biggest surprise for most families is what none of these cover well: long-term care at home or in a facility, plus routine dental, vision, and hearing aids in Original Medicare. Medicare's open enrollment runs from October 15 to December 7 each year, the main window to review and change plans.

Mom's mailbox is full of Medicare ads. She's not sure whether her plan still covers her doctors, her new prescription costs a fortune, and she asked you, "Do I need to do anything before December?"

Medicare, piece by piece

Part A (hospital insurance). Inpatient hospital stays, some skilled nursing facility care after a hospital stay, hospice, and some home health.

Part B (medical insurance). Doctors, outpatient care, preventive services, medical equipment, and some home health.

Part D (prescription drugs). Offered by private plans approved by Medicare.

Original Medicare is Parts A and B, often paired with a Part D plan and a Medigap plan.

Medicare Advantage vs. Medigap

Medicare Advantage (Part C) plans are offered by private companies and bundle Parts A and B, usually with drug coverage, sometimes with extras like dental or vision. They often use provider networks.

Medigap (Medicare supplement) plans work alongside Original Medicare to help pay deductibles, copays, and coinsurance.

Your parent generally has one or the other, not both. The right choice depends on their doctors, prescriptions, health, and budget.

Other coverage your parent may have

• Medicaid, for people with limited income and resources. Some people have both Medicare and Medicaid.
• VA health care, for eligible veterans, and TRICARE for Life, for eligible military retirees with Medicare.
• Retiree coverage from a former employer or union.
• Long-term care insurance, if your parent bought a policy.
• Life insurance, some of which includes long-term care benefits.

The gaps families don't expect

• Long-term care. Medicare doesn't pay for ongoing help with daily activities, like bathing and dressing, at home or in assisted living. See homecare insurance and how much long-term care costs per month.
• Routine dental, vision, and hearing aids aren't covered by Original Medicare. Some Medicare Advantage plans include limited coverage.
• Care outside the plan's network, for Medicare Advantage plans.

Review your parent's plan every fall

During Medicare's open enrollment, October 15 to December 7, check:

• Are your parent's doctors and hospitals still covered?
• Are their prescriptions still covered, and at what cost?
• Has the plan's premium, deductible, or network changed for next year?

Free, unbiased help in Utah

Utah's SHIP program offers free Medicare counseling through local Area Agencies on Aging. A trained counselor can compare plans with your parent, with no sales pitch. See our county-by-county guide to find your parent's local agency.

Where help at home fits

Insurance decides what's paid for. Our Care Professionals help with the daily care Medicare doesn't cover: bathing, dressing, meals, medication reminders, and rides to appointments, so you don't have to take time off work. If your parent has long-term care insurance, we can bill the insurance company directly once your parent signs an assignment of benefits. Our pricing is clear: the more hours a week, the lower the hourly rate. See your exact price in 30 seconds. See how everyday help at home works.

What to do next

1. Gather every insurance card and plan letter your parent has.
2. Before December 7, check doctors, prescriptions, and costs for next year.
3. Book a free SHIP counseling session through the local Area Agency on Aging.
4. Plan for long-term care, which Medicare doesn't cover.
5. Look at all our home care services, or see your exact price in 30 seconds.

Need help for someone in your family? See your price in 30 seconds, or call us to talk it through.

This article is general information, not financial, legal, or medical advice. Talk with a qualified professional or licensed insurance counselor about your situation.