Text Size:  A A

Health Care Financing Optionslady

Health care costs can be a major concern for older people, but there are several programs that provide health care coverage to older adults. While these programs can be complex, it is important to understand all your options for health care coverage before making critical decisions. 

Medicare:  
Medicare is a federal health insurance program for people who are 65 or older, some people with disabilities under age 65, and people with end-stage renal disease. The Medicare program is best known by its four parts:  Part A (hospital and skilled nursing rehabilitation insurance); Part B (medical insurance); Part C (Medicare Advantage plans); and Part D (prescription drug plans). Most beneficiaries receive their Part A coverage with no premium, but have a monthly premium for Part B (physician and other medical services) deducted from their social security checks. Original Medicare (Parts A & B) can be replaced with a Part C Medicare Advantage Plan which is a managed care health plan from a private insurer. Private insurers also provide part D prescription drug plans.

To learn more about Medicare, its benefits, and your eligibility from the official Medicare website, click here.

For an alternative, comprehensive site with easy-to-understand Medicare information, go to http://www.mymedicarematters.org

Medigap (Medicare Supplement) Insurance:
Because Medicare has deductibles and co-insurance costs, beneficiaries have the option of getting an insurance plan to cover some or all of the costs that Medicare doesn’t cover. Sometimes retiree-group health plans coordinate with Original Medicare to cover more costs, or individuals may purchase a Medigap or Medicare Supplement plan to cover all or some percentage of their portion of health care costs in exchange for a monthly premium. Premiums increase as you age and new policies do not provide any prescription drug coverage. All Medigap policies in Wisconsin must offer the same benefit structure and are guaranteed renewable for life. Some also offer additional benefits such as coverage for annual physicals or membership in health clubs. Medicare Supplement plans ARE NOT the same as Medicare Advantage plans.

For an excellent overview of all of the options for health insurance related to Medicare, click here.

To learn about assistance available through Wisconsin’s Medigap Helpline, click here.

Medicare Advantage Plans:
Also known as Medicare Health, or Part C plans, these are private managed health plans that contract with Medicare to provide benefits and services that may even include prescription drug coverage. Some add benefits not covered by Medicare such as annual wellness exams or health club memberships. Unlike a traditional Medicare Supplement, however, Medicare Advantage plans have co-payments and cost shares that you need to pay for most services although some plans have no or a low monthly premium. These charges may be different than those under Original Medicare. For more information on Medicare Advantage Plans, click here.

Medicare Part D & SeniorCare Rx:
Because prescription drug costs are often a major concern for older people, there are programs in place to help seniors cover the cost of their drugs. Medicare Part D is the federal program that provides insurance coverage for both brand name and generic prescription drugs. Those enrolled will likely pay some combination of premiums, co-payments, and deductibles depending on the drug plan chosen. For more information on Medicare Part D, click here.

In addition, Wisconsin’s SeniorCare Rx program provides Wisconsin residents who are 65 or older with prescription coverage for a $30 annual enrollment fee. Program benefits vary based on income. For more information on SeniorCare Rx, click here.

Medicare Training & Counseling: 
GWAAR's Medicare Trainer and Counselor provides some direct counseling services to Medicare beneficiaries and caregivers as part of the State Health Insurance Program (SHIP). We provide Wisconsin-specific tips on dealing with Medicare issues including connecting older people to local aging offices for information and access to benefit specialists, the Medigap Helpline, and the Coalition of Wisconsin Aging Groups (CWAG) Prescription Drug Helpline. For more information, contact GWAAR Medicare Trainer & Counselor Peg Nugent.

ForwardHealth:  Wisconsin Medicaid program:
Medicaid is a program that covers the health care costs of people who qualify based on their financial need. Wisconsin’s ForwardHealth Medicaid plans for elderly, blind, or disabled U.S. citizens or legal immigrants provide health care to those who are:

  • Age 65 or older, blind or disabled
  • With family income at or below the monthly program limit

For more information on ForwardHealth, click here.