It’s common knowledge that Medicare Parts A and B are almost holy enough to kill vampires. But on a serious note, those holes or gaps in coverage can be much more dangerous than some sparkly teenage romantic hero. How does one cover those gaps effectively without breaking the bank? Thankfully, there exist insurances for the sole purpose of providing in those instances. They are known as Medicare Advantage and Medigap policies. As a Pennsylvania senior, there are surely plenty of questions you have about the topic of insurance.
Senior Medicare in Pittsburgh: Facts and Figures
- There are 42,748 senior citizens living in Pittsburgh right now
- There 10 hospitals in the Pittsburgh area where seniors can get emergency and/or in-patient care
- 41% of Pennsylvania seniors have a Medicare Advantage plan
- 27% of seniors have a Medicare Supplement (Medigap) plan
- Which leaves 32% of seniors potentially uninsured or underinsured against costly Medicare coverage gaps!
Becoming more vulnerable to disease is part of aging. It happens to everyone. And worse, most of the diseases we become more vulnerable to are chronic and will require treatment for the rest of our lives. This only makes medical costs even worse. Also, it is entirely possible that we will have more than one major disease at the same time, compounding difficulties and expenses. The chart below outlines the prevalence of the most common chronic diseases plaguing seniors in Pittsburgh:
|Disease||Prevalence (in Pittsburgh)|
|High Blood Pressure||34%|
|Coronary Heart Disease||6%|
Healthcare Costs in Pittsburgh, PA
Of course, it is vital to understand how expensive these diseases are to treat. Prescriptions, medical equipment, in- and out-patient care, doctor appointments; it all adds up. Not to mention, all medical costs in general are on the rise every year. A doctor’s appointment today is more expensive than the same doctor’s appointment at the same office with the same doctor this time last year. The upside is, thanks to advancing medicine, seniors are living longer. But they’re also incurring more and more medical debt. This means it is more important now than ever before to ensure your coverage is up to snuff going into your senior years.
|Disease||Prevalence (in Pittsburgh)||Annual Cost of Treatment|
|High Blood Pressure||34%||$288|
|Coronary Heart Disease||6%||$9,580|
Medicare Advantage Savings in Pittsburgh, PA
While the name ‘Medicare’ might make you think these programs are government-offered, that is not actually the case. Medicare Advantage is its own form of private insurance. It is approved by the government to sell to seniors who are already enrolled in Medicare. Instead of paying for your insurance costs directly, the government pays their share to Medicare Advantage, and you pay the rest of the premium. Law requires that Medicare Advantage plans provide at least every benefit which a traditional Medicare plan offers, but they go much further than just basics.
Seniors in general say they feel the coverage is better under the Medicare Advantage plans than under Traditional Medicare. It is the nature of chronic diseases to require on-going management, whether for sustained treatment or simply to stave off symptoms and improve quality of life. Over time, conditions worsen and costs continue to increase, leaving patients worse off than ever. Medicare Advantage plans can be far more comprehensive than the coverage offered by Medicare alone, even with options like Part D.
Medicare Advantage can cover even more than Original Medicare Parts A and B. Doctor visits, testing equipment, and drug plans are options as well. Many plans allow the option to add vision or dental coverage for additional premium costs. Thanks to the government paying some or potentially all of the premium, seniors can get a fully comprehensive Medicare Advantage plan starting as low as $0 a month out-of-pocket for their premium cost. There will still be certain items that insurance doesn’t cover, like copays or coinsurance, which will be the responsibility of the plan holder.
Medicare Supplement (Medigap) Savings in Pittsburgh, PA
There is another type of policy called Medigap, which is a Medicare supplement. They work a bit differently to a Medicare Advantage policy, but they can still save a great amount of money, particularly when covering gaps in Medicare Part A. The biggest chronic conditions, like coronary heart disease or kidney disease, can cost thousands just for the stay in the hospital and treatments while there. These stays can be incredibly long, and after a certain point, traditional Medicare stops coverage. You will have to have some sort of backup coverage, or face paying astronomical costs to continue care.
Right now, there are four plans designed to cover the gaps in Part A of Traditional Medicare. These plans are: Plans A, D, K, and L. Other plans cover gap in Part A as well as gaps in Part B, which will be discussed below. If you don’t think you will have extended Medicare Part B costs and are largely concerned with Part A, then you will be able to save even more, as plans which cover only Part A gaps are available at a lower premium. This could save a considerable amount as well over time for you.
The plans we previously referred to but didn’t discuss are Medigap Plans B, C, D, F, G, M, and N. These plans not only cover Medicare Part A gaps, but also Medicare Part B gaps. Of course, more comprehensive coverage leads to larger premiums every month, but lesser out-of-pocket costs when the time actually comes to use your policy. Also note that Plan F is being retired after the year 2020, and you will no longer be able to enroll in it after that year.
But what gaps are there in Medicare Part B? We know Part A is hospital stays and inpatient care, so what is left for B? Nearly everything else. Any outpatient procedures, specialist check-ups, medical or therapeutic gear, supplies or necessities. These are all supposed to be covered under Medicare Part B, but of course, there are always exceptions like copays and coinsurance. Still, there are Medigap plans designed to pitch in with those sorts of costs.
Medicare Supplement Insurance does not have coverage for medical drugs, dental, or vision care, unlike Medicare Advantage. Traditional Medicare does offer Part D, which is coverage specifically for the above mentioned items, whether or not any other original plan is purchased. With a quick search through your preferred search engine, you can likely find alternate dental or vision coverage in your area for an affordable price.
Seniors living in Pittsburgh, PA must know that having supplemental Medicare coverage is necessary for going into the final stage of life. It protects your retirement, and your health. Medical costs are only going to continue to rise for all, and especially seniors. That is beyond anyone’s control. But what you can control is how well you prepare. You must find a Medicare supplement policy that is comprehensive enough for your medical needs, and still fits your monthly budget. We want to help you find that policy today.
|Medigap Plan||Minimum Monthly Premium||Maximum Monthly Premium||Average Estimated Monthly Premium (Part B Premium Included)|
|Plan F (high deductible)||$34||$67||$186|