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LIUNA Retiree Health Care

As a working LiUNA member, you most likely have health insurance. But when you retire, you may no longer have access to such coverage. At the same time your health care needs and expenses will increase. Before you retire, start looking into what your health care coverage options will be in your retirement years.

Health Plan/Insurance Coverage

First find out whether your current health plan covers retirees. The extent to which benefit plans provide for coverage varies greatly among LiUNA and other workplace plans. Following are some of the details that you should explore, even if continued coverage is available for retirees.

  • Cost: Many plans require the retiree to pay all or part of the contribution or premium.
  • Benefit Scope: Some plans offer a different level of benefits for retirees than for active workers.
  • Dependent Coverage: Retiree coverage may be limited to the retiree only or the retiree and spouse only; a factor for retirees with dependent children at home.

Medicare

Contrary to what many believe, Medicare only pays for about a third of retiree health care expenses. This is because:

  • Medicare does not cover all types of medical services.
  • Medicare has deductibles: the amount you have to pay out of pocket before getting benefits.
  • Medicare includes coinsurance; Medicare pays a percent of the bill for the services that are covered and the retiree must pay the rest.
  • Some Medicare coverage, such as doctors visits and prescriptions are only available with additional premium costs paid by the retiree.

It is important that you understand the scope and limitations of Medicare and plan for your ability to fill in the gaps.

You are eligible for Medicare benefits at age 65, regardless of whether you are eligible for full Social Security benefits and even if you are still working. Some younger persons with specific disabilities and illnesses are also eligible. Because many LIUNA members retire at an age earlier than 65, this means that they may be missing Medicare protection for several years. All the more important they know what their options are for additional sources of health insurance.

Coverage

Medicare comes in two packages. Part A covers hospital stays, skilled nursing facility care, limited home health care and hospice care. Part B provides coverage for doctor visits, some outpatient services, diagnostic tests, durable medical equipment, and ambulance services. It also covers some preventive services. There are no premiums for Part A coverage. Part B has a monthly premium that, for most people, is deducted from their Social Security check.

Medicare offers prescription drug coverage called Part D. This plan is run by insurance companies and other private companies. Participates pay the premiums for coverage of choice. Plan options and costs will vary but all plans will have a minimal threshold level of coverage. If you decide not to enroll in a Medicare drug plan when you are first eligible, you may pay a penalty if you choose to join later.

Because participants face high out of pocket costs with this coverage, those with limited income and financial resources may be able to get extra help paying for their prescriptions through a special program set up by the Social Security Administration (800-772-1213 and ask for form SSA1020-income restrictions apply).

Medicare Plan Options

Traditional Medicare coverage allows you to use whatever health care provider you want to use for the benefits covered by Parts A and B.  Another option is to look into Medicare Advantage Plans (Medicare Part C), which are available in most parts of the country. Under these plans, you may pay lower co-payments and get extra benefits. The trade off is that patients are somewhat restricted as to where they get treated. Options include Medicare Managed Care Plans (like HMOs), Medicare Preferred Provider Organization Plans (PPOs), Medicare Fee for Service Plans and, for those with particular health care needs, Medicare Specialty Plans.

Supplemental Plans/Medigap Insurance

Because of Medicare’s limitations, some retirees take out supplemental insurance to cover the out of pockets costs that are associated with Medicare. In 2006, there will be twelve standard plans which offer different levels of coverage but are identical no matter who offers the plan or what state you live in. The only thing that changes is the premium so it is easy and important to shop around for the best deal. Most Medigap policies pay some, if not all, of the traditional Medicare coinsurance and outpatient co-payment amounts. Contact the insurance department within the state that you live to get a list of companies that offer Medigap insurance as well as how the state rates them.  

www.medicare.gov, 1-800-MEDICARE

Long Term Care Insurance

Because we are living longer and retirees are less likely to live with a family member who is able to care for them properly, many people look into long term care insurance to financially protect them if they have to enter a nursing home or other type of senior care center. Long term care insurance covers costs associated with the non medical at home care or full cost of long term care in a nursing home. These are services which currently are NOT covered by Medicare nor by traditional health insurance plans.

Long term care insurance covers the costs of care without forcing you to liquidate your assets. The cost for this insurance varies widely depending on how the benefit is designed and the age at which you take out the insurance. For this reason, it is important to weigh all your options and assess your current situation before taking out such a policy. At the same time, note that the older you are, the more costly the insurance will be, so again, the sooner this is considered the better. Contact your state insurance office or local Area Agency on Aging for more information on long term care insurance. The Social Security Administration website also has information to assist with long term care resource needs.

Spouse Coverage

Your review of your medical coverage should include consideration of your spouse’s medical coverage as well. This includes the coverage your plan provides for your spouse and, if your spouse works, your spouse’s own coverage and coverage for you. Even if your spouse has separate family medical coverage, consider what would happen in the event your spouse dies or retires before you do. In short, the same process you followed in noting your own options should be done with your spouse’s options.

State Assistance

A variety of state and local agencies can provide more specific information about government insurance programs and long term care. They include the following:

  • State Health Insurance Assistance Programs to help beneficiaries with their health insurance choices.
  • State Medicaid Agencies which provides coverage for people with low income and little or no resources.
  • Long Term Care Ombudsman/Agents to protect the rights of nursing home residents and respond to questions about facilities
  • State Pharmacy Assistance Programs for low income seniors who aren’t eligible for Medicaid.