How to Understand Your Health Care Benefits

Understanding your health-care benefits is important. However, it can be confusing, especially for older adults trying to understand Medicare and/or long-term-care insurance benefits. The general public often does not comprehend all the specifics of benefit coverage. Not all Medicare supplement plans, Medicare HMO's or Medicare private fee-for-service plans pay for every service, as benefits can vary. Benefits offered under long-term-care insurance policies can differ as well. Despite today's health-care plans changing to meet the needs of consumers, many Americans, including seniors, now find themselves paying more out-of-pocket expenses for their health care in the form of deductibles, co-pays, and non-covered services. In order to better understand your health insurance coverage, you should...

Difficulty: Moderately Challenging

Instructions

Things You'll Need:

• Summary of Benefits
• Medicare Handbook

1. Consider the quality of health care services offered by a plan, in addition to the cost and services covered. Be sure to review carefully any materials that you receive from your health-care plan, such as Summary of Benefits or Medicare handbook. If you are confused about coverage under a particular plan, ask your primary-care physician, family members or a trusted friend for assistance in clarifying any benefits about which you might be unclear.

2. Contact your local Social Security Office, Medical Assistance Program office or your state's Health Insurance Department if you have specific questions about Medicare coverage or require further explanation about benefits offered by other health-insurance plans. Also, if you or your spouse qualifies to receive supplemental insurance at age 65 through your employer or union after you retire, you should contact a benefits representative to help you review your health-care benefits and options.

3. Be proactive. Don't be afraid to question your health-care benefits. In particular, the distinctions between Medicare Part A and Part B can be perplexing to some older individuals. Ask that your questions be answered in plain language, as clear communication between health-care consumers and their health-care professionals not only improves health literacy, but also improves quality of health care.

Tips & Warnings

• Older adults, who must deal with more than one health plan, multiple medical facilities and doctors or public agencies, which are resources for funding assistance, may find it difficult to navigate the health-care system.