Health Insurance Options for Seniors Over 70: Medicare, Medigap, Medicaid & More
Navigating health insurance after 70 requires understanding how Medicare interacts with supplemental and alternative coverage. Here's a structured breakdown of options, eligibility, and key considerations.
1. Original Medicare (Fee-for-Service)
- Part A (Hospital): Premium-free if you/spouse paid Medicare taxes ≥10 years. Covers inpatient, SNF, hospice, home health.
- Part B (Medical): $174.70/mo standard premium (2024; higher if IRMAA). Covers doctor visits, outpatient, preventive, DME. 20% coinsurance after $240 deductible.
- Gaps: No out-of-pocket maximum; no dental/vision/hearing/long-term care; no foreign travel emergency.
2. Medigap (Medicare Supplement Insurance)
- Private policies standardized (Plans A–N) that pay Part A/B cost-sharing (deductibles, coinsurance, copays).
- Best time to buy: 6-month Medigap Open Enrollment (starts at 65 + Part B) — guaranteed issue, no medical underwriting.
- After 65/OEP: Medical underwriting applies (except few states: NY, MA, CT, ME have continuous open enrollment).
- Plan G & N are popular (G covers all except Part B deductible; N has copays).
- Does NOT work with Medicare Advantage.
3. Medicare Advantage (Part C)
- Private HMO/PPO plans replacing Original Medicare. Must cover all Part A/B benefits; most include Part D + dental/vision/hearing/wellness.
- Network restrictions: HMO = in-network only (except emergencies); PPO = out-of-network allowed (higher cost).
- Annual MOOP: Max out-of-pocket limit ($8,850 in-network 2024).
- Switch annually: Oct 15 – Dec 7 (AEP); Jan 1 – Mar 31 (MA OEP).
- Special Needs Plans (SNPs) for chronic conditions, dual-eligible, institutionalized.
4. Medicare Part D (Prescription Drugs)
- Standalone plans (with Original Medicare + Medigap) or integrated in MA-PD.
- 2024: $545 deductible max; $5,030 initial coverage limit; $8,000 catastrophic threshold (then $0 cost-share).
- Extra Help (LIS): Low-income subsidy for premiums/deductibles/copays.
5. Medicaid (Dual Eligibility)
- For low-income seniors (income/assets limits vary by state).
- Covers Medicare premiums, cost-sharing, + services Medicare excludes (long-term care, dental, vision, transportation).
- Medicare Savings Programs (MSPs): QMB, SLMB, QI — pay Part B premiums (+ cost-sharing for QMB) for incomes up to 135% FPL.
6. VA Health Care
- For veterans with service-connected disabilities, low income, or specific service history.
- Can use VA and Medicare (but not simultaneously for same service). VA drug coverage often creditable for Part D.
7. Employer/Retiree Coverage
- If still working at 70+ with employer ≥20 employees: employer plan primary, Medicare secondary (can delay Part B without penalty).
- Retiree plans: Often wrap around Medicare (secondary payer).
8. Individual Market (ACA Plans)
- Available but rarely optimal after 65 (Medicare-eligible cannot get premium tax credits).
- Only if not eligible for premium-free Part A (e.g., insufficient work history).
Decision Framework
| Priority | Best Fit |
|---|---|
| Predictable costs, provider choice, travel | Original Medicare + Plan G Medigap + Part D |
| Low premiums, extra benefits, network OK | Medicare Advantage (HMO/PPO) |
| Low income/assets | Medicaid / MSPs + Medicare |
| Veteran with service-connected condition | VA + Medicare |