Health Insurance

6 Best Health Insurance Coverage for Individuals 55 & Older

Jacqueline Slobin07 May 2021

6 Best Health Insurance Coverage for Individuals 55 & Older

There are several ways that you can get the health coverage you need if you are 55 and older. Some ways to get coverage are through employer health insurance, private health insurance, Medicaid, or Medicare. Alternatives to traditional health insurance might be your best bet to help you navigate affordable coverage.

Mira is an alternative to health insurance that offers access to low-cost urgent care, prescriptions, and lab tests for only $45/month. You do not need to meet a deductible with Mira and you can start using services as soon as you sign up

Best Health Insurance Options for Individuals 55 and Older 

There are many ways that you can get insurance if you are 55 and older. Below we outline and explain 6 common ways to get health coverage. 

  1. Employer-Provided Health Insurance: Employer-provided health insurance is insurance that is purchased by the employer of a company and covers employees. In many cases, employees’ spouses can also be covered through employer-provided health insurance. Your boss will split the premiums with you and may offer several options for different types of health insurance plans.
  2. On-Exchange Private Health Insurance: On-exchange plans are sold through the Health Insurance Marketplace of each state. If you qualify for subsidies from the government, you can use them for on-exchange plans.
  3. Off-Exchange Private Health Insurance: Off-exchange plans are bought directly from a private insurance company or broker, rather than from the official state marketplace. There may be more options for off-exchange plans compared to on-exchange plans.
  4. Medicare: Medicare is a federal health insurance program for individuals who are over 65 and some younger people who have disabilities or health conditions, such as End-Stage Renal Disease. Medicare has different parts that cover hospital care, medical care, and prescription drugs. You might qualify if you’re not 65 if you qualify for disability.
  5. Medicaid: Medicaid is a program that helps provide health coverage to individuals who have limited income. Eligibility for Medicaid varies by state. In New York, a family of 5 must have an annual income of less than $22,620 in order to qualify. 
  6. Non-Insurance or Gap Coverage: You can also receive low-cost health coverage through non-insurance options, such as Mira. For only $45/month, Mira members get access to low-cost urgent care, prescriptions, and lab tests. Mira may also be a great option for people who are freelancers or currently unemployed. You can pay month by month with Mira and start using services as soon as you sign up.

Types of Insurance Plans and Categories

If you get health insurance through your employer, the Health Insurance Marketplace, or a private insurance company, there are different types of plans that you can be covered by that come with different levels of quality. If you buy private insurance, you will also be able to select a metal category, often from bronze to platinum. 

Types of Plans 

There are several types of plans that differ based on the need for a referral, the ability to seek care at out-of-network providers, and payment methods. Below are some of the most common types of plans. 

  • Health Maintenance Organization (HMO): HMO plans limit coverage to doctors that are in-network. If you seek care from a doctor who is out of network, you will likely have to pay the full cost yourself. You may also need a referral from a primary care physician to see a specialist.
  • Preferred Provider Organization (PPO): PPO plans allow you to see providers that are out-of-network, but you will likely pay less for care from in-network providers. You do not need to have a referral to see out-of-network providers.
  • Point of Service (POS): POS plans have some elements of HMO and PPO plans. You must get a referral from a primary care provider in order to see a specialist. You can see in-network and out-of-network providers, but you will likely pay more to see out-of-network providers.
  • Exclusive Provider Organization (EPO): EPO plans only cover services from in-network providers, so if you seek care at an out-of-network provider, you will likely be responsible for the full cost. EPO plans do not require referrals to see specialists.
  • Indemnity Health Insurance: An indemnity plan, or fee-for-service plan, allows you to pick any doctor you would like to get care from. You have to pay for the services directly and then can file for reimbursement from your insurance company.
  • High Deductible Health Plan (HDHP): HDHPs typically have very low monthly premiums but high deductibles. If you have an HDHP, you may qualify for a Health Savings Account (HSA). HSAs help you put money aside to pay for medical expenses without being subject to federal income tax.

Metal Categories 

  • Bronze: Bronze plans have the lowest monthly premium, but you will have to pay the highest costs when you seek care. The deductibles for bronze plans are typically the highest.
  • Silver: Silver plans have higher monthly premiums than bronze plans, but you will pay less when you seek care in general. In addition, silver plans have lower deductibles than bronze plans.
  • Gold: Gold plans have a high monthly premium and low deductibles. The cost you pay when you need care is lower than the silver plan.
  • Platinum: Platinum plans have the highest monthly premiums, but very low deductibles. You will pay the least amount when you seek care.  

Source 

Platinum or Gold Private Health Plans: Best If You Seek Medical Care Frequently

Platinum and gold private health insurance plans are typically best if you seek medical care frequently or have a pre-existing chronic condition that you are managing. Monthly premiums are the highest for these types of plans, but your deductible and the cost of seeking care will be very low. 

Platinum and gold plans pay 80-90% of your medical expenses when you seek care; however, it is important to note that your monthly premium will be significantly higher than bronze or silver plans. Therefore, if you are in good health, do not take medications regularly, and do not seek medical care frequently, a gold or platinum plan may not be worth it for you. 

You should consider purchasing a platinum or gold plan if: 

  • You do not qualify for Medicare or Medicaid
  • Your employer does not offer health insurance or you are a freelancer
  • You seek medical care frequently or have a chronic health condition
  • You are comfortable paying high premiums and low costs when you seek care

Bronze Private Health Plans: Best If You Do Not Frequently Seek Medical Care 

Bronze plans may be a good option if you do not seek medical care frequently. These plans typically serve as a backup in case you are in an emergency. These plans have relatively low monthly premiums but have high deductibles. This means that many of your health services will not be covered by your insurance until you reach your deductible, which can be around $6,000. Bronze plans pay around 60% of your medical expenses when you seek care. 

You should consider purchasing a bronze plan if: 

  • You do not qualify for Medicare or Medicaid
  • Your employer does not offer health insurance or you are a freelancer
  • You are in good health and do not seek medical care frequently
  • You would rather pay low monthly premiums and higher costs when you seek care

If you have a bronze plan with a high deductible, you may decide to supplement your care with a non-insurance option like Mira. For only $45 a month, Mira can help you access low-cost health care before you meet your deductible on a health insurance plan. 

Silver On-Exchange Private Health Insurance: Best If You Qualify For Government Subsidies 

On-exchange private health insurance plans may be the best option if you qualify for a subsidy. Subsidies are financial assistance that can help you pay for your health insurance. Eligibility for subsidies depends on your income, family size, and the cost of health insurance where you live. 

There are two main types of health insurance subsidies: 

  1. Advance Premium Tax Credit: this subsidy helps lower the amount your pay in monthly premiums
  2. Cost-Sharing Reduction: this subsidy helps lower the amount you pay in copays, coinsurance, and deductibles.

While the premium tax credit can be applied to any of the four metal tiers, the cost-sharing reduction can only be applied to silver plans. Therefore, if you qualify for a cost-sharing reduction, you may want to consider purchasing a silver plan. 

You should consider purchasing an on-exchange plan if: 

  • You make less than 400% of the federal poverty level, which would be about $51,000/year. This will qualify you for Advance Premium Tax Credit, which can be used on any metal tier plan that is on exchange.
  • You make less than 250% of the federal poverty, which is about $31,900/year, you may qualify for both premium tax credit and cost-sharing reductions. Therefore, you should consider getting a silver plan on exchange.

Health insurance Frequently Asked Questions (FAQs) for Individuals 55+

When do I qualify for Medicare? 

Generally, you will qualify for Medicare at age 65. You can qualify for Medicare earlier if you have received social security disability benefits for at least 2 years, have End-Stage Renal Disease, or Amyotrophic Lateral Sclerosis. 

You are eligible for Medicare Part A, which is hospital insurance, without paying monthly premiums if you or your spouse paid Medicare taxes for at least 10 years. You can also be eligible for premium-free Medicare Part A if you are eligible for Social Security and Railroad benefits or if you or a spouse have Medicare-covered government employment. Otherwise, you can purchase Medicare Part A by paying monthly premiums. 

Everyone will have to pay premiums for Medicare Part B, which covers medically necessary and preventive services. 

If I have Medicare, do I need supplemental insurance? 

While you do not need supplemental insurance if you are covered by Medicare, many people choose to enroll in a Medigap program or Medicare Advantage. Medigap is supplemental insurance that covers some of the costs that regular Medicare does not, such as deductibles, co-insurance, and coverage if you leave the country. The cost of Medigap policies may vary based on age or health conditions. 

Other individuals may decide to enroll in a Medicare Advantage Program, which may be commonly referred to as Medicare Part C. These plans may be more comprehensive than Medicare alone and cover dental or vision services. There are many different types of Medicare Advantage Plans, such as HMOs and PPOs. 

Medicare Supplement Insurance vs Medicare Advantage 

Medicare Supplement InsuranceMedicare Advantage
Less restriction on what hospitals and doctor's offices you go toMay need to use in-network providers unless emergency
No referrals needed for specialistsMay need referrals to see specialists
No network restrictionsMay have network restrictions
Can purchase anytimeCan only purchase during specific periods
Pay an additional monthly premium but no co-paysPay a very low additional monthly premium, but will need to pay copays and coinsurance when seeking care
Does not include prescription drugsLikely includes prescription drugs

If you are eligible for both Medicare and Medicaid, you may not need Medigap or Medicare Advantage, as Medicaid can offer some of the additional benefits that Medicare does not. 

If I am retiring before 65 will I need to get health insurance? 

If you retire before you turn 65, you should look into options to continue to get health coverage. Some options are listed below: 

  • If your spouse is still working and received employer-provided health insurance, you can likely get coverage from your spouse’s plan.
  • You may be able to continue your health coverage if you qualify for COBRA. COBRA may be able to allow you to continue your health coverage for up to 18 months after you stop working.
  • You can purchase a plan from a private health insurance company either on or off-exchange. If you retire, you will likely qualify for a special enrollment period, so you will not need to wait until open enrollment the following year to get coverage.
  • If you are looking for alternatives to health insurance, ways to supplement a high deductible plan, or gap coverage, Mira may be a great option. For only $45/month, Mira members get access to the health care they need and do not need to meet a deductible to start using services.

There is also some talk about lowering the age to qualify for Medicare to 60. While the age to qualify for Medicare is still 65, is it possible that the age is lowered in the near future. 

Bottom Line 

Whether it be through your employer, Medicare, Medicaid, or private health insurance, there are many options to get health insurance for people 55 years and older. In addition to any insurance plan, you can add non-insurance options, such as Mira, to ensure that you get the medical care you need at a reasonable price. Sign up today and start using the services you need immediately.

Millennials are leaving health insurance carriers to join the new "CostCo" of healthcare.

"My insurance premiums went up 30% this year. My husband and I switched to Mira and never looked back," said Danna - Brooklyn, NYC