Age is Just a Number Unless You're Uninsured

February 26, 2013

You may think your uninsured, sixty year old father is old, but for Medicare, he is not old enough. The Medicare eligibility age is 65. And unless your 60 year old father is disabled, he will need to find health insurance elsewhere. What are his options? He has a few, including:

  1. Employer coverage. Your dad may be eligible to enroll in his employer's health plan or his spouse's employer health plan. In addition, some employers offer health insurance to pre-65 retirees and their spouses, until they are eligible for Medicare. He may have to pay the full cost of retiree coverage, but at least the coverage is guaranteed.

  2. COBRA. If dad lost employment and his health insurance along with it, he may be able to continue health insurance coverage under COBRA. If eligible, he should automatically receive a COBRA notice within 44 days of losing his employment-based coverage. He may pay more for COBRA coverage than he paid for coverage as an employee, but at least the coverage is guaranteed.

  3. Medicaid. Your pre-65 dad may be for eligible for Medicaid. Medicaid is a federal and state funded health insurance program for low-income individuals with limited assets, the disabled, and blind. Medicaid is managed by the state you live. Different states have different rules to qualify for Medicaid.

    To apply for Medicaid, contact your state's Medical Assistance office. Gather documentation verifying your income and assets in advance of applying. If your state determines you are not currently eligible for Medicaid, ask your rep. about other state or local programs that may help you get affordable, comprehensive health insurance coverage.

    In 2014, the Patient Protection and Affordable Care Act, often referred to as Obamacare, will extend Medicaid to certain previously ineligible individuals.

  4. Individual health insurance plan. Your dad can purchase individual health insurance from a federal or state operated marketplace in 2014. If he needs individual coverage now, he will have to find it on his own. Here are a few tips to help him out.

    In addition, in 2014, the Affordable Care Act will provide cost-sharing assistance and tax subsidies to qualifying individuals who purchase individual health insurance coverage from a federal or state marketplace (also called an exchange). This will make individual coverage more affordable. To find out if your dad is eligible for cost-sharing assistance or a tax subsidy, check out the Kaiser Family Foundation subsidy calculator at
    http://healthreform.kff.org/SubsidyCalculator.

  5. No coverage. If your dad does not have health insurance coverage, he may have to pay for his medical care out of pocket. Below are a few things to consider when self-funding medical care.
  • Use medical care price tools to find out the costs of common medical care procedures
  • Use local clinics and urgent care centers, which typically charge less than hospitals
  • If hospitalization is required, request a discount and payment plan. Work with the hospital's billing department to reduce the charges. Also, ask about monetary assistance the hospital offers for the uninsured. Some hospitals have funds set aside to help needy patients pay for care. These programs are not usually advertised to the public, so it is important to ask
  • Hire a medical billing advocate for assistance negotiating bill reductions and finding billing errors
Your pre-65 dad should not wait until he has a medical emergency to start thinking about how he is going to pay for care. Review group insurance (own employer, spouse's employer, COBRA) options now. Also, find out about state requirements for Medicaid and other state benefit programs. In addition, learn more about the Affordable Care Act and how to purchase individual coverage, with or without financial help. Lastly, stay healthy. But if you have to pay for medical services out-of-pocket, research rates, negotiate prices, and request financial assistance from the hospital and providers.
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