Vanguard Financial Education Series. Understanding your health care coverage in retirement

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1 Vanguard Financial Education Series health care Understanding your health care coverage in retirement

2 When you retire, you ll need good health care coverage. Even if you re in the best of health now, you will almost inevitably require more medical care as you get older. This pamphlet will help you obtain health care coverage in retirement. We ll examine which health care costs Medicare does and does not cover, and how supplementary Medigap and long-term-care insurance policies may provide more comprehensive coverage.

3 You qualify for Medicare at 65 If you are eligible for Social Security, when you turn age 65 you qualify for Medicare, the federal health insurance program for older Americans. You don t have to take a physical exam to qualify for coverage, and you can t be turned down. Medicare pays for major medical expenses, such as hospital stays and doctor visits. However, many related expenses including eyeglasses, dental care, and long-term nursing home care are not covered. How Medicare works Medicare is a multipart system. Part A, which covers inpatient hospital stays, is free (you pay no insurance premiums). It can also help pay for inpatient care in a skilled nursing facility (but not custodial or long-term care), hospice care services, and some home health care services. Health Care > 3

4 Medicare Part B, which covers medical services, including doctors visits, home health care services, and laboratory tests, among other things, does charge monthly premiums. Most people have Part B premiums deducted automatically from their Social Security check. The monthly premium you pay for Part B coverage depends upon your income. Affluent retirees singles with modified adjusted gross income of $85,000 or more and married couples with income of $170,000 or more pay higher monthly premiums. Medicare Part D covers prescription drug costs. It is open to everyone with Medicare but you have to sign up and, in most cases, pay a monthly premium for coverage. Part D coverage is offered by many different insurance companies. Look for a plan that operates in your area and that covers the specific prescriptions you take. Your costs including premiums, copayments, and the yearly deductible will all vary by plan. Applying for Medicare Everyone who is eligible for Social Security retirement benefits automatically qualifies for Medicare Parts A, B, and D at the beginning of the month in which he or she turns age 65. If you already get Social Security benefits, you do not need to apply for Medicare Parts A and B. Your Medicare card will be mailed to you about three months prior to your 65th birthday, and you will be automatically enrolled. You would still have to enroll in Medicare Part D (drug coverage) if you choose. If you are not receiving Social Security benefits, contact Social Security to enroll in Medicare Parts A and B, preferably during the three months before the month you turn age 65. If you miss the initial enrollment period that ends three months after your birthday month, your Medicare coverage will be delayed and you may have to pay higher premiums and penalties. You can sign up for Medicare Parts A and B by visiting your local Social Security office, by calling Social Security at , or by going online to ssa.gov. Medicare Part D (drug coverage) is offered by insurers or other private companies approved by Medicare. 4 < Financial Education Series

5 A guide to Medigap insurance Medicare Parts A and B do have deductibles, copayments, and other charges. To fill in the gaps in Medicare coverage, many retirees buy private supplemental insurance commonly called Medigap. If you have no health care coverage other than Medicare, consider buying one comprehensive Medigap policy. You can buy Medigap insurance once you reach age 65. You should apply for it within six months of enrolling in Medicare Part B. During this six-month open enrollment period, you cannot be rejected for the insurance because of illness, a medical condition, or your medical claims history. If you try to sign up after that period, you may not be able to buy the policy you want or you may have to pay a higher rate. Insurers are required to offer standard Medigap policies nationwide. The more services and coverage your Medigap offers the higher your premium will be. The basic benefits every Medigap plan includes are: Hospitalization: pays Part A coinsurance plus coverage for 365 additional days during your lifetime after Medicare benefits are exhausted. Medical expenses: pays Part B coinsurance (generally 20% of Medicare-approved expenses). An alternative to Medigap You may not need Medigap or Part D prescription drug coverage if you are in a Medicare Advantage Plan (sometimes called Medicare Part C). Medicare Advantage mostly offers managed care, as opposed to the fee-for-service plans of traditional Medicare. Medicare Advantage is not available in all parts of the country. Go to medicare.gov to learn more about Medicare Advantage and see whether it s available where you live.

6 Will you retire before you qualify for Medicare? You re eligible for Medicare at age 65. If you retire before then, you ll be responsible for paying all your medical bills, unless you still are covered by your former employer s health care plan or another health insurance policy. If you go without medical insurance, you re flirting with disaster. What can you do? Here are two options: If your spouse is working, you might be covered by his or her health care plan at work. Under federal legislation known as COBRA, you are entitled to purchase medical coverage through your employer for up to 18 months after you retire. You also can buy health insurance privately. This is generally the most expensive alternative, although you may be able to reduce costs by buying a policy with a high deductible and contributing to a tax-sheltered health savings account. Covering long-term-care needs One drawback of Medicare and most Medigap policies is that both have limited coverage of long-term nursing care. Medicare covers up to 100 days of care in a Medicare-certified nursing facility, but only for those who meet strict requirements. To qualify for coverage, the facilities must provide daily skilled nursing or rehabilitation services, not just 6 < Financial Education Series

7 custodial care. To collect benefits, you usually must have been in the hospital for at least three days and have entered the nursing facility within 30 days after discharge from the hospital. (If you re in a health maintenance organization, the three-day requirement is waived.) If you re confined at home, Medicare does cover home health care services prescribed by a doctor. Covered services include part-time or intermittent skilled nursing care, physical therapy, medical social services, medical supplies, and some rehabilitation equipment. The services must be provided by a participating home health care agency. However, neither Medicare nor Medigap covers basic custodial care. The average cost of a year in a nursing home exceeds $75,000; in some areas it can be $100,000 or more. Home health care expenses can also be very high. People typically cover long-termcare costs in one of three ways: They pay for it themselves. Many people begin paying for long-term care out of pocket. In the long run, this is an option best suited for the affluent, who have sufficient resources to cover nursing home bills. They rely on Medicaid, the joint federal-state welfare program that provides medical care to financially needy people. Medicaid is generally a last resort, available only after patients have spent most of their savings. They buy long-term-care insurance in advance. This option can be appropriate for people of moderate means who do not have the resources to pay for a long nursing home stay but do have assets they wish to preserve. Review your choices once a year You can change your Medicare Part D (drug) or Medicare Part C (optional Medicare Advantage Plan) provider each year during the Medicare Open Enrollment Period, October 15 through December 7. Review your coverage to see if it still fits your needs. Health Care > 7

8 A look at long-term-care insurance In general, long-term-care insurance is used to cover basic custodial care in a nursing home or a private home. The policies have several standard features, but as with other types of insurance premium costs can be reduced by accepting a lower level of coverage, as long as it s appropriate to your needs. Here are nine factors to consider when evaluating a policy: Standard features Maximum benefit period. This is the length of time that you can collect benefits. While lifetime coverage is an option, most policies cover either one, two, four, or six years. The average stay in a nursing home is about 2.6 years. The shorter the benefit period, the lower the premium. However, think twice before you choose a very short benefit period. 8 < Financial Education Series

9 An unexpectedly lengthy nursing home stay can exhaust a family s savings. You may be able to reduce your premium costs but secure reasonable protection by choosing a policy that provides coverage for a few years rather than a lifetime. Benefit level. Most policies provide a fixed daily benefit, regardless of the actual cost of care. Nursing home and home health care costs vary considerably from one part of the country to another, so you should be sure that the level of reimbursement you re buying will cover the cost of care where you live. Ask nursing homes and home health care agencies in your area about their charges. Waiting period. This is the number of days that you must pay out of pocket for care until you start receiving benefits. Waiting periods generally range from 20 to 365 days. The longer the waiting period, the lower your premiums. However, make sure that you can pay for your own care during the waiting period you select. Consider the extras Inflation protection. This provision increases the daily benefit level in line with the rising cost of living. This is a valuable option; you pay a higher premium, but it s worth it. Over a number of years, a fixed benefit level would lose much of its purchasing power to inflation. Home health care. This option provides coverage for care received at home. The benefit level usually is half of the amount paid for nursing home stays. A variation of home health care is adult day care benefits, which provide relief for family caregivers. Comprehensive coverage. The policy should pay benefits anytime you re unable to perform two or more of the activities of daily living (eating, bathing, dressing, toileting, continence, and moving from one place to another) without assistance. Coverage should specifically include Parkinson s disease and Alzheimer s disease. You may also want a policy that extends benefits without first requiring a hospital stay. Health Care > 9

10 And don t forget... Renewability. You should be allowed to renew your policy indefinitely. This means that the insurance company cannot cancel your coverage after you initially qualify. Financial stability. The insurance company that issues your policy should carry a top financial rating from at least one of the independent rating agencies. Ask the insurer or your insurance agent for this information. Waiver of premium. With some policies, you can waive premium payments after you ve received benefits for a specified time, often 60 or 90 days. If you recover and no longer need care, you resume paying premiums. When to buy long-term-care insurance The premiums for long-term-care insurance can be high, and they rise sharply with age. If you choose to purchase longterm-care insurance, consider buying a policy between ages 50 and 60. At that age, the likelihood that you will eventually need long-term care may be high enough to warrant coverage, but the chances are better that you can find an affordable policy that meets your needs. A sample modest-benefit policy from an A+ rated company will provide: Monthly benefit of $6,000. Care in a nursing home up to 100% of the monthly benefit. Care in an assisted living facility up to 100% of the monthly benefit. Care in your own home or an adult day care center up to 50% of the monthly benefit. Informal care (provided by family or friends) up to 50% of the monthly home-care benefit. A waiting period of 90 days (once in your lifetime). Periodic inflation protection (an automatic 5% compounded increase in the monthly benefit). A benefit period of three years of care. 10 < Financial Education Series

11 Your action plan Health care will be a big expense in retirement, so don t put off the job of obtaining adequate insurance. Understand your benefits. If you have questions about your eligibility or want to apply for Medicare, call the Social Security Administration at For specific information about what Medicare covers, call or log on to medicare.gov. Obtain private insurance if retiring before age 65. Look into COBRA coverage or private insurance until you re eligible for Medicare at age 65. Shop for Medigap insurance. For detailed descriptions of Medigap insurance plans, read Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare published by the Centers for Medicare & Medicaid Services. To order a free copy, call or go to medicare.gov. Evaluate long-term-care insurance. You may want to talk with an insurance agent or financial planner about your options. Another resource is iquote by Longevity Alliance, an independent insurance broker that offers comparative data. You can look it up on the web at longtermcare.iquote.com or call the agency at

12 Institutional Investor Group P.O. Box 2900 Valley Forge, PA Connect with Vanguard retirementplans.vanguard.com > The Vanguard Group Inc. All rights reserved. BBBBFVYG

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