Understanding the Needs of Elderly Clients Looking for Insurance Plans

Published on December 22, 2020

Trying to find the right health insurance policy can be an overwhelming task for everyone. It is especially true for the elderly. There are so many options available for seniors, and several benefits that apply to all levels of healthcare needs. It is, therefore, essential to understand the limitations of both coverage and eldercare options. Doing so means no one wastes their time and money on benefits they will not receive or services that do not apply to them. Those interested in long-term planning especially need to understand their coverage limitations to prevent any confusion about how their healthcare needs will be covered in the years to come.

What is Eldercare?

Eldercare is a term commonly used by health insurance providers in their benefits descriptions about the many areas of coverage offered explicitly to the elderly. It is crucial to understand what these benefits are and how they are relevant to seniors and their healthcare needs.

Areas of Coverage Offered to Seniors

Below are the types of healthcare coverage most commonly offered to seniors and referred to as Eldercare:

Medication Coverage – Includes full or partial payment coverage for prescription drugs. This can include both generic and brand name drugs as well as some over-the-counter medications.

Care in a Nursing Home Facility – Seniors need to understand the difference between nursing home care coverage and coverage for services provided at an assisted living facility. Nursing home care is considered a specific level of care and may be used for either short term rehabilitation or long-term healthcare needs.

Care at an Assisted Living Facility – At most assisted living facilities, only non-medical services are offered. If healthcare services are provided, they are usually provided by a third-party who bills the insurance company separately.

Home Health Care – It is vital to distinguish between non-medical and medical services provided by home health care representatives. A certified medical professional can only provide medical care. In contrast, non-medical services can be provided by caregivers who do not have a medical background.

Payment for Medical Equipment – Healthcare policies will usually pay for durable medical equipment, also known as DME. These are durable and long-lasting reusable devices, including hospital beds, wheelchairs, lift chairs, and ventilators.

Payment for Medical Supplies – Commonly referred to as home care supplies, these are disposable or single-use medical items most plans will pay for, such as diabetic test strips, adult diapers, and alcohol swabs.

How to Get the Most Out of an Insurance Policy for Seniors

Health insurance is a complex topic for most individuals. To help seniors understand more about getting the most out of their insurance, it is essential to know what your benefits are.

When individuals understand what their insurance will pay for and what it will not, they can learn how to use their policy to their advantage. It is common for health insurance companies to decline a payment if they feel a service or medication is not medically necessary. Therefore, policyholders must understand what benefits they are entitled to and provide evidence as to why they need a certain procedure or medication. Lab tests and letters from a physician describing why a patient needs a particular service can help an insurance provider decline payment.

Another tip for seniors who want to maximize their insurance coverage is to be proactive with their doctors. It can be particularly useful when a patient is trying to get a medication or healthcare service approved.

When a doctor prescribes a patient to have a wheelchair covered by their insurance provider, they will need to include specifics such as the patient’s weight, muscle strength, and their usage patterns. These details can distinguish whether the insurance provider pays for a manual or a powered wheelchair. Therefore, providing as much information as possible can help a patient who has a particular medical need gain help with payment for services.

To learn about the specific needs of elderly clients looking for insurance plans, contact our experts today for more details. We look forward to assisting you and addressing any questions you may have. 

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