How Much Health Insurance Do I Need in My 60s?
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When considering health insurance in your sixties, your mind may focus mostly on Medicare coverage, which typically starts around age 65. However, you have years before this coverage becomes available to you, and your sixties are hardly a time you should skimp on comprehensive healthcare. So, what does the health insurance landscape look like for those on the brink of retirement or other major lifetime milestones?
In this article
What is health insurance?
Health insurance is a form of coverage that pays for medical and surgical expenses incurred by the insured. It can reimburse the insured for expenses incurred from illness or injury, or pay the care provider directly. It's a crucial tool for managing health care costs, ensuring that individuals have access to medical care without facing financial hardship due to high medical bills.
Health insurance policies can vary widely, offering a range of coverage options from basic emergency care to comprehensive plans that include preventive care, prescription drugs, mental health services, and more. By spreading the risk of health costs across a large group of people, health insurance makes healthcare more accessible and affordable for everyone, providing a safety net that helps maintain public health and financial stability.
What does health insurance cover?
Paying for medical expenses out-of-pocket is so costly that it’s likely impossible for most individuals. While each plan varies in coverage details, a comprehensive health insurance plan can cover many expenses in addition to the ones listed above, including:
- Doctor visits. This includes doctor visits for routine checkups, consultations, and examinations with primary care physicians, specialists, and other healthcare professionals.
- Hospitalizations. Hospital expenses often include room charges, surgical procedures, anesthesia, and medications administered during the hospital stay.
- Emergency care. Emergency room visits for medical conditions or injuries requiring immediate attention.
- Laboratory tests and diagnostic services. Doctors may need laboratory tests, imaging services (such as X-rays, MRIs, and CT scans), and other diagnostic procedures for diagnosing medical conditions.
- Mental health and substance abuse treatment. Health insurance may provide coverage for mental health services, including counseling, therapy sessions, and treatment for substance abuse disorders.
- Rehabilitation services. Including physical therapy, occupational therapy, or speech therapy.
While your sixties can mean major career changes, including retirement, downsizing or moving, caring for both aging parents, and helping your children as their families expand, not having adequate healthcare coverage can put you in a financial bind during such an important time in your life.
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Why do I need health insurance in my 60s?
Health insurance is essential at any age, but particularly in your sixties, for several reasons:
Increased health risks
Being in your sixties can increase the chance of health conditions, ranging from chronic conditions like heart disease or diabetes to needing a stronger prescription for eyeglasses or hearing aids. These health risks can cost a small fortune when you factor in diagnosis and treatment, but a health insurance plan can help manage these conditions.
Cost of healthcare
You can expect increased healthcare expenses as you age, especially if you have to increase your medical care or prescription medications. Medical insurance can offset some of these costs by covering some of your most common medical bills, such as doctor visits, hospital stays, prescription drugs, and preventive services.
Protection against catastrophic events
While you may have enjoyed good health your entire life, there’s no guarantee a catastrophic event won’t happen. Health insurance can help cover expensive medical treatment or surgery if needed due to an accident, injury, or illness, helping you avoid financial disaster.
Medicare eligibility
In the United States, individuals don’t become eligible for Medicare (the federal health insurance program for people aged 65 and older) until they reach age 65. Having health insurance coverage leading up to Medicare eligibility can ensure you have continuous coverage throughout your sixties and without any gaps in coverage.
Prescription drug coverage
Today’s health insurance plans typically include coverage for prescription medications, which can be vital for illnesses or treating chronic conditions. The coverage can make prescription drugs more affordable, considering the costs are often astronomical when paying out of pocket.
Preventive care and screenings
Regular preventive care, which includes screenings, vaccinations, and wellness exams, not only helps detect potential health issues early, but they may prevent more serious complications as you age–especially as you face a higher likelihood of facing illness in your sixties. Health insurance can cover preventive services at little to no cost, so you don’t have to choose between getting the care you need or the cost.
Ensuring you have a comprehensive health insurance plan in your sixties can provide financial protection against unexpected medical expenses and support your overall well-being.
Up to $2 million in coverage
- Get covered in 5 minutes.
- 95% of customers approved.
- No Hassles. No Gimmicks. Easy Application.
- Non-Commissioned Agents.
- Ages 20+
- 100% Online Application.
- Fast Coverage.
Healthcare insurance and Medicare
Healthcare insurance and Medicare represent two critical components of the health coverage spectrum in the United States, each serving distinct populations with varying needs.
Healthcare insurance
Healthcare insurance, broadly speaking, is a private or public system that finances or reimburses the costs associated with medical care. Private health insurance comes from employers or can be purchased individually and offers a variety of plans with differing levels of coverage, deductibles, and out-of-pocket costs. Public health insurance, on the other hand, includes programs like Medicaid, which serves low-income individuals and families, providing them access to necessary medical services.
Medicare
Medicare is a federal program primarily serving people over the age of 65, regardless of income, as well as younger individuals with certain disabilities and diseases. It's divided into several parts: Part A covers hospital and hospice services; Part B covers outpatient services; Part C, also known as Medicare Advantage, offers an alternative way to receive your Medicare benefits through private health insurance plans; and Part D covers prescription drugs. Medicare is designed to tackle the significant healthcare costs faced by the elderly and disabled, ensuring access to essential medical services.
The interplay between healthcare insurance and Medicare is complex. While Medicare provides a broad safety net for older adults and those with specific health conditions, many beneficiaries still rely on private insurance to cover gaps in Medicare coverage, such as certain types of long-term care, dental, vision, and hearing services not fully covered by Medicare. Additionally, some individuals may choose Medicare Advantage plans, which are offered by private insurance companies but approved and regulated by Medicare, to receive more comprehensive coverage.
Many individuals who are eligible for Medicare also maintain additional health insurance coverage to help cover costs that Medicare does not fully pay for. This can include employer-sponsored health insurance, retiree health plans, or private "Medigap" policies specifically designed to supplement Medicare coverage.
Here's how it typically works:
- Primary and secondary payers. When you have both Medicare and another type of health insurance, the two will coordinate benefits by determining which one pays first (primary payer) and which one pays second (secondary payer). For instance, if you're 65 or older and covered by both Medicare and an employer group plan because you or your spouse is still working, the employer plan might pay first, and Medicare would then pay for costs not covered by the primary insurance.
- Medigap policies. These are private insurance policies that can be purchased to cover Medicare's deductibles, co-payments, and other out-of-pocket expenses. Medigap plans only work with Original Medicare (Parts A and B) and not with Medicare Advantage Plans (Part C).
- Medicare Advantage Plans (Part C). Some individuals opt for Medicare Advantage plans instead of Original Medicare. These plans are offered by private insurance companies approved by Medicare and often include coverage beyond Original Medicare, such as vision, hearing, dental, and sometimes even prescription drugs.
- Medicare Part D. For prescription drug coverage, individuals with Medicare can also enroll in Part D, which is provided through private insurance companies approved by Medicare.
Up to $2 million in coverage
- Get covered in 5 minutes.
- 95% of customers approved.
- No Hassles. No Gimmicks. Easy Application.
- Non-Commissioned Agents.
- Ages 20+
- 100% Online Application.
- Fast Coverage.
How much health insurance do I need in my 60s?
Determining how much health insurance you need in your sixties depends on multiple considerations, including your overall health, financial situation, lifestyle, and personal preferences. When deciding how much health insurance you need in your sixties, keep the following in mind:
Evaluate your current health needs
Consider your current health status, pre-existing conditions, anticipated health problems, family medical history, whether you have life insurance, and lifestyle habits that may impact your health.
Assess potential healthcare costs
You can estimate potential costs by factoring in routine doctor visits, specialist care, prescription medications, preventive screenings, and potential emergencies.
Review coverage options
Compare the coverage options, health insurance premiums, deductibles, copayments, and out-of-pocket maximums to find a plan that aligns with your healthcare needs and budget while exploring plans through the various channels (such as ACA marketplace, private insurance, or employer-sponsored plans).
Consider your financial situation
Choose a health insurance plan with a premium, deductible, and out-of-pocket costs that you can afford while still providing adequate coverage for your medical needs. Balance the health insurance rates with the coverage level and potential out-of-pocket expenses.
Think about long-term care
While you’re in your sixties, it’s an ideal time to consider long-term care insurance. This helps cover the costs of future nursing home care, assisted living facilities, or home healthcare services.
Review policy benefits and exclusions
Carefully review the health benefits, coverage limits, and exclusions of the health insurance policy and companies you're considering. Pay attention to network providers, prescription drug coverage, and coverage for services like mental health care and alternative therapies.
Ultimately, the health insurance you need in your sixties depends on your lifestyle and preferences. Consulting with a qualified insurance agent or financial advisor can help you navigate your health insurance options and make informed decisions.
Up to $2 million in coverage
- Get covered in 5 minutes.
- 95% of customers approved.
- No Hassles. No Gimmicks. Easy Application.
- Non-Commissioned Agents.
- Ages 20+
- 100% Online Application.
- Fast Coverage.
How to purchase healthcare insurance in your 60s
Your sixties is a critical time because you won’t qualify for Medicare for five years, so you’ll need to make a plan for getting healthcare coverage during this time. A healthcare plan must either come through employer benefits, purchased privately or own your own, through the Affordable Care Act (ACA) marketplace plan (commonly referred to as Obamacare), or government-assistance programs like Medicaid.
Healthcare insurance costs
The average cost of health insurance depends on numerous factors, making it almost impossible to determine the exact coverage costs without getting quotes. One of the biggest factors is the type of plan you choose, such as an HMO, PPO, or high-deductible health plan (HDHP). Coverage level is another influence on cost, age, location, number of dependents, and household income. Employer contributions are another big influence on cost if you’re purchasing through your workplace.
According to data from Healthcare.gov, purchasing a policy through the ACA marketplace averages $393 to $860 in monthly premiums purchased in Georgia, depending on whether you purchase the Bronze, Silver, Gold, or Platinum plans. This doesn’t include any additional coverages, such as dental care.
Average premiums (the amount you pay monthly for insurance coverage) aren’t the only costs to factor in. Other healthcare insurance costs include:
- Deductibles. The amount you pay before your insurance provider pays for the covered healthcare expenses. You typically have an individual and family deductible, plus a maximum you’ll pay out of pocket each year.
- Co-pays. A fixed amount you pay for medical expenses. You’ll generally find plans with higher premiums have lower co-pays, so this may be where you can lower your overall cost.
- Coinsurance. Coinsurance is what you pay after the deductible has been met. It’s a percentage of the cost of treatment and varies based on each event.
- Endorsements. Endorsements refer to add-ons to your healthcare plan. It either adds coverage to the standard amount or a new coverage, such as maternity care.
FAQs
What is the Premium Tax Credit with health insurance?
The Premium Tax Credit, or PTC, is a refundable tax credit that helps reduce premium costs for lower-to-middle income families who purchase healthcare through the ACA marketplace.
What does cost share mean in health insurance?
Cost-sharing reductions, or CSRs, refer to a discount you can receive when you purchase a plan through the health insurance marketplace. It lowers the amount you have to pay for deductibles, copayments, and coinsurance.
Does health insurance go up when you turn 60?
Age can impact your insurance costs, especially if you purchase a private plan or a plan through the ACA marketplace. However, if you do purchase a plan through the ACA, there are limits imposed on how much higher rates there can be, based on age.
Up to $2 million in coverage
- Get covered in 5 minutes.
- 95% of customers approved.
- No Hassles. No Gimmicks. Easy Application.
- Non-Commissioned Agents.
- Ages 20+
- 100% Online Application.
- Fast Coverage.
The bottom line
No matter how you purchase health insurance in your sixties, whether through your employer, the marketplace, or a government-assisted program, it can become a financial lifesaver should an accident or illness occur. While your sixties mean access to Medicare, you’ll still need to adequately plan for coverage to ensure there aren’t any gaps before you finally qualify.
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Writer
Sara Coleman is a former corporate gal turned creative entrepreneur. She began writing professionally several years ago and now contributes to multiple websites, blogs, and magazines. She’s also an avid reader and can’t resist a great historical fiction novel. Sara holds a BA in journalism from the University of Georgia and can be found supporting her Bulldogs every chance she has. She resides in Charlotte, North Carolina, with her wonderfully supportive husband and three children. When she’s not ushering her kids to sports and dance lessons, she can be found creating content for her own website, TheProperPen.com.
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