Preparing for and Managing Healthcare Costs

As we grow older, we may need more medical and dental care to keep us healthy. For example, to manage a chronic condition, we may need to visit the doctor or take prescribed medicines regularly. Or, we may need immediate care for a sudden illness. To get the right care, you should know your options for care and treatment, make the best decisions for you, and learn how to manage and pay your costs of care.

What steps can you take to prepare? Ask your doctor or healthcare team about your condition and your options for care and treatment. Let them know what is important to you. In some cases, you may be able to make a decision about your care with your provider (and your caregiver, if you have one) using a decision aid.

Knowing how much you will pay for your care also may be part of your healthcare decisions. How much you pay out of pocket will depend on things like your coverage—whether you have any, and what type—and your circumstances. You may want to keep track of funds you have set aside for out-of-pocket healthcare costs that are not covered by your insurance.

The medical and cost lookup tools on this website allow you to estimate your costs of care, but it is still always a good idea to double-check and ask your provider what they may be. The articles and checklists on this website also offer questions to ask doctors and health plans. If you need help using the healthcare system, getting coverage or paying bills, refer to the list of organizations and other helpful resources on this website.

Get and Understand Your Coverage

There are three main sources of health coverage. The first is your job. The second is a plan that you buy. The third is a government program for older, disabled or low-income people.

If You Are 64 Years Old and Younger

If you don’t have coverage from your job, you can buy coverage straight from an insurer. You can also buy it through exchanges (or marketplaces) set up through the Affordable Care Act (ACA). The marketplaces are open from November 1 to January 15 each year. You may be eligible to sign up at other times—for instance, if you lose your job. You generally pay a monthly premium for coverage. If you buy a plan through the marketplace, you might qualify for help paying your premium. You may also have costs like deductibles, copays and coinsurance.

To buy a marketplace plan, visit healthcare.gov, or your state’s marketplace site. You’ll see the costs and benefits for all of the plans in your area. You can also find out whether you qualify for premium help. Call 800-318-2596 for help understanding the different plan choices. Or, visit localhelp.healthcare.gov to find in-person help near you.

COBRA (Consolidated Omnibus Budget Reconciliation Act). COBRA allows you to stay on your employer’s health plan for 18 months if you leave your job. If you are not yet eligible for Medicare, you can apply for COBRA coverage. But you will have to cover the whole cost of the plan.

Learn more about coverage by reading Getting Covered, Health Insurance in Retirement and Medicare.

If you are about to turn or are 65 years old, think carefully about your health coverage options.

If You Are 65 Years Old or Older

If you are 65 or older, you may be eligible for Medicare. You also may want to consider other public insurance options offered by the government programs, such as Medicaid, Department of Veterans Affairs and TRICARE.

Medicare. Medicare is the US health insurance program for people 65 and older (and for those with disabilities or certain illnesses). It has different parts that cover different things. You can choose the parts that best meet your healthcare needs. If you have health insurance through your (or your spouse’s) employer, you can probably wait and sign up for Medicare when you (or your spouse) retire. But in some cases, you may need to enroll in Medicare when you turn 65, to avoid gaps in coverage or late enrollment penalties.

Medicare does not cover all healthcare services, such as long-term care or most dental services. Read more about Medicare here. Visit the Medicare website to learn more.

Medicaid. Medicaid offers coverage for people with low incomes. If your income is below a certain limit, you may qualify for Medicaid and get care for free or at a lower cost. If you have a disability, you also can get free care or care at a lower cost. Visit the Medicaid website to learn more.

Dual eligibility for Medicare and Medicaid. You might qualify for both Medicare and Medicaid. If you are eligible for both Medicare and Medicaid, you may be enrolled in both to cover your costs. In that case, the two plans will “coordinate” the payments for your care. Make sure to show both your health insurance ID cards when you visit the doctor or get care.

Please keep in mind that the medical and dental reimbursement cost estimates that you receive from the FAIR Health Consumer website are relevant for private health plans, not public insurance plans.

Department of Veterans Affairs. The VA offers health benefits to people who served in the active military and were discharged other than dishonorably. If your injury or illness is linked to your military service, you can get free healthcare at any VA location. To learn more about VA health benefits, visit the Department of Veterans Affairs website. Read about VA health benefits here.

TRICARE. TRICARE offers health benefits for active-duty military members, retirees, dependents and military families. It covers healthcare services, mental health services, dental services, services for special needs and vision services. Learn more on the TRICARE website. Read about its benefits and eligibility here.

Dental Coverage

Dental insurance can help make sure you can afford the dental care you need as you get older. If you’re working, you may get dental coverage through your employer. But, once you retire, getting dental coverage may not be as easy.

Starting at age 65, Americans can get health insurance from Medicare, a federal government program. Since most people retire around that age, Medicare is often thought of as health insurance for retirees. (Actually, some people on Medicare keep working, and Medicare also covers disabled people and people with end-stage renal disease.) But, Medicare doesn’t cover most dental services. So, if retirees want dental insurance, they have to look elsewhere.

To learn more about dental coverage in retirement, keep reading here.

Other Coverage

Employer-sponsored retiree health benefits. Some employers and unions may offer health benefits to retirees. If you are eligible for retiree health benefits, you may want to sign up for your employer-sponsored plan. If your spouse or domestic partner is working and has health coverage, you may be able to receive health benefits. If you were part of a union, ask if you are eligible for such benefits.

Learn more from our Insurance Basics articles:

• Getting Covered
• Health Insurance in Retirement
• Medicare
• Dental Coverage for Retirees

Know How Much You May Pay

Even if you have Medicare or coverage from another plan, you will still have to pay some costs out of your own pocket. How much you pay out of pocket will depend on your coverage and individual circumstances.

In addition, you may be able to use leftover funds in a Health Savings Account (HSA). An HSA is often offered alongside a high-deductible health plan. An HSA is a savings account that lets you set aside pretax dollars to pay for qualified medical costs. Some of these costs include copays, deductibles and coinsurance. You can continue to use the funds in your HSA when you retire—it is money that belongs to you.

You cannot use money from an HSA to cover the cost of a premium, unless it is an employer-sponsored COBRA premium or a premium being paid while receiving unemployment. Learn more about HSAs here.

Resources

Learn more about healthcare costs in older age. See these resources:

• The National Council on Aging (NCOA) is a national nonprofit that supports older adults. It offers information, support and tools to help older adults and caregivers keep good health and financial security. On their website, you can find:
  • The AgeWell Planner: offers forms of support that meet your needs, tools and expert help.
  • BenefitsCheckUp: a tool that links you to benefit programs where you live.
  • The Eldercare Locator: a tool that offers information on health insurance, home and community-based services, housing and transportation.
• The AARP Foundation offers programs, services and resources to adults aged 50 and older. AARP’s Find Help section can help you find health, food, housing and employment programs in your area.

Managing Healthcare Costs

To manage your healthcare costs, use the tools and resources below to know how much you may owe.

FH^® Cost Lookup Tools

Use FAIR Health’s medical and dental cost lookup tools to estimate costs for medical and dental services in your area. Use the tools to check differences between FAIR Health’s estimated costs and the prices you were charged by your provider. You may be able to negotiate costs for care in some cases.

For help using these cost lookup tools, you can email consumer@fairhealth.org or call 855-LOOKUP-1 (855-566-5871).

FH^® Healthcare Toolkit

Use the toolkit to access checklists for shared decision making and using the healthcare system. Learn about quality in healthcare and find questions to ask of your doctor and health plans. Access the FH Healthcare Toolkit here.

FH^® Insurance Basics Articles

• FH^® Total Treatment Cost;
• Managing Costs of Chronic Conditions; and
• Negotiating Your Costs: Using FAIR Health Cost Estimates to Negotiate the Costs of Care.

Paying for Care

Reviewing Your Explanation of Benefits (EOB) and Medical Bills

After you visit a provider, you may get a medical bill that tells you how much you pay. The amount you owe will depend on a number of things. Those may include whether you have insurance, type of plan and cost-sharing requirements. They may also include whether you receive services in or out of your plan’s network. Your bill tells you the service and total amount you owe. Most often, you’ll get a separate bill for each type of specialty care.

An Explanation of Benefits (EOB) is a summary of the services you received and the date they were performed. The EOB also tells you how much your provider charged your insurer and how much your insurer paid. The EOB may also include the amount you have paid toward your deductible.

You can find out more about medical bills and EOBs by reading these articles:

• How to Review Your Medical Bill; and
• Explanation of Benefits.

If you need help with your bill, some organizations can help, such as:

• Patient Advocate Foundation; and
• Medicare Rights Center.