Medicare vs. Private Health Insurance: Part 2

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Finding health insurance to cover costly, chronic conditions can be difficult, and we know that looking at a variety of health care plans can be overwhelming. One common choice for seniors and individuals with disabilities is Medicare. While Medicare may be the right option for some people, others may need Medicare supplement insurance, private health insurance plans commonly known as Medigap plans.

In the previous installation of this series, we talked about some of the details of basic Medicare coverage. In this second part of this series, we will be taking a closer look at commercial health insurance plans.

About Medicare Supplement Insurance
At the most basic level, commercial health insurance helps consumers avoid risk. By pooling risk among a large group of consumers, either through a company health plan or the individual market, insurers spread out this risk to lower individual health care costs. However, while many people transition to public coverage like Medicare after they turn 65, this coverage is not enough for everyone. By investing in additional Medigap plans, consumers can benefit from expanded coverage for essential health benefits, prescription drugs, and more.

If you choose to look into plans other than Medicare, there are a few issues you may run into. Some of these issues could include:

  • Supplement insurance will cost more
  • These plans may cover only specific types of services
  • It can be confusing to research these plans on your own

Because researching commercial health or life insurance options can be overwhelming, many people choose to work with an insurance company like Bankers Fidelity.

To help you better understand your options, below is a list of questions to help you compare the cost and benefits of various Medicare insurance programs.

  1. How much are monthly premiums?
  2. Does this plan cover preventative health?
  3. What services are covered by this plan?
  4. Does this plan cover trips to the hospital or urgent care?
  5. Are prescription drugs covered?
  6. Does this plan cover vision and/or dental care?
  7. Are there any specifications about previous serious, chronic medical issues?

There are also a few different types of individual health insurance that you should be aware of.

Fee-for-Service Insurance pays for a part of each medical service you receive. You may go to any doctor or hospital you choose, but you typically pay a higher monthly cost for the medical care.

Managed Care Plans can be received through care plans like health maintenance organization (HMO) or preferred provider organizations (PPO). In these types of plans, health and life insurance companies work with specific doctors to provide healthcare to their patients. If you have this type of plan, you’ll likely be able to only see the doctors covered on your plan, which can be an inconvenience if there’s not one close to you. On the other hand, doctors visits are prepaid by the plan, meaning you only have to pay a copayment.

Association-Based Health Insurance can be purchased through a professional association that you belong to. If you are a member of a professional, community, or religious organization, there’s a good chance they offer health or life insurance. Just be sure to ask for all the details to make sure you’ll be getting the kind of coverage you need.

There are numerous kinds of health and life insurance policies, and it’s important to find one that will give you the coverage you need. As a senior, there are many different options to help cover medical expenses as you age, and as such, the number of seniors covered by health insurance is increasing steadily. In fact, according to The Commonwealth Fund, 50% of Americans over the age of 65 had no health insurance in 1962, while only 2% of Americans over age 65 lack health coverage today.

This concludes our two-part series on the differences between Medicare and private health insurance. Hopefully you’ve learned enough about the basics to go further into your research and decision-making with confidence.

Sources

  1. Health Affairs, “Medicare And Commercial Health Insurance: The Fundamental Difference,” February 2012
  2. AARP, Medicare Insurance

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Dan

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