Conley & Conley Insurance Solutions

How is Medicare Different than Private Health Insurance?

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As you grow older, you will find a lot of options when it comes to health insurance. While having options is great, it can also be confusing. Which policy is best for you? What is the difference between purchasing Medicare and private health insurance? 

What is Medicare? 

First, Medicare is a federally sponsored health insurance program designed to cover people 65 years of age and over. This type of policy is called Original Medicare and includes two parts: Part A and Part B. 

Part A is known as hospital insurance as it covers inpatient hospital care, home health care, hospice, lab tests, skilled nursing facilities and more. 

Part B covers outpatient care and emergency expenses such as mental health services, ambulance services, doctor visits, diagnostic screenings, lab tests, medical equipment and more. 

You must purchase Original Medicare through the U.S. government when you qualify, which is generally within six months of your 65th birthday. If you already receive financial assistance from the government, you may be automatically enrolled. If not, you will have to enroll manually. People who miss the first enrollment period must then wait for the next open enrollment period to purchase Medicare. 

What is Private Medicare? 

Private Medicare, also known as private health insurance or Medicare Advantage, can be purchased through a private insurer rather than through the government.  Medicare Advantage is also known as Medicare Plan C and encompasses Part A and Part B, as well as coverages that are not available on these plans. This may include wellness programs, hearting, dental and vision. Medicare Advantage can also be tailored to include Part D, which is Medicare prescription coverage. This helps you pay for your prescription medications, whereas basic Original Medicare does not. 

Medicare Advantage still does not generally cover cosmetic services, although it can assist with services such as adult day-care, transportation, over-the-counter medication and more. 

To get Medicare Advantage, you must qualify for and already have Medicare parts A and B. 

Can You Have Private Health Insurance and Medicare? 

In many cases, you can have a Medicare plan as well as a private health insurance policy. This generally occurs if you are still covered by you or your spouse’s employer’s group health insurance policy. In this case, the insurer may work with you to coordinate benefits between them and your Medicare plan. 

You cannot have both Original Medicare and Medicare Advantage, however. Since Medicare Advantage plans encompass Part A and Part B of Original Medicare, these parts will be covered under your new Medicare Advantage plan as opposed to Original Medicare. There are some cases where you may want to go back to Original Medicare. In this case, you will have to wait for an open enrollment period in order to downgrade. 

Carefully consider your finances and your insurance needs when debating whether or not to stay on a group health insurance policy as well as your Medicare plan. Paying two premiums can get expensive, and one policy may benefit you more than the other. 

Is Medicare Better than Private Health Insurance? 

Everyone’s insurance needs and health care needs are different. You may not have the same health concerns as your neighbor or even your spouse. Medicare plans are generally more beneficial for seniors, as they are tailored to cover expenses related to extra at-home and hospital care. But you will not qualify for Medicare until you are 65 years of age, unless under special circumstance, such as if you have End Stage Renal Disease. Until then, you should have a reliable and comprehensive health insurance policy either through an employer or a private insurer. 

This is the same when debating between Original Medicare and a Medicare Advantage Plan. A Medicare Advantage plan is generally more expensive, as it is purchased through a private insurer. But these types of plans also typically offer more ranges of coverage for your health care needs. If you are looking to save money and do not need everything offered under Medicare Advantage, you may want Original Medicare instead. But it is also impossible to predict when you will need medical assistance, so it is just as important to make sure you are as prepared as you can be. 

Discuss your insurance and health needs with your loved ones and your health care provider to find the best option for you and your family. 

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