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Medicare vs. Private Health Insurance

are you newly eligible for medicare? You may have been covered by private insurance all your life, so you may be wondering what to do. If you’re skeptical about the quality of Medicare vs. private insurance, you may want to know that you can actually have both.

what types of medicare coverage do private insurance companies offer?

medicare works with private insurance companies to provide medicare benefits. The types of Medicare coverage you can get from Medicare-approved private insurance companies include:

Reading: What is the difference between medicare and non medicare insurance

  • medicare part d prescription drug coverage
  • medicare supplement insurance (medigap) to help cover out-of-pocket medicare expenses, such as deductibles, copays, and coinsurance
  • medicare advantage plans, which include your part a (hospital) and part b (medical) insurance in one convenient plan. Medicare Advantage plans may also include additional benefits such as prescription drugs, routine vision, routine hearing, and routine dental coverage.
  • regardless of the coverage option you choose, you will still be in the medicare program. You must still remain enrolled in Medicare Part A and Part B to qualify for Medicare Advantage or Medicare Supplement. if you join a standalone medicare part d prescription drug plan, you must have medicare part a or b (both are fine).

    does medicare coverage from private insurance companies cost more?

    Medicare coverage from Medicare-approved private insurance companies may cost you an additional monthly premium, but it can also save you money over time.

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    You may be surprised to learn that Original Medicare (Part A and Part B) has no out-of-pocket maximum. this means that if you need extensive medical care, you could face huge bills. Two Medicare Supplement Plans, Medicare Supplement Plan K and Plan L, have out-of-pocket limits. other medicare supplement plans may still help you cover your out-of-pocket medicare costs.

    All Medicare Advantage plans must have an out-of-pocket limit, protecting you from devastating financial liability if you have a serious health condition. limits may vary between plans.

    medicare versus private insurance: premiums and costs

    Private insurance companies can generally increase your premium based on three factors that do not affect your original Medicare premiums.

    • Age: Private insurance companies can charge seniors up to three times higher premiums than younger people, according to healthcare.gov.
    • on the other hand, most people who qualify for medicare do not pay a premium for hospital insurance (part a). Most people with Medicare pay a premium for health insurance (Part B), but this premium doesn’t go up or down based on your age.

      • Location: According to healthcare.gov, where you live has a big effect on your premiums from private insurance companies. Medicare Part A and Medicare Part B premiums are the same regardless of where you are in the United States.
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        If you get any type of medicare coverage from a private insurance company, like medicare prescription drug coverage, a medicare supplemental plan, or a medicare advantage plan, these premiums can vary from place to place. premiums and other costs can also be different between insurance companies.

        • Tobacco use: The use of cigarettes will not increase your original medicare premiums (part a and part b). however, according to medicare.gov, medicare supplemental plans may offer discounts to non-smokers.
        • medicare versus private insurance: dependents

          Private health insurance often allows you to extend coverage to dependents, such as your spouse and children. Medicare, on the other hand, is individual insurance. Most people with Medicare coverage have to qualify based on their own age or disability. but in some cases, your spouse may be able to help you qualify for certain coverage.

          medicare vs private insurance: benefits

          Original Medicare has some significant gaps in coverage for things private insurance typically covers, like prescription drugs. Original Medicare may cover prescription drugs you are given in the hospital or certain drugs (such as injections or infusions) you are given at a doctor’s office, but it generally does not cover most prescription drugs you take at home.

          The only way to get Medicare prescription drug coverage for most medications you take at home is through a Medicare-approved private insurance company. you can choose a standalone medicare part d prescription drug plan along with original medicare or a medicare advantage prescription drug plan.

          To find a medicare plan from a medicare-approved private insurance company, enter your zip code on this page.

          See also: Find Care | GEHA

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