TUESDAY, APRIL 12, 2022
If you’re approaching the age of 65, you may be wondering what the difference is between your health insurance plan and a Medicare plan. The primary difference between a private health insurance plan and Medicare is that Medicare is a plan provided by the government primarily for individuals 65 and older. Private health insurance can allow for dependent coverage, unlike Medicare. At E-Shop Medicare, we’re here to help you sort through your health insurance options to discover which decision is best suited for your needs.
What Are the Eligibility Requirements for Medicare Versus Private Health Insurance?
Medicare has some strict eligibility requirements compared to enrolling in a private health insurance plan. The following are the requirements to enroll in a Medicare plan:
- Age 65 or older
- Those younger than 65 with disabilities
- Those with End-Stage Renal Disease
You should enroll for Medicare coverage during your enrollment period, which is traditionally three months before you turn 65 and the three months after you turn 65.
Private health insurance works differently because you can enroll via your employer plan if offered or shop for plans based upon your individual needs.
What Are the Differences in Private Plan Structure Versus Medicare Structure?
There are significant differences between private health insurance plans and Medicare plans. Original Medicare has two main parts that make up coverage:
- Part A, or hospital insurance, covers inpatient care, limited home healthcare, limited skilled nursing facility care and hospice care.
- Part B, or medical insurance, covers outpatient visits and services and preventive healthcare.
Private health insurance plans have several options depending on where you get your coverage. Many opt into their health insurance through an employer since it’s usually the cheapest and most feasible choice. If this isn’t an option through your employer, you can purchase insurance through the Healthcare Marketplace; this offers four tiers of coverage based on the percentage of services you’re responsible for paying for:
- Bronze plans cover 60% of your healthcare costs. These plans have the highest deductible of all the plans but the lowest monthly premium.
- Silver plans cover 70% of your healthcare costs. These plans generally have a lower deductible than bronze plans but with a moderate monthly premium.
- Gold plans cover 80% of your healthcare costs. These plans have a lower deductible than bronze or silver plans but with a high monthly premium.
- Platinum plans cover 90% of your healthcare costs. These plans have the lowest deductible, so your insurance often pays out very quickly, but they have the highest monthly premium.
- Part C, or Medicare Advantage, is another way to get Part A and Part B coverage. This is often offered by private insurance companies.
- Part D, or prescription drug coverage, can help cover specific drugs. If you require specific coverage, be sure to ask your agent if your prescription is covered.
Despite being vastly different, there are some similarities between the two coverage options. Some of the similarities include:
- Preventive care—Preventative care is covered under both types of care.
- Plan structure—There are multiple options available that can help you structure your plan to your unique health needs.
- Overall flexibility—Flexibility in the plans depends on the plan type you choose.
- Additional coverage—Both plans require add-ons for additional coverage
Whether Medicare or a private health plan is right for you depends on your needs and which options you qualify for. Be sure to discuss your needs with an agent before determining your coverage.
How Do Medicare Costs Compare to Private Health Insurance Costs?
The costs of your health care can vary based on factors such as the services you need, deductibles, types of plans you enroll in and health factors. Generally, private health plans typically cost more than a Medicare plan, especially for hospital services. To discuss the variables in cost, be sure to reach out to an agent today.
Learn More About Coverage
Our agents at E-Shop Medicare specialize in Medicare coverage and are prepared to help you with any questions regarding your current or future health care needs. Reach out to an agent today to discuss an action plan to get started with Medicare coverage or for more information regarding the types of health insurance available to you.
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