Traditional Medicare healthcare insurance schemes provide individuals who are eligible for Medicare benefits with a safety net. However, these healthcare insurance policies not completely reimburse such individuals for medical expenses they incur for the services covered under the policy. Moreover, medical expenses that individual might incur on vision, dental and hearing do not come under the purview of insurance coverage under Medicare. The cost-sharing arrangement under traditional Medicare includes hospital deductibles, co-pays along with co-insurance for outpatient services.
Dee Yancey the President, CEO and Chairman of State Mutual Insurance Company says that when comparing Medicare Part C with Part A and Part B of traditional Medicare healthcare insurance schemes, Medicare Part C offers:
- Co-pays for a number of services that Medicare covers like doctor visits, diagnostic tests and visits to the emergency room;
- In many cases, Medicare Part C has an inclusive of drug coverage that Medicare Part D provides. This normally results in potential cost savings for the policyholder.
- Medicare Advantage Plans provide additional insurance coverage that Medicare does not provide such as dental, vision, hearing along with health club membership;
- Many individuals suffering from special medical conditions find Medicare Advantage plans provide the insurance cover they need for their individual condition; and
- Medicare advantage plans reimburse policyholders with an annual maximum out-of-pocket sum. Traditional Medicare does not cap a policyholder’s amount under the cost-sharing arrangement on an annual basis. However, under the Medicare Advantage plan, once an individual eligible for benefits under Medicare reaches a threshold, the insurance reimburses 100% for the expenses incurred on the services.
Medicare Supplemental plans have been in the market for almost four decades. As most people are aware that a private healthcare insurance company receives a premium from the government for filling in the gaps on services that the traditional Medicare program does not provide.
However, not every person is eligible to qualify for the benefits for a Medicare Supplemental and a Medicare Advantage plan may be a viable solution for them. The most important reasons why Medicare Supplemental policies are not feasible are because:
- Premiums for Medicare Supplemental Plans are expensive;
- Under Medicare Advantage Plans, a policyholder can qualify for both Medicare and Medicaid but this is not possible under Medicare Supplemental Plans;
- There may be situation where policyholder may not be eligible for a supplemental policy because he/she may have missed the guaranteed enrollment period. Due to this such a policyholder cannot qualify because of such insurance policies have underwriting requirements.
Many people who are eligible for Medicare benefits can also avail to maintain coverage with their former employer or still are in their employment. In many cases, these people feel that having a medical healthcare insurance policy in such situation is a reward for the services they have rendered to their employer.
Dee Yancey also states that for individual policyholders who are eligible to the benefits under Medicare, there are many reasons why he/she should opt for a Medicare Advantage plan over other policies. However, he/she need to assess their medical needs and choose an appropriate Medicare insurance policy that caters to those specific medical needs.