You are here: Home Government ... Medicare 101: An ... Should I Keep ... If You Are The Only ...
Information about all aspects of finances affected by a serious health condition. Includes income sources such as work, investments, and private and government disability programs, and expenses such as medical bills, and how to deal with financial problems.
Information about all aspects of health care from choosing a doctor and treatment, staying safe in a hospital, to end of life care. Includes how to obtain, choose and maximize health insurance policies.
Answers to your practical questions such as how to travel safely despite your health condition, how to avoid getting infected by a pet, and what to say or not say to an insurance company.

Should I Keep Private Insurance In Addition To Medicare?

If You Are The Only Person Covered Under A Private Health Insurance Policy

Next » « Previous

3/4

There is no absolute answer whether to keep the private insurance as well as Medicare. Private insurance can act as supplemental insurance to fill the gaps that Original Medicare doesn't pay for. For example, private health insurance may pay for the following:

  • Deductibles (amount you pay per year before the insurance pays)
  • Coinsurance (amount you pay of a medical bill - usually stated as a percentage, such as 20%).
  • Drug coverage (prescription drug coverage only. Health insurance does not generally cover over the counter medications).
  • Health care that Medicare doesn't cover

The only way to determine whether it is worthwhile to keep private health insurance in addition to Medicare is to take the following steps. As you take the steps, keep in mind that we are doing a financial exercise. The assumptions involved in the exercise do not reflect what will happen to you (or to any other particular individual. (If you're not good at math or not up to the exercise, ask a team member such as a family member or friend to do it for you).

Step 1Speak with your doctor(s) or other health care provider(s) to get an idea of what you can reasonably expect in the next year with respect to doctor prescribed medical treatments, complementary treatments and prescription drugs. Ask about specifics such as how often you will need doctor prescribed treatments or complementary treatments, how often and over what period of time you may need to take the drugs, etc.

  • Ask the doctor for a ballpark estimate of the cost of medical treatments that may be indicated.
  • Ask your pharmacist for an annual ballpark cost of the drugs the doctor mentioned - using generic drugs as much as possible. (Generic drugs have the same active ingredients as the equivalent brand name drugs).

Step 2. Compare benefits with respect to treatments.

  • Compare the Original Medicare (Fee-For-Service) benefits (traditional Medicare) to the benefits in your private health insurance policy for the treatments you may need. (You can get an overview of your private policy from your employer or insurer). Note what treatments you may need that are not covered by Medicare. Are they covered by your private health insurance?
  • Look at the deductibles and co-insurance you may have to pay under Medicare. How much of the total is covered by your private health insurance? Note the difference.
  • Note that you don't make money by having both Medicare and a private health policy. Private health insurance policies generally provide that Medicare payments are subtracted before the private insurer pays.

Step 3. Compare drug costs.

  • Medicare Part D plans are in addition to Original Medicare. Medicare Part D plans cover drugs subject to a separate premium. Check the Medicare Part D plans which are available in your state. Note how much they cost per year. Also note the cost you will have to pay for the drugs you may need. (Medicare Part D plans have a deductible, co-insurance and a hole during which there is no coverage).
  • How much will you have to pay for the same drugs under the private health insurance plan?

Step 4. Do the math. Compare the totals you will have to pay out of pocket for medical care you anticipate against the part of the premiums you would have to pay to continue the private health insurance policy. How much can you reasonably expect to save by continuing to keep your private health insurance?

Step 5.  Check out Medicare Advantage.  If it appears financially worthwhile to keep your private health insurance, it is worthwhile to tceck out Medicare Advantage and what it covers. As you are likely aware, Medicare Advantage often covers more than Original Medicare, and at less cost to the consumer. You may be able to find a policy that covers treatments that Original Medicare doesn't cover as well as better drug coverage.

Keep in mind that that if you choose a Medicare Advantage plan, you will likely be subjected to managed care type restrictions such as having to call for approval before receiving a treatment, and only being able to see doctors who have an arrangement with the insurer. It's up to you whether the trade-off of cost savings versus restrictions is worth it.

NOTE: Keep in mind that if you give up your private health insurance, it is unlikey that you will be able to get it back.




Please share how this information is useful to you. 0 Comments

 

Post a Comment Have something to add to this topic? Contact Us.

Characters remaining:

  • Allowed markup: <a> <i> <b> <em> <u> <s> <strong> <code> <pre> <p>
    All other tags will be stripped.