When it comes to Medicare, you may be considering dropping your private insurance and going with original Medicare (Parts A and B). When making a major decision such as this, it’s always best to make a pro and con list. To make things easier for you, here are the pros and cons of switching to Medicare.
Pros
- You can choose your preferred healthcare provider.
With Medicare, you are able to choose which doctor you want to see. The only small catch is that the doctor must accept Medicare, but you will still have a lot of options. On the other hand, when going through private insurance companies, you must use their network of physicians, so your options become very limited. You may not even be able to continue to see your current doctor. - You only have one monthly payment in most cases.
Original Medicare is pulled from your Social Security Income in most instances, so you don’t actually have to make any insurance payments yourself. Plus, when you have Part A and Part B Medicare coverage, you will have medical and hospital insurance without extra costs. Additionally, if you’re married, you are able to get Medicare insurance as a couple rather than two individual policies. - You can get private insurance to help fill any gaps.
While Medicare Part A and Part B will cover a lot, there are certain things that Medicare won’t pay for, or you may not be pleased with your copayments and deductibles. You can take advantage of supplemental coverage called “Medigap” to help cover the gaps left with original Medicare. This is insurance that is provided by private insurance companies at a small cost to you, but it may make things easier for you when it comes to visiting doctors or other healthcare services. - The cost is lower compared to many private insurance companies.
The cost of Medicare Part A and Part B is much lower than if you choose to go through a private insurance company. In 2014, the average monthly premium for Part A and B was $104.90. Your monthly premium may be more or less than $104.90 depending on your income and other factors.
Private insurance can charge what they feel is necessary. Generally, this is hundreds of dollars per month, anywhere from $200-$500 depending on the status of your health. Those who need more medical supervision will have a higher premium – especially if they require a low deductible. - You don’t need to get referrals for specialists.
Sometimes you will have to go see a specialist for certain disorders or irregular health issues. Your primary care physician may send you to someone who specializes in the area of care that is affecting you in order to help solve the medical problem as quickly as possible. Unfortunately, many private insurance companies may require you to get a referral before you are able to see a specialist. With Medicare, you won’t need a referral, and you won’t have to go through a middle-man. You can visit the specialist of your choosing.
Cons
- It doesn’t cover everything.
Original Medicare doesn’t cover everything. It fails to cover hearing aids and exams for hearing aids. It also doesn’t cover routine foot care, dental and dentures, visual exams, and most eyeglasses. This means that you’ll have to pay for these types of coverage separately. Most notably, it also has limited coverage of prescriptions, for which you’ll have to also purchase Medicare Part D. - Missing deadlines can be costly.
Missing deadlines with Medicare can end up being very costly. You have a few months from October 15th to December 7th to enroll or change your plan. If you miss this deadline, you’ll have to pay a fee. Late enrollment fees will vary depending on which Medicare Part you’re altering. Both Part A and B will go up 10% for each full 12-month period you could have had it, but did not take it. - Small costs will add up.
After coinsurance, copayments, and deductibles, your monthly cost can go up quite a bit. Since Medicare Parts A and B alone will not cover most medications, you’ll also have to pay for that out of pocket unless you enroll in Medicare Part D as well. These costs can end up being much more than you expect. Overall, it could end up costing you much more than simply having a private insurance plan. - No coverage outside of the United States.
When you go outside of the United States, some private insurance companies may cover your medical healthcare needs. However, when you sign up for Medicare, you will not have any healthcare coverage when you are outside of the country. This may be an issue if you leave the country often or plan to do so after retiring. - It can be very time-consuming.
When you get Medicare, it may require you to call several places to see if they accept your insurance. Sometimes you may be subject to interacting with up to three different entities in order to receive your benefits and coverage, which can quickly complicate the situation more than most people want.
