Is health insurance necessary if I am eligible for Medicare?

by the Editor, SeniorInsider | Jun 02, 2011

Whether or not health insurance is necessary if you are eligible for Medicare and Medical Supplemental insurance seems like a fairly simple question. It is likely that many people have asked it over the years. While the question is simple, the answer might not be. In truth, the answer for you might be very different than the answer for your neighbor, your sister, or even your spouse.

Medicare and Insurance Basics


Once you reach the age of 65, you become eligible for Medicare Health Insurance. There are multiple parts to Medicare coverage, and it is important that you understand what each part provides to you. Once you have an understanding of the coverage you can expect from Medicare, you can make an informed decision as to whether you need Medicare only, Medicare and insurance, or some sort of Medicare supplemental coverage.

What Comes Standard with Medicare?


First established in 1965 by the US Government, Medicare started as hospital and medical insurance for seniors age 65 and older. Through the years, it has been expanded. There are four standard parts to Medicare, creatively named Part A, Part B, Part C, and Part D. When you reach the age of 65, you qualify for coverage under these plans, but you also have other Medicare and insurance decisions that must be made.

Medicare Parts A, B and D are generally grouped together, and are the parts that everyone has access to upon meeting the government requirements for Medicare and insurance coverage. Some consider them the “original Medicare” even though Part D is only a few years old. Medicare Part C is considered separately, and is known as a Medicare Advantage Plan. Not all seniors will have access to a Medicare Advantage Plan.

Medicare and Insurance: What Does Each Part Cover?


Medicare Part A consists of the hospital coverage portion of your Medicare Health Insurance. It covers hospital stays, short-term inpatient care at skilled nursing facilities, home health services and hospice care. Most people are enrolled automatically in Medicare Part A at age 65. There is normally no cost for Part A.

Medicare Part B is the other half of Medicare as it was first implemented. It is considered the medical insurance portion of Medicare. It covers your visits to doctors, some preventative services such as flu shots, outpatient care, diagnostic procedures like x-rays and laboratory tests, and durable medical equipment. Unlike Part A, there is an insurance premium for Part B coverage that is based on your income.

Medicare Part D is relatively new. It is the prescription drug coverage component of Medicare, though private companies that have been approved by Medicare provide the coverage. If you have Parts A and B you will also qualify for Part D. You will pay an insurance premium for Part D coverage.

Medicare and Insurance Coverage Through Advantage Plans


Some seniors qualify to select Medicare Part C, normally referred to as a Medicare Advantage Plan. Private insurance companies offer Medicare Advantage Plans. You receive your coverage through this plan instead of through Medicare Parts A and B. Medicare must approve companies that provide coverage through Medicare Advantage Plans.

More than 10 million Americans receive their Medicare and insurance coverage through Medicare Advantage Plans. These plans generally cover more services than Parts A and B, providing more benefits than Medicare offers. This can include such benefits as dental, vision and hearing coverage. In addition, many Medicare Advantage Plans include prescription drug coverage, so you do not have to separately select a Plan D provider.

Medicare Part C is not available in every state, so you will need to understand if you have access to a Medicare Advantage Plan. You will pay an insurance premium for Part C coverage. In addition, you will have to pay the Part B premium.

Deciding What Coverage You Need


Now that you have a basic understanding of what sort of health coverage you can expect from the government plan, you have to make a decision on Medicare and insurance. If you are generally in good health, you might feel that standard Medicare coverage in sufficient.

Through the years, the government realized that some people require more than this basic health insurance. As a result, Medicare supplemental health coverage insurance options were created. These options are in place for seniors to select, should they believe they need additional health insurance coverage.

Medicare Supplemental Insurance


These Medicare supplemental insurance options that have been added are often referred to as Medigap plans. While private companies offer the plans themselves, they are actually standard plans as defined by Medicare.

Designated as Plan F, Plan G, Plan H, etc., each Medigap plan has the same standard features no matter where you live and no matter which private company offers it. For example, if you live in Ohio and select Medicare supplemental insurance under Plan F from a private company, you will have the same level of coverage as someone who lives in Idaho and selects Plan F coverage from a different company.

Is Medicare Supplemental Insurance Necessary?


In the end, only you can decide what level of Medicare and insurance for seniors you need. You need to evaluate your current health condition, what your family medical history might portend, what prescription medications you use, your lifestyle, what your budget looks like and any other factors you think are important when making a health insurance decision.

For many people standard Medicare coverage is sufficient. For those who have access to a Medicare Advantage Plan, that might be the right solution. For others, it might be a combination of Parts A, B and D in conjunction with Medicare supplemental insurance through a Medigap plan.

Besides understanding yourself and your health, it is very important that you understand your options for Medicare and insurance. This is a complicated subject, so you need to spend what time and effort it takes to be informed before making a decision about your health insurance.

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