(By Saad Imran

Suppose you are a senior US citizen and have turned 65, regardless of whether you’re working or not. In that case, you can get enrolled in Medicare, a federal health insurance program for older, low-income people and people with certain medical conditions. 

For people who are still working after 65, enrollment in Medicare is not mandatory if they are covered under their employer’s group health plan and if their employer has twenty or more employees. 

Still, it is advisable to get enrolled in Medicare Part A at least, as it won’t cost you anything, and that way, Medicare will become your secondary insurer. 

However, by doing so, you won’t be able to make contributions to your Health Savings Account if your employer provides it.

If you are over 65 and retired and don’t have insurance through your spouse’s employer, you may want to get private insurance since it has a lot of benefits over Medicare. 

For that, your options are Medicare Advantage Plans and Medigap. You can get either of these plans in addition to Medicare. 

If you are eligible for Medicare and have not signed up, you can also get private insurance from an Insurance Marketplace. A 2018 Census found out that about 64% of people in the US have some kind of private insurance. 

Let’s discuss whether getting private health insurance is worth it or not. 

Pros of Getting Private Health Insurance

  • Dental and Vision Coverage. Original Medicare plan does not cover dental and vision care, and neglecting the care can prove to be a costly mistake for youIf you choose to get Medicare Advantage Plan in addition to Original Medicare, your routine dental and vision care will be covered.
  • Out-of-Pocket Costs May be Covered. With Original Medicare, the out-of-pocket costs such as deductibles and copays can quickly add up and be quite expensive. A Medigap plan will cover your out-of-pocket expenses, except for Part D (prescription drugs coverage plan).
  • No Network Provider Restrictions. A Medigap Insurance plan can be used with any provider that accepts Medicare; you don’t need prior authorization to use it. 

Cons of Getting Private Health Insurance

  • High Costs. Having a high cost is the most significant disadvantage of a private health insurance plan. Although the premium costs may be low, you can end up paying a lot of money for other expenses. For example, this article gives an estimate of costs associated with the health insurance plan provided by a private company.
  • Limited Service Areas. Medicare Advantage Plans do not provide coverage all over the country; these plans only cover some limited and specific regions. To be considered eligible for these plans, you must live in their covered region for at least six months a year.
  • Pre-Existing Conditions are not covered. Any medical condition you had before starting a new insurance plan is considered a pre-existing condition.

Some of the insurance plans won’t provide coverage if you have pre-existing conditions such as heart disease, diabetes, lung or kidney disease, etc. 

While choosing an insurance plan, you should keep your financial resources, health condition, and your daily lifestyle in mind. 

This article goes into great detail and compares the best health insurance plans available for seniors. The Pros and Cons of insurance plans by UnitedHealthcare, Humana, Golden Rule Insurance Company, and Cigna are discussed. 

If you have any confusion about making a choice, you can consult an insurance broker to help you select an insurance plan that completely fits your needs. 

Some good questions to ask your broker before selecting a plan are:

  • What is the total amount of money to pay every month?
  • Does this plan have any provider network restrictions?
  • Does this plan offer any extra benefits?
  • Are prescription drugs covered?
  • What kind of emergency cover is covered?
  • Is there a waiting period in this plan that will affect my current care?
  • Does this plan cover routine examinations?

At Zupnick & Associates, we can help you choose an insurance plan that takes care of all of your health needs. Our experienced insurance experts help you save money on an insurance plan and travel so you can buy an insurance plan sitting in the comfort of your own home.

We have over a decade of experience and hundreds of satisfied clients

Call us at 718-534-1194 now! 

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