6 Major Pros and Cons of Medicare

healthcare reformMy Comments: This comes from, of all places, the National Latino Council on Alcohol and Tobacco Prevention (nlcatp.org). It was written by their chief editor whose name I cannot find.

As someone who professes to know the basics about retirement planning, having a good understanding about paying for medical care as your life plays out is critical.

I’m often asked about Medicare and when to apply. My suggestion is to get yourself into the system as early as 3 months before your 65th birthday. You can delay participation if you have other coverage. It avoids problems later on if the wheels come off your alternative plans.

Jul 10, 2015

Once reaching age 65, older people in the United States become eligible for Medicare, a form of health insurance provided by the federal government. The program, which also covers disabled people, provides a bevy of health insurance benefits that covers the full spectrum of health care services in the country.

Medicare, despite its prevalence in the senior health insurance industry, isn’t for everyone who’s eligible. In this article, we’re going to review some essential information about Medicare, including the pros and cons of the health insurance program.

Medicare: Who’s Eligible?

As mentioned, seniors aged 65 or older are eligible for Medicare in the United States, as long as they’re legal citizens. Non-citizen seniors can gain eligibility if they’ve legally entered the U.S., have gained permanent residency or have lived in the country for more than five years. People who are under age 65 may be eligible for Medicare if they have been disabled for two years or more.

Types of Medicare

Medicare coverage is available in several different types. Each type covers different health care expenses and may overlap in some cases.

Medicare Part A: Covers inpatient stays, hospice care, short-term nursing home stays (limited basis) and some types of home care.

Medicare Part B: Covers doctor’s fees, outpatient service fees, some types of home care and some types of physical and/or occupational therapy.

Medicare Part C (Medicare Advantage): Enables private health insurers to offer all standard benefits of Medicare Part A and B within a managed care plan like PPO or HMO. These plans typically include extras like prescription drug insurance and vision insurance.

Medicare Part D: Covers prescription drug insurance benefits. This plan is usually offered through private insurers to provide prescription drug insurance for those who pay monthly premiums.

Many eligible people consider and compare the original Medicare to Medicare Advantage. The ‘original’ Medicare typically includes Medicare Part A and Part B, along with the option of selecting Part D and Medigap coverage. Medicare Advantage, on the other hand, includes Part A and Part B coverage with the option of selecting Part D coverage if needed. Advantage plans generally don’t need additional Medigap coverage.

List of Pros of Medicare

Medicare, also known as Original Medicare, provides many health insurance benefits to eligible seniors. It also allows them to freely choose any health care professional that accepts the program. Let’s review some of the best known pros of Medicare.

1. Policyholders can choose their preferred health care provider.

As mentioned, Medicare allows policyholders to select any health care provider they like. The catch is that their health care provider must accept Medicare and/or work in a facility approved by Medicare. But it’s a good catch for those who regularly rely on Medicare for health insurance coverage.

2. Original Medicare plans only have one monthly premium (in most cases).

Original Medicare plans typically have one monthly premium. Medicare Part B (doctor and outpatient care) requires a monthly premium, which can vary based on your insurance provider and state. Medicare Part A (hospital) usually doesn’t have a monthly premium, particularly if a policyholder or their spouse paid Medicare taxes while employed. Going by that, most people only have to pay for Part B coverage.

3. Medicare isn’t restricted to specific plan networks or requires specialist referrals.

Medicare policyholders also have the advantage of selecting health care providers in and out of their network. Many are not restricted to only one plan network.

Because Medicare is accepted at a wide variety of health care providers, it allows policyholders to see medical assistance at any medical facility of their choosing. Policyholders also don’t need to get a referral to see certain health care specialists, especially if they need urgent medical care from that particular specialist.

List of Cons of Medicare

While Original Medicare provides a significant amount of benefits to policyholders, not everyone can benefit from Medicare. Let’s examine some of the cons of Medicare.

1. Original Medicare costs can get high.

Original Medicare policyholders are typically responsible for at least 20 percent of their doctor and outpatient care expenses, which isn’t annually capped. In addition, policyholders are responsible for some co-payments and/or deductibles if sick or hospitalized. Annual costs, if including Part D and Medigap, can potentially cost more than Medicare Advantage.

2. No coverage, including emergency coverage, for policyholders if they travel outside the country.

Original Medicare doesn’t provide coverage for policyholders who travel outside the United States. In order to have health insurance coverage, they may need to purchase a separate policy for that purpose.

3. Policyholders with drug coverage and other supplemental plans may need to interact with several providers to fulfill coverage conditions.

Some policyholders may be subject to interacting with up to three different entities in order to receive Part D benefits and supplemental coverage like Medigap. This might complicate the situation more than most policyholders would like.

Medicare In Closing

As you can see, Medicare harbors both advantages and disadvantages. People who are or will be eligible for Medicare soon should visit Medicare.gov for more essential information about the health insurance program.

One thought on “6 Major Pros and Cons of Medicare

  1. Thank you for the information about the benefits of having medicare, and what it can do for the people who have it. I would say that it’s important to have the choice on the health care provider when receiving medicare. The client should have a provider that they can trust and rely on for their medical needs.


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