How is Medicare Different from Other Health Insurance?

There are many key differences between Medicare and other types of health insurance plans. In this guide, we’ll explain what makes Medicare different from those other types of health insurance.

Prescription Drug Coverage

Some health insurance plans, such as a group health plan, usually include coverage for prescription drugs as part of the health package. However, Original Medicare (Medicare Part A and Part B) does not include prescription drug coverage.

To get prescription drug coverage, you have to enroll in Part D or in a Medicare Advantage plan that includes prescription drug coverage.

Dental, Vision, and Hearing Coverage

Some health insurance plans, such as employee health insurance and other private plans, may include coverage for dental, hearing, and vision services. However, Original Medicare does not include this. It only covers certain inpatient and outpatient hospital and medical services. To get dental, vision, and hearing coverage, you can enroll in a Medicare Advantage plan that offers this coverage.

Out-of-Pocket Maximum

While most health insurance plans have an annual out-of-pocket limit, Original Medicare does not have one. There is no limit on the out-of-pocket expenses you can cover each year. The only part of Medicare with an annual out-of-pocket maximum is Medicare Advantage. The limit for 2021 is currently set at $7,550. This means that a Medicare Advantage plan can set its out-of-pocket maximum to this amount or even below this amount, but they cannot ask you to pay more than this.

With this in mind, if you find it to be a bit difficult to cover some of your out-of-pocket costs and are not interested in enrolling in a Medicare Advantage plan, you can enroll in a Medicare Supplement plan. This will supplement your Original Medicare coverage and can provide coverage for any deductibles, copayments, or coinsurance costs you may have.

Joint Coverage

While some health insurance plans, such as a group health plan, may offer coverage for your spouse or dependents, Medicare does not offer joint coverage. Qualified individuals have to enroll individually to get covered by the program.

At Proinsurance Hawaii, we are committed to finding you the best coverage that Hawaii has to offer! To learn more about Medicare and the coverage available to you in your area, contact us today at 808-735-0106.