Medicare Vs Private Insurance

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Although Medicare is only available for individuals that are 65 years or older and disabled patients, when compared to private insurance companies there are several similarities. Throughout this paper we will discuss the different types of Medicare and some examples of private insurance policies, while exploring how they work together. It is important for every nurse to have a basic understanding of Medicare compared to a private insurance plan so that they can educate their patients about needed medical coverage and covered procedures under their plan.
Medicare Verses Private Insurance When discussing insurance options for an individual there are four different categories to be considered: a private individual health plan, an employer …show more content…
Medicare is a federal insurance program for people who are 65 years of age or older, patients with end stage renal disease, or people who are disabled. There are several different categories of the Medicare program. Medicare Part A includes coverage for hospitalizations, skilled nursing facilities, hospice, and certain aspects of home health, while Medicare Part B covers doctor’s services, outpatient care, medical supplies, and preventive care. In addition to part A and B, Medicare also has a part C and D. Medicare Part C, also known as Medicare Advantage Plan, is contracted through private insurance companies to provide the individual with the Medicare Part A and B benefits for a fee. Last of all, Medicare Part D provides prescription drug coverage to patients. Although Medicare Part A is entitled once you become 65 years old and you or your spouse paid taxes into the Medicare program for at least 10 years, Part B, C, and D requires a premium to be paid just like a private insurance provider. Medicare should not be confused with Medicaid, in that Medicaid is a government funded program that provides health care coverage to the low-income …show more content…
Private insurance is usually expensive if not provided for through an employer and typically covers 70-80% of the health care cost depending on the patient’s plan. Private insurance resembles Medicare coverage, in that, both insurances only pay a specific portion of the cost and the patient is responsible for the remainder. Both Medicare and private policies allow the individual to have more than one provider. For example, if the individual is a Medicare recipient and their spouse has a family plan through their work. The employer-sponsored plan will be considered the primary insurance and Medicare will be the secondary. Depending on the plan, the primary insurance may pay 80% of the claim and the secondary will cover the remaining
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