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Thread: Private Insurance vs. Medicare

  1. #1
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    Private Insurance vs. Medicare

    My son is changing health insurance. Is it better to be on a group plan through Blue Shield, United Healthcare, Aetna, etc. or use Medicare with supplemental PPO? It's all so confusing and I have heard some horror stories dealing with Medicare. Any advice would be greatly appreciated! Thanks!!!!

  2. #2
    Senior Member Oddity's Avatar
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    Without exception my group plan benefit packages have been better than what I have now with Medicare. I also paid higher premiums for the group plans, of course, and I'd still be willing to if it were an option in my current situation. Comparing benefits and premiums between my family's post-ACA private plan, however, leaves me thinking Medicare ain't but SO bad!
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    While it is in no way my intent to further complicate the issue, you need to consider the time, effort, hassle, etc. of reinstating your Medicare benefits should you decide to decline those benefits. Also, if your group plan is through an employer, you have to know if it is a small group or large group plan (more than 100 eligible participants). This determine who is primary for claims. This does not have to make a huge difference in the long run but you need to know.

    I know that Medicare premiums are not free. The back-up coverage, however, can be more than worth the premiums. If you have medical needs on a continuing basis, the dual coverage may be worth it. If you need durable medical equipment (see a post for some one with group coverage with no cath coverage), it may be worth it.

    Bottom line, you need to sit down and look at the last few years of medical needs. This will allow to make an educated projection on future needs. Will the out of pocket costs exceed the Medicare premiums? Do you have DME needs?

    Yes it is confusing. Yes it can make your head hurt. However, information is power and you have to do your homework to feel good about whatever decision you make.--eak
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  4. #4
    Private insurances are increasingly borrowing Medicare's policies and procedures, In many. if not most instances there is very little difference these days.
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  5. #5
    Senior Member Oddity's Avatar
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    It is certainly true with a handful of specific services (that private insurance "adopts" Medicare benefit guidelines), Medicare benefits still lag significantly behind most employer sponsored group plans. In terms of reimbursement limits, out of pocket potential, provider availability, and exclusions/allowable services group policies still have the edge. Medicare is a close second. Individual plans are a distant third, in my experience.
    "I have great faith in fools; self-confidence my friends call it." - Edgar Allen Poe

    "If you only know your side of an issue, you know nothing." -John Stuart Mill, On Liberty

    "Even what those with the greatest reputation for knowing it all claim to understand and defend are but opinions..." -Heraclitus, Fragments

  6. #6
    In our experience, I would still try to hang on to private insurance as long as possible. It will depend a little on where you live and what your private options are and what the premiums are like to some degree.

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    Thank you to everyone! As always, some very good advice!

  8. #8
    Yep, definately private.
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  9. #9
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    I am on medicare have no issues really

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