Pros and Cons of Medicare

Pros and Cons of Medicare

Medicare is an insurance plan offered to individuals by private companies and it replaces the original Medicare plan. If you choose to use Medicare advantage, all the services offered by original Medicare Part A (hospital insurance) and B (medical insurance) will be covered in the new Medicare plan.

Medicare advantage has attractive features some that match your personal preferences and lifestyle while others don’t favor you.

 

Pros:

1. Payless: When you join the Medicare advantage plan, you continue to Medicare part B premium and other additional premiums. The insurance company determines the Medicare advantage plan premium while other plans cost you premium as low as $0. This reduces out-of-pocket expenses.

2. Coordinate care among health care providers: Medicare advantage has a network of contracted care providers like the Health Maintenance Organization (HMO). This gives you an opportunity to choose a primary care physician (PCP).

3. Switch plans: Medicare advantage plan allows you to switch from one plan to another, adjust the plan coverage or switch back to the original Medicare during open enrollment.

4. Qualify to SEP: Medicare advantage plan gives you an opportunity to qualify for the Special Enrollment Period (SEP) under certain circumstances. This happens if you have lost your employment-based health insurance.

5. Offer more advanced benefits: Medicare advantage plan offer extra benefits not offered in the original Medicare. The new plan includes drug coverage, routine hearing care, and dental service as well as offering gym discounts.

6. Medicare leads to productive population:
Medicare leads to having a healthy and productive population. Statistics in the United States shows that, since the inception of Obama care, most Americans have accessed quality health services. Hospitals provide services to everybody without social stratification option. Before this, Hospitals were categorized into low or high class.

7. Medicare provides a reprieve for companies: It lowers the burden of paying health insurance by companies to their employees. The responsibility of the employer is to pay health cover for their employees. Medicare provides a reprieve. This medical allowance can be channeled to other staff motivational programs.

8. Patient can choose the Doctors of his choice: There are no restrictions on choosing the doctor you want. A patient has the freedom to engage the doctor of their choice even though Medicare meant for optical, mental health, and dental initially.

9. Medicare covers the pre-existing condition of the patient: The worry of life condition no longer disturbs the patient. Cancer or dialysis can adequately be handled without additional cost. The stress of footing the medical bills of these conditions is sorted.

10. Does not require monthly premiums: There is no payment of monthly premiums. Unlike before, when payment is not updated, hospital will turn you away this is not the case. However, with Medicare, it is the sole responsibility of the government. Whether the payment delays to the hospitals, the patient doesn’t feel the ripple effect.
Providers typically receive the same payment. The standard rate of payment of doctors and physicians are the same. Therefore they don’t choose whom to give quality services.

 

Cons:

1. Limit choice of health care providers: Medicare advantage plans have restrictions on the network of medical service providers. If you’re out of the medical network coverage, the plan you have may not cover your medical cost. You don’t have the freedom to go to any doctor or medical facility.

2. Enrollment period: You can’t sign up for a Medicare advantage plan anytime. You have to take advantage of the initial enrollment period and take advantage of the services offered in each plan.

3. Doctor referral and authorization is needed in some plans:
Some of the services and procedures have to be authorized by a doctor to prevent misuse of health care services and facilities. You have to get some authorization for hospital stays, use of medical equipment, and performing some complicated procedures.

4. Offer specific service areas: To enroll in a particular network of medical providers, you have to be within the service area for a period of six months within a year. Medicare plans are state-specific coverage, therefore, if you stay at home in different locations, you may have a hard time receiving Medicare aid services.

5. Follow rules: To receive payment for all Medicare advantage covered services, you have to follow the plan’s rules. Otherwise, you will not receive any payment.

6. There is an increased government burden: Most people are looking up to the government for their medical bills. Should the government resources fail, Medicare will be badly hit. The citizens will blame the government because they don’t contribute. The government needs to set up a budget that can finance Medicare.

7. There are some hidden cost that you must pay: The government may not offer home care. So in case you are under home-based care, you must employ your physician. The prescription may include the drug not found in government pharmacy. The transport to the health facility are at your own cost.

8. Some patients may be unserious: When all the cost of treatment catered for, people take their health issues less serious. Some may abuse the given drugs because they know they have unlimited access. Others may not go for medication at all because they don’t feel the burden.

9. Its is stressful for the hospitals: Most hospital strain to admit the surging numbers of patients. Since majority the Medicare beneficiaries are a low class, their number is enormous. This may prompt the hospitals to look for additional admission facilities with a constrained budget.

10. Medicare attracts corrupt and fraudulent doctors: Some will over bill patients to get more funds. Others will bill medicine; they don’t own stock.
Poor health management is likely to cost a lot. If people don’t take care of their lives, then the treatment cost will continuously skyrocket.

Conclusion: Medicare is the best solution to a healthy life. Before you choose a Medicare plan, take spend some time in conducting a thorough research. The government may be useful in implementing medical service, though not 100% effective. Hence, you must learn to take care of their health. The best gift you can give your self is choosing a reliable Medicare.

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