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What Is Non-Medicare Insurance? Complete Guide

HealthPlans of NC

Living without health insurance can leave you financially vulnerable to sudden illness or injury. Many individuals with health insurance coverage may feel that their plans don’t fulfill their needs.

If this is the case, several options are available, and Non-Medicare is one of the most widely used. But what is Non-Medicare insurance? And do you benefit from choosing it?

This article will offer a comprehensive understanding of non-Medicare insurance and how it differs from other types of insurance plans.

Understanding the Difference Between Medicare and Non-Medicare Insurance

Non-Medicare health insurance coverage is either purchased individually or offered by an employer. It is a private form of insurance that has more comprehensive coverage. Medicare is more limited because it is a federal health insurance program focused on seniors over 65 or people with disabilities. It is not available for all types of people and is more specifically directed.

In most cases, Non-Medicare is typically more costly than Medicare. This is because health insurance benefits are more comprehensive and serve various issues. Many employers that offer health insurance plans assist in paying health insurance premiums. Ask your employer if this is part of their plan options.

Why Non-Medicare Insurance Is Also An Option for Better Health Coverage

Non-Medicare health insurance benefits are more extensive than Medicare. Although health coverage is more expensive, it often includes doctor visits, preventive care, hospitalizations, a prescription drug plan, dental care, and vision. Medicare health insurance plans are compartmentalized, offering Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage), and Part D (prescription drug plan) separately.

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Types of Non-Medicare Insurance Providers

Due to high health insurance premiums and healthcare costs, many retirees and self-employed professionals don’t have proper health coverage. Finding the right health plan can be difficult for people who don’t know where to look.

Here are a few non-Medicare health insurance plans that can get you started. Health insurance agents are also available for additional one-on-one assistance.

Employer-Based Insurance

An employer-based insurance health plan is a form of non-medicare. Usually, an employer or a family member’s employer offers these programs. Often, you are responsible for paying for some or all of your health insurance premiums.

Payments may be taken straight from your paycheck. Or, you may be asked to pay your Human Resources manager an outstanding balance. 

Private Health Insurance

Many individuals who don’t have access to employer-based insurance decide to explore private health insurance plans.

The Health Insurance Marketplace is one way to weigh all of your options. Some individuals may qualify for assistance, potentially lowering their healthcare costs (co-pays, co-insurance, and insurance premiums).

Insurance Marketplace

Sometimes, individuals may turn to The Health Insurance Marketplace to purchase health insurance. This platform provides enrollment services, information about different plans, and access to multiple non-medicare insurance plans.

Health Plans Under Non-Medicare Insurance

We can dig into specific plans now that we know more about Non-Medicare insurance providers. This section will help you better understand the specific nuances of each plan so you can feel confident with your decision.

Enhanced Care PPO (ECP) Plan

The ECP, or the Enhanced Care PPO, is a nationwide health plan for non-Medicare Trust members. Blue Cross Blue Shield offers the ECP plan. A major benefit of this plan is that it provides unlimited primary care and specialist physician visits at a flat dollar copay. 

Another perk of this primary plan is access to a personal health guide. This guide helps you find the right hospital and doctor near you, answers all your healthcare and billing questions, and more.

Preferred Provider Organizations (PPO)

PPOs are a combination of HMOs and fee-for-service plans. These plan options offer the most choice in medical providers by letting you go to any provider that accepts your insurance. With Preferred Provider Organizations, working within their network of providers is much cheaper. They may cover providers outside of the network but at a higher cost.

Health Maintenance Organizations (HMOs)

HMOs are designed to cover most expenses after your copay and deductible. It is important to note that Health Maintenance Organizations strongly encourage you to choose healthcare providers within their approved network. HMOs will likely not cover a doctor outside of their network.

Point-Of-Service Plans (POS)

POSs are a specific type of HMO. Essentially, primary POS doctors refer you to another doctor within that plan. If a doctor is chosen outside the network, you must pay co-insurance. Check if your plan covers your new doctor before your visit.

Going Out-Of-Network for Health Care

Many people go out of network to get care from a particular facility, doctor, or surgeon. This is often more expensive, but it is possible to negotiate costs when necessary. Before going out of network, check whether the same service is available within your network. This can mean switching doctors to one with lower healthcare costs. Alternatively, you may wish to consider changing plans if you need to see a specific provider regularly that’s covered under a different plan. You can also ask your healthcare provider about assistance programs you may be eligible to receive.

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Frequently Asked Questions

How can you use your private insurance with Medicare?

Private insurance and Medicare can work together to cover medical expenses. Usually, your primary payer (private insurance) pays what is owed, and then the secondary payer (usually Medicare) pays for the rest.

Is Medicare more efficient than private health insurance?

Yes, Medicare is more efficient.

What are the benefits of private health care over Medicare?

Private health care often includes doctor visits, preventive care, hospitalizations, a prescription drug plan, dental care, and vision. Medicare is less comprehensive and doesn’t offer all of these perks.

Which has higher overhead, Medicare or private insurance?

Private insurance has a higher overhead.

Which insurance is best for health?

Private insurance offers the most comprehensive insurance, which assists with more healthcare needs.

Are You Interested in Enrolling in a Non-Medicare Plan?

Non-Medicare insurance is a form of private healthcare that offers more comprehensive coverage than Medicare. Although it is more expensive, non-medicare covers more of your healthcare needs. You can access Non-Medicare through your employer, privately, through the marketplace, and directly with insurance providers. 

If you’re looking for a private insurance plan in North Carolina, let's get started. Discover the right plan for you today. 

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