A couple going over health insurance options.

Medicare, Medicaid or Private Insurance?

Health Insurance for Seniors

There are different options for health insurance, and it's important to have it as you age. Seniors can often opt for Medicare, Medicaid or a private insurance plan, based on their needs and budget. In this article we break down the pros and cons to help you make an informed decision.


Medicare is a federal provided health insurance for seniors over the age of 65 and to be eligible you need to have completed a minimum of 10 years of full-time work. It is funded by the 2.9% mandatory payroll deductions, the enrolment premiums which are paid monthly and by government contributions.

There are four separate parts to Medicare, so it is essential to have a really clear understanding of what you will receive for free and what you will still have to pay for. Here are the different parts to Medicare:

  • Part A, which everyone enrolled is usually entitled to. This part helps to cover the cost of hospitalization, care needed when in a nursing facility or care if you need to stay at a hospice.
  • Part B provides cover for outpatient services so things such as visits to the doctor, lab tests and some surgeries. The cost is around $144 per month, though it may be higher, depending on your income.
  • Part C is also known as Medicare Advantage. Offered by Medicare-approved private companies, you have the cover provided by Part A and B and then additional services such as dental and vision care. Some policies also offer extras such as wheelchair ramps and meal delivery. If you decide to go down this route, you still need to enroll for Part A and B, pay the Part B premium and then choose and sign with a Medicare Advantage plan.
  • Part D provides cover for the cost of prescription drugs. Because private insurers provide this cover, the price varies from plan to plan, as do the drugs which are included within each one.

Advantages of Medicare


Millions of seniors have received medical care when they otherwise would not have been able to afford it.

Opportunity to Take Additional Coverage

More and more Americans are enrolling in Medicare Advantage plans each year to receive additional benefits.

Disadvantages of Medicare

High Costs

While it might be expected that costs will increase with more medical issues, Medicare really does not adapt well for seniors at a time in life when there may already be financial challenges. Medicare Part B, for example, usually covers 80% of your medical costs, but you may be responsible for covering the value of the remaining 20%.


Medicaid is run by each state with some funding coming from the federal government for health insurance for seniors. Each state has different criteria on who qualifies for the program and what is covered, but generally, a senior would be eligible if they had little in terms of available assets.

Medicaid will usually pay most costs which relate long-term health care, so that includes time spent in a nursing home or hospice and also skilled care provided at home.

Advantages of Medicaid

Affordable Healthcare

When your income is low, and you meet the state criteria, you have access to both basic and specialized healthcare.

Mandatory Benefits

While there can be different eligibility criteria, there are mandatory benefits that all states have to offer through Medicaid. These include physician visits, inpatient services and x-rays.

Disadvantages of Medicaid

Limited Health Care Provider Options

In some areas, the number of providers who will accept Medicaid may be restricted. The reimbursements they receive are substantially less than what they may usually bill, so they may be deterred from accepting new Medicaid patients.

Unfair Treatment of the Elderly

Discrimination is also frequently reported by Medicaid seniors in nursing homes. There have been reports of the elderly being refused entry upon finding out the type of coverage they have, stating that they had met their “Medicaid quota.”

Private Health Insurance Plan

Much of the cover provided by private health insurance policies is sponsored by the employer, so they tend to end when retirement comes around. With their high expense, it is often just not possible to take on the policy cost once leaving employment, but there are some significant advantages to private cover, which we have detailed for you, so if the premiums fit within your budget, it is worth considering.

Advantages of Private Health Insurance

You Choose Your Doctor

Within the private healthcare system, you often have the opportunity to choose both your doctor and the medical facility you attend. This means that you can see the same doctor throughout your treatment.

Shorter Wait Times

For non-life-threatening surgery, wait times can be very long, but with private health insurance, you could be treated much sooner. This means you are also on the road to recovery and back to your normal life much more quickly.

Improved Facilities

Sadly, the public system just does not have the funds which are available to the private sector. This can mean overcrowding and some comfort amenities being missing. Private health care facilities will be well maintained, with individual rooms and bathrooms, and amenities such as phones and TVs.

Disadvantages of Private Health Insurance

Prohibitive Cost

Just as insurers consider risk factors when calculating premiums for car and home insurance, the same applies to private health insurance. This means that the cost goes up the older you are, if you have existing medical conditions or even if you have a predisposition to developing a condition.

Seldom Covers all Medical Services

Rarely will you find a health insurance plan which is perfect for your needs, so you may find yourself having to pick and choose which health benefits are most important to you and which ones you think you can do without.

Health Care Options for Military Veterans and Spouses

Veteran Affairs health care provides comprehensive cover for preventative, inpatient and emergency treatment for those who have served within the active military, naval, or air service. Several requirements need to be met, including being honorably discharged and having served a continuous 24-month period.

The spouse, dependent child, or family caregiver of a Veteran may also be eligible for cover through the TRICARE or CHAMPVA schemes.