The comparison table provides a concise overview of the similarities and differences between Medicare, Mediplans, and the Affordable Care Act (ACA) in terms of their purpose, coverage, eligibility, enrollment periods, plan types, premiums, deductibles and co-pays, coverage for pre-existing conditions, essential health benefits, and penalties for not enrolling.
The table highlights the unique features and advantages of each option, while also noting potential drawbacks and considerations for consumers. By evaluating the key differences between these health coverage options, individuals can make informed decisions about which plan is best suited for their specific healthcare needs and financial situation.
For more detailed information, refer to the table below.
| Category | Medicare | Mediplans | Affordable Care Act (ACA) |
|---|---|---|---|
| Purpose | Federal health insurance program for people who are 65 years or older, people with certain disabilities, and people with end-stage renal disease | High-deductible health plan that allows individuals to contribute funds to a savings account that can be used to pay for medical expenses | Federal law that aims to make healthcare more affordable and accessible for Americans |
| Coverage | Hospital stays, doctor visits, prescription drugs, medical equipment, and more | Catastrophic insurance plan that provides coverage for major medical expenses after the individual has paid their deductible | Health insurance plans that provide coverage for essential health benefits, such as preventive care, prescription drugs, and hospitalization |
| Eligibility | People who are 65 years or older, people with certain disabilities, and people with end-stage renal disease | Individuals who choose to enroll in a high-deductible health plan with a medical savings account | Individuals and families who do not have access to employer-sponsored health insurance or other types of health coverage |
| Enrollment Period | Initial enrollment period begins 3 months before an individual’s 65th birthday and ends 3 months after their 65th birthday. | Enrollment period varies depending on the plan and the provider | Open enrollment period runs from November 1st to December 15th each year for coverage starting January 1st of the following year |
| Plan Types | Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage plans), and Part D (prescription drug coverage) | Various types of high-deductible health plans with medical savings accounts | Marketplace plans, Medicaid expansion, employer-sponsored health insurance, and more |
| Premiums | Typically free for Part A, Part B premiums vary based on income, and additional premiums may apply for Parts C and D | Varies depending on the plan and the provider | Varies depending on the plan, income level, and subsidy eligibility |
| Deductibles and Co-pays | Varies depending on the plan and the service provided | High deductibles and out-of-pocket maximums, with some plans covering preventive care and some prescription drugs before the deductible is met | Varies depending on the plan and the service provided |
| Coverage for Pre-existing Conditions | Yes | No, but individuals with pre-existing conditions may still enroll in a high-deductible health plan with a medical savings account | Yes, all marketplace plans must cover pre-existing conditions |
| Essential Health Benefits | Varies depending on the plan and the provider | No, but catastrophic insurance plans must cover at least three primary care visits per year and preventive care | Yes, all marketplace plans must cover essential health benefits, such as preventive care, prescription drugs, and hospitalization |
| Penalties for Not Enrolling | Yes, individuals who are eligible for Medicare but do not enroll may be subject to a late enrollment penalty | No | Yes, individuals who do not have qualifying health coverage may be subject to a tax penalty (the individual mandate) |
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(RECURRING MESSAGES & DATA RATES MAY APPLY)
