Unlike individual insurance, Medicaid benefits provide pregnancy services.
Medicaid provides quality health insurance to low income individuals. Recipients must qualify for Medicaid services. Unlike private health insurance, eligibility for Medicaid is income-based, because benefits are typically provided for no out-of-pocket cost. If you are eligible for Medicaid, strongly consider the pros and cons before buying individual health insurance.
Advantages
Individual health insurance has many advantages for the right person. Individual health plans are offered through private organizations with private funding, whereas Medicaid services rely on public money. Individual health plans offer participants more flexibility in the type of coverage and care received as well as a wider variety of options for health care providers and facilities.
Drawbacks
A major drawback of individual health insurance is the cost. Private health insurance premiums are expensive, and costs vary by age and health status. Most Medicaid recipients do not have to pay for health care. Payments are subsidized by the governing state agency. Individual health insurance plans are usually subject to copays, deductibles and co-insurance costs that plan participants must pay to receive coverage. Chances are, if you are eligible for Medicaid your income is too low to afford individual health insurance premiums and fees.
Another disadvantage of individual health insurance is the eligibility restrictions. To be eligible for individual health insurance you must answer questions about your health and, in some cases, take a physical. If you suffer from a health condition, disability or illness you may be denied individual insurance coverage or forced to exclude your health condition from coverage. If you have an existing health condition or illness that may disqualify you from individual health insurance, or if your income is not sufficient for paying the out-of-pocket costs associated with private insurance, take advantage of Medicaid services to ensure you receive the health care you need.
Coverage Similarities
Individual insurance and Medicaid services offer similar plan benefits. Both typically cover inpatient and outpatient hospital services, laboratory and diagnostic services, wellness visits, childhood screenings and immunizations, emergency care, and family planning services. If you qualify for Medicaid and only require essential health care services such as annual check-ups, health screenings and protection against unexpected emergencies or illness, it is unnecessary to purchase individual insurance.
Coverage Differences
Medicaid services are usually all-inclusive, whereas with individual health insurance, participants are required to pay extra or obtain a separate policy for dental, vision, pregnancy and long-term care insurance. Pregnancy-related services are not included in individual policies but can be purchased for an additional premium.
Medicaid is ideal for essential services but if you need more specialized care such as dermatology, neurology and orthopedic services, Medicaid coverage may be limited. If you have special health care needs, an individual health insurance plan that effectively covers and treats the specialized condition may be appropriate.
