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Compare Coverage:  HMO vs. Medicare

My personal history with health insurance has been that I had NONE for most of my life.  If I had some, it was rather an accident of the fact that an employer provided it, or my wife's employer provided it.  Since I have not had an "employer" for some 30 years, but was in business for myself, I had no health insurance coverage until I reached 65 and became eligible for Medicare.

Even though I have a very low opinion of "health insurance" as a concept, once I reached the age where illness becomes more and more common, and expensive, and when there was "so-called free" insurance coverage through Medicare, I had no hesitation to use it.

So, I went for a year with simple Medicare coverage.  During that time I tried to understand HMOs and other sources of insurance.  The one basic fact I learned is that you could "sign over" your Medicare coverage to a private insurance company, like an HMO, and get another version of health insurance coverage.  I also learned that you could change your mind on this decision only during a few months of the year -- in other words, you could not go back and forth between different types of coverage freely.

I decided that was the best thing to do, and joined an HMO called Secure Horizons.  I had my coverage with them for a while and then ran into various opinions that I would get better health insurance coverage if I was simply on Medicare alone.  So, I left the HMO, went back onto Medicare for another while, and then decided (on rather flimsy research) that I would probably be better off back with the HMO.

So, I re-joined the Secure Horizons HMO and that is where I am as of this present writing. 

I continued to run into opinions, often from medical doctors, that the HMOs were very famous for "rationing care" and that Medicare did not have that characteristic.  I also was told that a combination of Medicare plus a "premium-pay supplement" with someone like AARP would be the best possible coverage.

As of the beginning of writing this article, December, 2004, the above constitutes almost all my knowledge about a comparison between

1)  Medicare, alone

2)  An HMO

3)  Some combination of Medicare and a private supplemental health insurance

So, that's where this article starts, and if you have anything like the same situation and need some facts and guidance, this is the place to find it.  It is a very personal research, and uses my own personal situation as the central data with which to make judgment.

You'll find many links on this page to other pages on this web site -- so you can see what resources I've looked at in presenting my analysis.

The first place I looked was the official government web site for Medicare.  I found that they had s search service that would seem to provide exactly the type of information I was looking for.

The information that applied to ME is shown on THIS PAGE.  On that page you'll find all the various insurance plans I could join, in my zip code, where the Medicare coverage would completely take care of the private insurance -- in other words, no extra cost.

Then, below this group of choices were some choices called "MedicGap" which involved premiums in various amounts.

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