9 Things to Know About Medical Insurance

Medical insurance

Health should be everyone’s priority, but most people don’t consider medical insurance a crucial investment. Not everyone is keen on discussing hospital coverages, and some find the topic intimidating. Medical insurance can help you deal with expenses when you get sick to the point of hospitalization. Before dealing with this type of insurance, here are some things you need to know: 


1. Medical Insurance and Health Insurance Are Different

Some people interchangeably use medical insurance to refer to health insurance and vice versa. In that case, people don’t realize that they do have differences, albeit slight. 

Health insurance has a broader range of coverage—medical, dental, vision, hearing, surgical, and prescription drugs. It is offered publicly through federal funding and is customizable through private companies. Companies may offer health insurance to entice customers or for prospective employees to apply to them. 

Medical insurance, on the other hand, only has limited coverage for treatment and hospitalization in general. Government insurance such as Medicare uses Medigap to fill in benefit gaps. There are also other well-established insurance companies, such as Transamerica Medigap insurance review, that offer various Medicare supplement plans suitable to the needs of their policyholders.


2. Medical Insurance Coverage

Now that the difference between health and medical insurance has been made clear, let’s cover the purpose of medical insurance. Basic private medical insurance typically covers day-care surgery and in-patient treatments that include diagnostics as well.

While its primary purpose is to pay for medical treatment (intensive and critical care), some providers may add higher premiums for outpatient surgery (including specialists), ambulance services, and the number of nights you need to stay in a National Health Service (NHS) hospital.

The cost may also be more affordable than other policies, but it will depend on the benefits availed of. For instance, your smoking habit may also make premiums higher. One of the reasons is that smoking causes dental problems. Hospital or medical insurance does not cover dental issues. You’ll most likely be compelled to get dental insurance and add more to your existing premium.


3. What Private Medical Insurance Does Not Cover

Medical insurance doesn’t cover the conditions mentioned below:

  • Medical conditions that are already pre-existing
  • Sports injuries and injuries related to war or hostilities
  • Organ transplants
  • Pregnancy and childbirth
  • Diabetes, epilepsy, hypertension, HIV/AIDS, and other related illnesses

Some companies would offer coverage for sports injuries and mental health conditions.


4. Eases Out-Of-Pocket Expenses

The cost of hospitalization and treatment can leave deep financial trouble for individuals and families who earn less salaries. Hospital indemnity insurance can serve as a supplementary insurance policy when your health or Health Maintenance Organization (HMO) benefits are not enough. It covers co-pays, deductibles, care services, and, depending on the plan, can also include hospitalization.

It also helps enrollees avoid exhausting their savings due to the high cost of treatments. Hospitals also tend to charge more depending on the duration of the patient’s stay. Medical insurance may also cover the cost of rooms. 


5. Affordable Option for Employers

Employers often offer hospital or medical insurance because it can offset the high costs of deductibles. It provides a win-win solution since it makes hospitalization affordable for the employees, and it’s cheaper to provide on the part of employers.

While employers offer them, individuals can purchase them privately. There are affordable monthly payments that will pay out a specific amount to help cover surgery, diagnostics, or ambulance transport. Enrollment is also easy as there are no medical inquiries or examinations required. 


6. Partner Medicare With Private Medical Insurance

If you’re paying for Medicare, you already know that Plan A covers hospital care. But Medicare doesn’t cover everything, since you may still need to pay out-of-pocket for specific expenses such as deductibles. In this case, you can make Medicare your primary insurance and take on another separate policy.

As the primary payer, Medicare can coordinate with your other medical insurance company to compromise as to which of them gets to pay first. Regardless, this cooperative effort eases the out-of-pocket expenses of the policyholder. 


7. Medical Insurance Is Family-Friendly

Families can benefit from hospital insurance as infants make up the majority of minors who need hospital care. The expense of hospitalization can take a toll on a family’s economic well-being, especially when young children and infants require intensive and emergency treatments.

Either of the spouses can also use this even when they don’t have children. Room admittance can cost thousands of dollars, especially in confinements that take several days. Additionally, pregnant women can also make use of medical insurance from admittance to post-childbirth. Seniors can use hospital or medical insurance when they get hospitalized for age-related illnesses. 


8. Waiting Period

No matter the reason, hospitalization is an urgent matter that insurance companies should prioritize. In actuality, if you have an illness that is not considered life-threatening, you may have to let 30 days pass before receiving a check.

Injuries by accidents are a different story as you may not have to wait at all. Medical insurance providers generally send the money directly to the policyholder, similar to other supplemental insurance policies. Before purchasing this type of insurance, always know the waiting period. 


9. Private Medical Insurance

Private medical insurance eligibility applies only to those with issues that the NHS can’t cover with drugs and treatment. These include injuries from playing sports activities and surgeries. If you prefer being admitted to private hospitals for treatment rather than in NHS facilities, you’d want to avail yourself of private medical insurance instead.  Other benefits of private medical insurance are as follows:

  • You’re free to choose your surgeon and hospital
  • You can get a private room
  • You can take as many scans as you need
  • They can lower the waiting time for treatment, if more than six months
  • You can get second opinions from specialists
  • You have access to physiotherapy sessions
  • You have access to specialist treatment and drugs



Medical insurance can serve as separate coverage or supplementary insurance, even for Medicare policyholders. Knowing how it works will help you get the most out of it. It likewise helps ease your potential out-of-pocket expenses such as deductibles and co-payments. Remember that it pays to know the coverage of your policy, your rights, and the benefits you can reap from it. You may ask the insurance company in case confusion arises and when you need assistance.

Related posts