Which one is better, MediCard or Maxicare?

Maxicare Healthcare Corporation is the biggest health maintenance organization (HMO) in the Philippines in terms of market share, revenue, and medical network size.

Key Details About Maxicare

• Market Position: It holds the largest overall market share and top revenue ranking among local HMO providers.
• Network Size: It features an extensive nationwide network including over 1,300 accredited hospitals, 1,000 affiliated clinics, and more than 20,000 doctors.
• Offerings: It provides comprehensive healthcare plans for individuals, families, and corporate groups, alongside accessible prepaid options like Maxicare PRIMA.

Other Major HMO Competitors

• Intellicare (Asalus Corporation): A dominant leader in the corporate sector known for strong financial performance and high net income rankings.
• MediCard: A top-tier provider backed by AIA Philippines, popular for its accessible entry plans.
• iCare (Insular Health Care): Rapidly growing in membership revenue, net income, and overall industry ranking.

Kaiser Permanente is widely rated as the best overall Health Maintenance Organization (HMO) plan provider for its combination of high quality of care, integrated services, and affordability.

Top-Rated HMO Providers

• Kaiser Permanente: Earns top marks nationwide for low customer complaints, high clinical ratings, and cost-efficiency, though it is limited to specific geographic service areas.
• Blue Cross Blue Shield (BCBS): Offers strong, extensive local HMO networks with solid customer satisfaction across many states.
• Aetna: Features exceptionally low consumer complaint ratios and reliable network coverage.

Key Characteristics of an HMO

• Lower Costs: Generally features lower monthly premiums, lower deductibles, and affordable copays compared to PPO plans.
• Primary Care Physician (PCP): Requires you to select a main doctor who coordinates your routine care.
• Specialist Referrals: Requires a referral from your PCP before you can see a specialist.
• In-Network Only: Does not cover non-emergency care outside of the defined network.

The best health insurance in the Philippines depends on your budget and medical needs, but a layered approach combining PhilHealth, a private HMO (Health Maintenance Organization), and a critical illness plan offers the most complete protection.

Because no single provider fits everyone, the top choices are categorized by how they work:

1. Best for Everyday Care and Hospitalization (HMOs)

HMOs cover outpatient check-ups, lab tests, emergency room care, and inpatient confinement within an accredited network of local hospitals.

• Maxicare: Widely considered an industry leader with a massive nationwide network of primary care clinics, doctors, and accredited partner hospitals. They offer comprehensive individual/family plans as well as budget-friendly prepaid cards (like LifeSavER or PRIMA).
• Intellicare / MediCard: Highly trusted local HMO alternatives frequently bundled by corporate employers or utilized by freelancers for reliable private clinic and hospital access.
• Pacific Cross: Known for high-limit medical and hospitalization plans (such as Select or Blue Royale) with strong coverage options extending into major private facilities.

2. Best for Comprehensive Medical & Higher Limits (HMO-Insurance Hybrids)

These bridge the gap between basic HMO cards and heavy life insurance, offering higher coverage limits for medical treatments.

• AXA Philippines: Their Health Care Access plan functions like an elevated health card, offering high benefit limits up to ₱5 million and cashless access to over 1,500 partner hospitals and clinics.

3. Best for Major Critical Illness Protection

HMOs have annual spending limits, meaning they may fall short during catastrophic illnesses like cancer or severe stroke. Traditional health-adhesion or critical illness plans pay out a lump sum diagnosis benefit.

• FWD Philippines: Their Set for Health product is popular for allowing multiple claims (up to 3x) for unrelated major critical illnesses with a money-back feature if you reach age 75 without filing a claim.
• Sun Life Philippines: Offers robust protection lines like SUN Fit and Well or budget-friendly term options like Sun Life Assure covering dozens of critical conditions up to advanced ages.

4. The Mandatory Foundation

• PhilHealth: The government-mandated national health insurance program is your basic baseline. While automatic for local employees, its fixed case rates only chip away at large private hospital bills—meaning it must be paired with private coverage to avoid out-of-pocket balance billing.

Maxicare prepaid and comprehensive health plans range from ₱999 for basic consultation cards to over ₱30,000 annually for full comprehensive HMO coverage depending on your age and chosen tier.

🚨 Emergency Prepaid Plans (LifesavER)

• LifesavER Accident: ₱1,100/year (Covers accident-related emergencies)
• LifesavER / Standard ER: ₱2,299/year (Covers ER up to ₱25,000)
• LifesavER+ / Pro: ₱6,999/year (Covers ER up to ₱50,000 including confinement)

💡 PRIMA Consultation & Diagnostic Plans

• PRIMA Consult: ₱999/year (Unlimited consults and basic APE at Maxicare Clinics)
• PRIMA Access: ₱9,999/year (Unlimited consults, APE, and select lab tests)
• PRIMA Elite: ₱19,999/year (Unlimited consults, comprehensive labs, and diagnostics)
• Specialized/Condition Cards: ₱2,099 to ₱16,499 (Targeted for diabetes, hypertension, or maternity)

📊 Comprehensive HMO Plans (MyMaxicare)

• Note: Full HMO prices vary based on your age bracket and exact tier; public sample rates range around:
  • Silver (Semi-private room, ₱100k MBL): ~₱15,000+ per year
  • Gold (Regular private room, ₱150k MBL): ~₱17,000+ per year
  • Platinum (Large private room, ₱200k–₱350k MBL): ~₱23,000 to ₱32,000+ per year

No, you generally cannot use standard U.S. Original Medicare to pay for routine medical care or doctor visits in the Philippines.

General Coverage Rules

• Original Medicare (Parts A and B): Does not cover health care outside the United States and its territories, with very rare and strict emergency exceptions (such as if a foreign hospital is closer to you than the nearest U.S. hospital during an emergency).
• Medicare Advantage (Part C) & Medigap: Some Medicare Supplement (Medigap) plans offer limited foreign emergency care (covering 80% after a deductible), and certain Medicare Advantage plans provide emergency or urgent care abroad. However, these do not function as comprehensive health insurance for living or retiring permanently in the Philippines.
• Active Advocacy: While organizations like US Medicare Philippines are lobbying for "Medicare Portability" to let retirees use benefits abroad, no full law or agreement allows general coverage in the Philippines as of 2026.