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With Medicare, you can choose different ways to obtain the services covered by Medicare. Depending on where you live, you may have different choices.
In most cases, when you first enroll in Medicare, you are in the Original Medicare Plan. You may want to consider a Medicare Prescription Drug Plan to add drug coverage. Or, you may want to consider a Medicare Advantage Plan that provides all of your Part A, Part B, and often Part D coverage.
You usually make a choice when you are first eligible for Medicare. Each year you can review your health and prescription needs and switch to a different plan in the fall. There are things you should consider to help you meet your needs.
Medicare Advantage Plans are one of the health plan options that are part of the Medicare program. If you join one of these plans, you generally get all of your Medicare-covered health care through that plan. This coverage can include prescription drug coverage. Medicare Advantage Plans include:
- Medicare Health Maintenance Organization (HMO)
- Preferred Provider Organizations (PPO)
- Private Fee-for-Service Plans
- Medicare Special Needs Plans
When you join a Medicare Advantage Plan, you use the health insurance card that you get from the plan for your health care. In most of these plans, there are extra benefits and lower copayments than in the Original Medicare Plan. However, you may have to see doctors that belong to the plan or go to certain hospitals to get services.
To join a Medicare Advantage Plan, you must be enrolled in Medicare Part A and Part B. You will have to pay your monthly Medicare Part B premium to Medicare. In addition, you might have to pay a monthly premium to your Medicare Advantage Plan for the extra benefits that they offer.
If you join a Medicare Advantage Plan, your Medigap policy won’t work. This means the Medigap Policy will not pay any deductibles, copayments, or other cost-sharing under your Medicare Health Plan. Therefore, you may want to cancel your Medigap policy if you join a Medicare Advantage Plan.
Things to Consider
- Cost
- What you will pay out-of-pocket, including premiums
- Be sure to read and understand Plan benefit summary
- Benefits
- Look for extra benefits and services, like eye exams or hearing aids. (These may be covered by some plans.)
- Be sure to read and understand the plan details.
- Doctor and Hospital choice
- Can you see the doctor(s) you want?
- Do you need a referral to see a specialist?
- Can you go to the hospital you want?
- Do you pay less to go to certain doctors or hospitals?
- Be sure to read and understand plan benefits and details.
- Contact the plan or Broker for more information about their doctors and hospitals.
- Convenience
- Where are the doctor’s located?
- What are the office hours?
- How much paperwork is involved?
- Are they accepting new patients?
- Does the plan offer regional or Nationwide coverage?
- Contact your Broker for specific plan details
- Prescription Drugs
- What will your prescription drugs cost under the plan's formulary (list of covered drugs)?
- Be sure to read and understand the details and coverage levels.
- Pharmacy Choice
- Which pharmacies can you use?
- Be sure to read and understand how to receive benefits.
- Quality of Care
- Quality of care varies among plans, doctors, hospitals, and other health care providers. Giving top quality health care means doing the right thing, at the right time, in the right way, for the right person—and getting the best possible results.
- Be sure to read and understand plan details.
