Your Medicare coverage choices

Note
New to Medicare? Get the basics.

When you first enroll in Medicare and during certain times of the year, you can choose how you get your Medicare coverage. There are 2 main ways to get your Medicare coverage—

Original Medicare

 (Part A and Part B) or a 

Medicare Advantage Plan (Part C)

. Some people need to get additional coverage, like Medicare prescription drug coverage or Medicare Supplement Insurance (Medigap).

Use this information to help you compare your coverage options and decide what coverage is right for you.

Original Medicare

  • Original Medicare includes Medicare Part A (Hospital Insurance) and Part B (Medical Insurance).
  • If you want drug coverage, you can join a separate Medicare drug plan (Part D).
  • You can use any doctor or hospital that takes Medicare, anywhere in the U.S.
  • If you choose Original Medicare, you can also decide to:
Note

If you don't get Medicare drug coverage or Medigap when you're first eligible, you may have to pay more to get this coverage later. This could mean you’ll have a lifetime premium penalty for your Medicare drug coverage.

Learn more about how Original Medicare works.

Medicare Advantage (also known as Part C)

  • Medicare Advantage is an “all in one” alternative to Original Medicare. These “bundled” plans include Part A, Part B, and usually Part D.
  • Plans may have lower out-of-pocket costs than Original Medicare.
  • In many cases, you’ll need to use doctors who are in the plan’s network.
  • Most plans offer extra benefits that Original Medicare doesn’t cover—like vision, hearing, dental, and more.

Learn more about how Medicare Advantage Plans work.

Compare your Medicare options

Can I get my health care from any doctor, other health care provider, or hospital?

Original Medicare

In most cases, yes. You can go to any doctor, health care provider, hospital, or facility that's enrolled in Medicare and accepting new Medicare patients.

You don't need a 

Referral

, but the specialist must be enrolled in Medicare.

Medicare Advantage

In many cases, you’ll need to use doctors and other providers who are in the plan’s network and service area for the lowest costs. Some plans won’t cover services from providers outside the plan’s network and service area.

You may need to get a

Referral

 to see a specialist. Each Medicare Advantage Plan can have different rules that can change each year.

Are prescriptions covered?

Original Medicare

With a few exceptions, most prescriptions aren't covered in Original Medicare. You can add drug coverage by joining a Medicare drug plan (Part D).

Medicare Advantage

Medicare drug coverage (Part D) is included in most plans. In most types of Medicare Advantage Plans, you don’t need to join a separate Medicare drug plan. You can join a separate Medicare drug plan with certain types of plans that:

You’ll be disenrolled from your Medicare Advantage Plan and returned to Original Medicare if both of these apply:

  • You’re in a Medicare Advantage HMO or PPO.
  • You join a separate Medicare drug plan.

Should I get a supplemental policy?

Original Medicare

You may already have employer or union coverage that may pay costs that Original Medicare doesn't. If not, you can buy a Medicare Supplement Insurance (Medigap) policy to help pay your remaining out-of-pocket costs (like your 20% coinsurance).

Medicare Advantage

You can’t buy and don’t need Medigap. You can’t use Medigap to pay for any costs (copayments, deductibles, and premiums) you have under a Medicare Advantage Plan.

What are my costs?

Original Medicare
  • For Part B-covered services, you usually pay 20% of the Medicare-approved amount after you meet your deductible. This is called your coinsurance.
  • You pay a premium (monthly payment) for Part B. If you choose to join a Medicare drug plan (Part D), you’ll pay that premium separately.
  • There’s no yearly limit on what you pay out of pocket, unless you have supplemental coverage—like Medicare Supplement Insurance (Medigap).

Learn about the factors that affect your Original Medicare out-of-pocket costs.

Medicare Advantage
  • Out-of-pocket costs vary—plans may have lower out-of-pocket costs for certain services.
  • You may pay the plan’s premium in addition to the monthly Part B premium. (Most plans include Medicare drug coverage.) Plans may have a $0 premium or may help pay all or part of your Part B premiums.
  • Plans have a yearly limit on what you pay out of pocket for services Medicare Part A and Part B covers. Once you reach your plan’s limit, you’ll pay nothing for services Part A and Part B covers for the rest of the year.

Learn more about the costs for Medicare Advantage Plans.

Other options

Find out how Medicare drug coverage works with other insurance.

Note
You can get personalized health insurance counseling at no cost to you from your local State Health Insurance Assistance Program (SHIP).