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  Medicare: 

Original Medicare

 (Part A and Part B) or a 

Medicare Advantage Plan (Part C)

. Some people need to get additional coverage, like Medicare 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).
  • You can join a separate Medicare drug plan to get Medicare drug coverage (Part D).
  • You can use any doctor or hospital that takes Medicare, anywhere in the U.S.
  • To help pay your out-of-pocket costs in Original Medicare (like your 20% coinsurance), you can also shop for and buy supplemental coverage.
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 a Medicare-approved plan from a private company that offers an alternative to Original Medicare for your health and drug coverage. These “bundled” plans include Part A, Part B, and usually Part D.
  • In most cases, you’ll need to use doctors who are in the plan’s network.
  • Plans may have lower out-of-pocket costs than Original Medicare.
  • Plans may offer some extra benefits that Original Medicare doesn’t cover—like vision, hearing, and dental services.

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

You can go to any doctor or hospital that takes Medicare, anywhere in the U.S.

In most cases, you don't need a 

referral

 to see a specialist.

Medicare Advantage

In many cases, you’ll need to only use doctors and other providers who are in the plan’s network (for non-emergency care). Some plans offer non-emergency coverage out of network, but typically at a higher cost.

You may need to get a

referral

 to see a specialist. 

Are prescriptions covered?

Original Medicare

You can join a separate Medicare drug plan (Part D) to get Medicare drug coverage.

Medicare Advantage

Medicare drug coverage is included in most plans. In most types of Medicare Advantage Plans, you can’t 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 can get a Medicare Supplement Insurance (Medigap) policy to help pay your remaining out-of-pocket costs (like your 20% coinsurance). Or, you can use coverage from a former employer or union, or Medicaid.

Medicare Advantage

You can’t buy and don’t need Medigap. 

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, you’ll pay a separate premium for your Medicare drug coverage (Part D).
  • 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 different out-of-pocket costs for certain services.
  • You pay the monthly Part B premium and may also have to pay the plan's premium. Plans may have a $0 premium or may help pay all or part of your Part B premium. Most plans include Medicare drug coverage (Part D).
  • 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).

 

Find out who to call about Medicare options, claims and more.