Medicare health plans provide different ways to get your health care coverage in the Medicare program. The Medicare health plan that you choose affects many things like cost, benefits, doctor choice, convenience, and quality. Your Medicare health plan choices include:
The Original Medicare Plan
The Original Medicare Plan is a fee-for-service plan managed by the Federal Government. In general, with the Original Medicare Plan:
- You use your red, white, and blue Medicare card when you get health care.
- You can go to any doctor or supplier that accepts Medicare and is accepting new Medicare patients, or to any hospital or other facility.
- You pay a set amount for your health care (a deductible) before Medicare pays its part. Then, Medicare pays its share, and you pay your share (your coinsurance or copayment) for covered services and supplies (unless you have a Medigap policy or other supplemental insurance that may pay for these costs.)
- You may have a Medigap policy or other supplemental coverage that may pay deductibles, coinsurance, or other costs that aren't covered by the Original Medicare Plan.
Medigap policies are health insurance policies sold by private insurance companies to fill "gaps" in Original Medicare Plan coverage. In general, with a Medigap policy:
- You get help paying for some of the health care costs that the Original Medicare Plan doesn't cover.
- You also get benefits not covered by Original Medicare, like emergency health care outside the United States.
- You pay a monthly premium to the private health insurance company that sells you the policy. Medicare and the Medigap policy both pay their shares of covered health care costs.
Medicare Advantage Plans
Medicare Advantage Plans are health plan options that are approved by Medicare but run by private companies. They are part of the Medicare Program, and sometimes called "Part C." When you join a Medicare Advantage Plan, you are still in Medicare.
- Some of the plans require referrals to see specialists.
- In many cases, the premiums or the costs of services (co-pays and deductibles) can be lower than they are in the Original Medicare Plan or the Original Medicare Plan with a Medigap policy.
- Medicare Health Plans charge different premiums and have different costs of services, so it is important to check with the plan before you join.
- The plans provide all of your Part A (hospital) and Part B (medical) coverage and must cover medically-necessary services.
- They often have networks, which means you may have to see doctors who belong to the plan or go to certain hospitals to get covered services.
- They generally offer extra benefits, and many include prescription drug coverage. In many cases, your costs for prescription drug coverage can be lower than in the stand-alone Medicare Prescription Drug Plans.
- Some of the plans coordinate your care, using networks and referrals, more than others. This can help manage your overall care and can also result in savings to you.
If you decide to join a Medicare Advantage Plan, you will use the health care card that you get from your Medicare Advantage Plan (provider) for your health care.
To join a Medicare Advantage Plan, you must have Medicare Part A and Part B. You will have to pay the 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're in a Medicare Advantage Plan, you don't need a Medigap policy because Medicare Advantage Plans generally cover many of the same benefits that a Medigap policy would cover, like extra days in the hospital after you used the number of days that Medicare pays for.
The Medicare health plan that you choose affects many things like cost, benefits, doctor choice, convenience, and quality. To compare your Medicare health plan choices, go to the Medicare Personal Plan Finder.
You can also order or download the Medicare & You 2021 Handbook from the Centers for Medicare & Medicaid Services.