Choosing a Medicare plan FAQs

Original Medicare lets you see any doctor who accepts Medicare. HMO plans (health maintenance organization) usually require you to see doctors in their network. Some HMOs also need a referral from your primary care provider (PCP) to see a specialist. PPO plans (preferred provider organization) let you see doctors outside the network, but it may cost more if you do.

The cost of seeing a doctor can change based on the Medicare plan you choose. Original Medicare usually asks you to pay a part of the cost (coinsurance). Medicare Advantage plans often have a set amount you pay for each visit (copay). But some Medicare Advantage plans use coinsurance, too. Medicare Advantage plans also set a yearly limit on what you pay for medical care. Original Medicare does not have this limit.

With an HMO plan, you usually must see a doctor in the network unless it’s an emergency. You might be able to keep seeing your current doctor. You can check if your doctor is in the plan's network before you choose a plan.
  
PPO plans let you see doctors outside the network, but it will cost more. You can still see your current doctor, but it’s best to check if they are in the network first.

Even if you don’t take any drugs now, it’s a good idea to get Medicare Part D coverage. Part D protects you if you need drugs later. If you don’t get Part D when you’re first eligible, you’ll have to pay a higher cost (penalty) for life. This is called the Part D late enrollment penalty.

Medicare Part D covers your prescription drugs. Each Medicare Part D plan has its own list of drugs that it covers (formulary). Check the list for the plan you choose to make sure your drugs are covered.

Each Medicare Part D plan has a pharmacy network. It’s a list of pharmacies you can choose from that will cover your prescription drugs. Some plans have preferred pharmacies that may offer better savings. Make sure to know which pharmacies are in your plan’s network. In most cases, your plan will only cover your drugs at a network pharmacy.

If you have a Medicare Advantage plan, there are many ways you may lower your costs. You can:
 

• See doctors who are in your plan’s network
• Consider a plan that offers a copay (set amount) versus a coinsurance (percentage)
• Use prescription drugs on a lower drug tier
• Know if your plan has deductibles for medical care or prescription drugs

Medicare Advantage plans set a yearly limit on what you pay for medical care. Original Medicare does not have this limit.
 

If you’re still not sure which Medicare plan is right for you, learn more about your coverage options.