Choosing a Medicare plan FAQs

Original Medicare lets you see any doctor that accepts Medicare. Generally, Health Maintenance Organization (HMO) plans require you to use their network of doctors, and some require a referral from a primary care provider (PCP) to see a specialist. Preferred Provider Organization (PPO) plans allow you to go out of network, but using network doctors typically costs less.
 

The costs of seeing a doctor can vary depending on how you get your Medicare. Original Medicare typically charges you a percentage of the costs (called coinsurance). Medicare Advantage plans often have a set amount per doctor visit (called a copay) but may also have a coinsurance structure. Medicare Advantage plans also limit what you pay for medical care each year. Original Medicare does not have a limit.

With an HMO plan, unless it’s an emergency, you usually must see a doctor that’s part of the plan’s network. You may be able to continue seeing your specific provider — be sure to check if your provider is part of a plan's network.

With a PPO plan, you can see an out-of-network provider, but it typically will cost more.

Even if you do not take any prescriptions, it is highly recommended you still get Medicare Part D coverage. Part D acts as protection for you in case you do need a prescription, and those who don’t get Part D when they’re first eligible may pay a lifetime penalty. 

Each Medicare plan has its own list of covered drugs (formulary). It’s important to check the list to make sure the drug you take is covered.

Each Medicare plan has a network of pharmacies you must choose from. However, it’s important to know which pharmacies you can use to get your prescription drugs. Some plans have preferred pharmacies that offer greater savings than others.

If you have a Medicare Advantage plan, you may lower your costs by:

• Seeing doctors who are in the plan’s network
• Considering a plan that offers a copay (set amount) versus a coinsurance (percentage)
• Using prescription drugs on a lower drug tier
• Knowing if your plan has a deductible for medical and/or prescription drugs

Finally, remember that a Medicare Advantage plan limits what you pay for medical care each year, while Original Medicare does not.

If you’re still unsure which Medicare plan is right for you, explore Medicare coverage in more detail.