New Opportunities in Medicare? Let’s explore your options.

How much are your premiums, deductibles, and other costs? How much do you pay for services like hospital stays or doctor visits? Is there a yearly limit on what you could pay out-of-pocket for medical services? Make sure you understand any coverage rules that may affect your costs.

Costs in Original Medicare

There’s no yearly limit on what you pay out of pocket, unless you have supplemental coverage—like Medicare Supplement Insurance (Medigap).

Costs in Medicare Advantage

Plans have a yearly limit on what you pay out of pocket for services Medicare Part A and Part B cover. Once you reach your plan’s limit, you’ll pay nothing for services Part A and Part B cover for the rest of the year.

How well does the plan cover the services you need?

Coverage in Original Medicare

Original Medicare covers most medically necessary services and supplies in hospitals, doctors’ offices, and other health care facilities. Original Medicare doesn’t cover some benefits like eye exams, most dental care, and routine exams.

Coverage in Medicare Advantage

Plans must cover all medically necessary services that Original Medicare covers. In many cases, you may need to get approval from your plan before it covers certain services or supplies. Plans may also offer some extra benefits administratorthat Original Medicare doesn’t cover—like certain vision, hearing, and dental services.

Note
If you're in a Medicare plan, review the "Evidence of Coverage" (EOC) and  "Annual Notice of Change" (ANOC) .

If you have other types of health or prescription drug coverage, make sure you understand how that coverage works with Medicare. If you have employment-related coverage, or get your health care from an Indian Health or Tribal Health Program, talk to your benefits administrator or insurer before making any changes.

Supplemental coverage in Original Medicare

You can choose to buy Medigap to help pay your remaining out-of-pocket costs (like your 20% coinsurance). Or, you can use coverage from a current or former employer or union, or Medicaid.

Supplemental coverage in Medicare Advantage

Medicare Advantage Plans may offer some extra benefits that Original Medicare doesn’t cover— like certain vision, hearing, and dental services. If you're in a Medicare Advantage Plan, you can’t buy Medigap.

Note
If you're in a Medicare plan, review the "Evidence of Coverage" (EOC) and  "Annual Notice of Change" (ANOC) .

Do you need to join a medicare prescription drug plan? Do you already have creditable prescription drug coverage? Will you pay a penalty if you join a drug plan later? What's the plan’s overall star rating? What will your prescription drugs cost under each plan? Are your drugs covered under the plan's formulary? Are there any coverage rules that apply to your prescriptions? Are you eligible for a free Medication Therapy Management (MTM) program?

Prescription drug coverage in original medicare

You’ll need to join a medicare drug plan (part d) to get drug coverage.

Prescription drug coverage in medicare advantage

Most medicare advantage plans include drug coverage. If yours doesn't, you may be able to join a separate part d plan.

Note
If you're in a medicare plan, review the "Evidence of coverage" (eoc) and "Annual notice of change" (anoc) .

Do your doctors accept the coverage? Are the doctors you want to see accepting new patients? Do you have to choose your hospital and health care providers from a network? Do you need to get referrals?

Doctor and hospital choice in Original Medicare

You can use any doctor or hospital that takes Medicare, anywhere in the U.S. In most cases, you don’t need a referral to use a specialist.

Doctor and hospital choice in Medicare Advantage

In many cases, you can only use doctors and other providers who are in the plan’s network and service area (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 use a specialist.

Note
If you're in a medicare plan, review the "Evidence of coverage" (eoc) and "Annual notice of change" (anoc) .

Are you satisfied with your medical care? The quality of care and services offered by plans and other health care providers can vary. How have Medicare and other people with Medicare rated your health and drug plan’s care and services? Get help comparing plans and providers.

Travel coverage in Original Medicare

Original Medicare generally doesn’t cover medical care outside the U.S. You may be able to buy a Medicare Supplement Insurance (Medigap) policy that covers emergency care outside the U.S.

Travel coverage in Medicare Advantage

Plans generally don’t cover medical care outside the U.S. Some plans may offer a supplemental benefit that covers emergency and urgently needed services when traveling outside the U.S.

Example:
If you're in a medicare plan, review the "Evidence of coverage" (eoc) and "Annual notice of change" (anoc) .