Health Insurance

Medicare at a Glance (cont.)

What are my Medicare health plan choices?

In most areas, you can get your Medicare benefits in more than one way. Your Medicare health plan choices include the Original Medicare Plan and Medicare Advantage Plans(formerly called Medicare + Choice Plans). It's important to choose the plan that meets your health care needs. Costs for Medicare services depend on what Medicare health plan you choose.

  • Original Medicare Plan. The Original Medicare Plan, managed by the Federal Government, is available nationwide and accepted by most doctors. It's a "fee-for-service" plan. This means you are usually charged a fee for each health care service or supply you get. For some services, you will pay a fee called a deductible before Medicare pays its part. Then, when you get a medical supply or service, Medicare pays its share, and you pay your share, called the coinsurance or a copayment.
  • Medicare Advantage Plans. Medicare Advantage offers you many different plan choices by letting private companies manage your health care. These plans are available in many areas of the country. To join a Medicare Advantage Plan, you must have both Medicare Part A and Part B. Some of these plans offer added benefits, like coverage for extra days in the hospital. These plans might charge monthly premiums as well as copayments for services. In some Medicare Advantage Plans, you can only go to doctors, specialists, or hospitals on the plan's list, called a network.

With Medicare Advantage, your choices include

  • Medicare Managed Care Plans
  • Medicare Preferred Provider Organizations (PPOs)
  • Medicare Private Fee-for-Service Plans
  • Medicare Specialty Plans (provide more focused health care for specific people)

The Medicare health plan that you choose affects many things like cost, benefits, doctor choice, convenience, and quality of care. For help comparing your health plan choices, look at www.medicare.gov on the web. Select "Medicare Personal Plan Finder." Or, call 1-800- MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. Be sure to know all of your options before choosing a Medicare health plan so that the plan you choose fits your needs.

What isn't covered by Medicare Part A and Part B in the Original Medicare Plan?

The Original Medicare Plan doesn't cover everything. For example, Medicare doesn't cover dental care, health care you get while traveling outside the United States (except in limited cases), hearing aids, most hearing exams, long-term care, most eyeglasses, and more. To find out if Medicare covers a service or supply, look at www.medicare.gov on the web. Select "Your Medicare Coverage." Or, call 1-800-MEDICARE (1-800-633-4227).

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This information is from Publication No. CMS - 11082 September 2004