This web site was copied prior to January 20, 2005. It is now a Federal record managed by the National Archives and Records Administration. External links, forms, and search boxes may not function within this collection. Learn more.   [hide]

Search Frequently Asked Questions

d

Medicare.gov site Flag Logo   Home  |  Screen Reader Version  |   Español  |   Link to Chinese Section  
The Official U.S. Government Site for People with Medicare
Help  |     |   Mailing List Mailing List   |   Questions  

Questions

Medicare Billing 

Medicare Appeals 

Long Term Care 

Plan Choices 

Stay Healthy 

Medicaid Enrollment

Provider Information

Glossary

Privacy Practices

Search Tools 

Medicare Plan Choices

What are Medicare Health Plans?

Medicare offers you different ways to get your Medicare benefits. These different options are called Medicare health plans. One option is the Original Medicare Plan. Some private companies contract with the Medicare program to offer Medicare health plans. These are called Medicare + Choice ("Medicare plus Choice") plans. How you get your health care in the Medicare program depends on which plan you choose. Depending on where you live, you may have more than one plan to choose from.

What types of Medicare health plans are available?

In 2003, Medicare offers the following types of Medicare health plans:

  • The Original Medicare Plan (sometimes called fee-for-service) -- Everyone with Medicare can join the Original Medicare Plan. This plan is available nationwide. Many people in the Original Medicare Plan also have a Medigap (Medicare Supplemental Insurance) policy or supplemental coverage provided by their former employer to help pay health care costs that this plan does not cover.
  • Medicare + Choice (pronounced "Medicare plus Choice") plans --
    Medicare + Choice plans include:

    • Medicare Managed Care Plan, and
    • Medicare Private Fee-for-Service plans.


    Medicare + Choice plans provide care under contract to Medicare. They may provide benefits like coordination of care or reducing out-of-pocket expenses. Some plans may offer additional benefits, such as prescription drugs. There are two types of Medicare + Choice plans. They are available in many parts of the country.
To find a list of plans available in your area, look at the Medicare Personal Plan Finder.

Making the Best Choice for You

How you get your Medicare health benefits affects many things, like cost, extra benefits, doctor choice, convenience, and quality. They are all important, but some may be more important to you than others. You need to look at what plans are available in your area, what each plan offers, and make the best choice for you.

Your choice will affect:

Cost - What will my out-of-pocket costs be?

Benefits - Do I need extra benefits and services, like prescription drugs, eye exams, hearing aids, or routine physical exams?

Doctor Choice - Can I see the doctor(s) I want to see? Do I need a referral to see a specialist?

Convenience - Where are the doctors' offices and what are their hours? Is there paperwork? Do I have to file claims myself? Is there a telephone hotline for medical advice from a nurse or other medical staff?

Think about what is most important to you in a health plan. Then look at this chart. It can help you see which types of plans have the things that are most important to you.

Medicare + Choice Plans
Original Medicare Plan Managed Care Plan Private Fee-for-Service Plan
Costs

Total Out-of-Pocket Costs
High Low to Medium Medium to high
Extra Benefits

In addition to Medicare covered benefits.
None Most

Like prescription drugs, eye exams, hearing aids, or routine physical exams.
Some

Like foreign travel or extra days in the hospital.
Doctor Choice Widest

Choose any doctor or specialist who accepts Medicare.
Some

Usually must see a doctor or specialist who belongs in your plan.
Wide

Choose any doctor or specialist who accepts the plan's payment.
Convenience Varies

Available nationwide.
Varies

Available in some areas. May require less paperwork and have phone hotline for medical advice.
Varies

Available in some areas. May require less paperwork and have phone hotline for medical advice.

Help with Health Care Coverage

Before making a health plan decision, it is important to learn more about what the different health plans cover and how that may affect your out-of-pocket costs. For example, the Original Medicare Plan does not pay for or cover everything. To get extra coverage, you may buy a Medigap policy, or join a Medicare + Choice plan. You may also have or qualify for:

The way each of these types of insurance work varies. Remember: Whether you get your Medicare health care coverage from the Original Medicare Plan or another Medicare health plan, you are still in the Medicare program.

Quality Data to Help You Choose

Research shows that Medicare health plans differ on quality. The Medicare program measures the quality of care that people like you get. This information is available to everyone. You can view quality information in the detailed results section of the Medicare Personal Plan Finder.

When can I Join a Medicare + Choice Plan?

Generally, you may join a Medicare + Choice plan at any time. However, some Medicare + Choice plans limit the number of members in their plans. These plans may not accept new members when they reach their limit. A plan can tell you if it is signing up new members. Also, if you are in an institution (like a nursing home), check with the plan to see if you may be able to join at other times.

When can I leave A Medicare + Choice Plan?

You may leave your plan at anytime, for any reason.

Buying (Joining) Medigap Plans

The best time to buy a Medigap plan is during your Medigap open enrollment period. Your Medigap open enrollment period lasts for 6 months. It starts on the first day of the month in which you are both:

  • Age 65 or older, and
  • Enrolled in Medicare Part B.

In some situations, you have the right to buy a Medigap policy outside of your Medigap open enrollment period. These rights are called "Medigap Protections" or "Guaranteed Issue Rights." Medigap Protections are important because without them, if you are not in your Medigap open enrollment period, an insurance company can refuse to sell you a policy, or you may be charged more for the policy. In addition, if you drop your Medigap policy, you may not be able to get it back except in very limited situations. For more information on Medigap Protections, look at the Choosing a Medigap Policy publication below.

To find a list of Medigap Policies offered in your area, look at the Medicare Personal Plan Finder

Health Plan References and Materials

Listed below are some additional publications that can help you learn about Medicare's health plan options and guide you in choosing the best plan for you. You can view the publication by clicking on its title below or call 1-800-MEDICARE (1-800-633-4227, TTY/TDD: 1-877-486-2048 for the hearing and speech impaired) to get free copies of these publications.

Medigap Policies, The Basics

Your Guide to Private Fee-for-Service Plans

 

Centers for Medicare & Medicaid Services Centers for Medicare & Medicaid Services Link to Department of Health and Human Services Website Department of Health and Human Services

116