Medicare Rights Center




Use this chart
to compare your
Medicare options		 Green light! The plan may meet your needs

Yellow light! Look carefully and ask questions

Red light! The plan may not meet your needs

The chart below compares the benefits of Original Medicare to the most common types of Medicare private health plans. Click on a question, the type of Medicare plan, or each light for more details.

Original Medicare Private Medicare Plans*
What health care coverage do you need? Medicare Only Original Medicare + Supplemental Coverage Medicare HMO
(Health Maintenance Organization)		 Medicare PPO
(Preferred Provider Organization)		 Medicare PFFS
(Private Fee-for-Service Plan)
1. Choice of any doctor You can see any doctor, including specialists, anywhere in the country at any time. You can see any doctor, including specialists, anywhere in the country at any time. You can only see doctors in the HMO’s network and in the HMO’s service area, and you usually need a referral before you can see a specialist. You can see any doctor, including specialists, anywhere in the country at any time but, if you see a doctor who is not in the PPO’s network, your costs will be much higher. You can see any doctor, including specialists, anywhere in the country at any time, but you have to make sure they are willing to accept the PFFS’s fees, terms and conditions.
2. Easy access to specialists without unexpected bills You can go directly to the specialist, but the 20% coinsurance for doctors’ services can lead to unexpectedly high out-of-pocket costs. You can go directly to the specialist, and with most supplemental coverage the 20% coinsurance is covered so your costs are more predictable. You usually have to get a referral from your primary care doctor before you can see a specialist and copays can be high depending on the type of services you need. You can go directly to the specialist, but copays can be high depending on the type of services you need. Your costs are even higher if you go to out-of-network specialists. You can go directly to the specialist, but copays are generally higher and your costs will be high if the doctor you go to does not accept the PFFS’s fees, terms and conditions.
3. Affordable on a fixed budget Coinsurance and deductibles make your out-of-pocket costs as unpredictable as your health care needs. Your premium will vary depending on the type of supplemental coverage you have. Your coinsurance and deductibles are generally covered, so your costs are more predictable, but premiums are subject to change every year. HMOs may have low premiums and copays, but costs can be high if you do not follow the plan rules. Premiums and copays are subject to change every year. PPOs usually have higher premiums than HMOs and costs can be high if you get care out-of-network. Premiums and copays are subject to change every year. PFFS’s premiums and copays vary, but can be lower than some HMO’s. You will have to pay the full cost if you go to a provider who will not accept the PFFS’s fees, terms and conditions. Premiums and copays are subject to change every year.
4. Coverage away from home You can go to any doctor or hospital anywhere in the country. You can go to any doctor or hospital anywhere in the country. Your care is usually limited to the HMO’s service area. You can go to any doctor or hospital anywhere in the country, but your costs will be higher. You can go to any doctor or hospital anywhere in the country, but you have to make sure they will accept the PFFS’s fees, terms and conditions.
5. Prescription drug coverage Medicare prescription drug coverage through stand-alone private drug plans, but your costs will vary widely depending on the plan you choose and the drugs you need. No Medigap plan supplements Medicare prescription drug coverage. Retiree or coverage from your State Prescription Assistance Program may work with Medicare drug coverage. Starting in 2006 HMOs will offer Medicare drug coverage, but your costs will vary widely depending on the plan you choose and the drugs you need. Starting in 2006 PPOs will offer Medicare drug coverage, but your costs will vary widely depending on the plan you choose and the drugs you need. Starting in 2006 you can get Medicare prescription drug coverage through stand-alone private drug plans or your PFFS plan, but your costs will vary widely depending on the plan you choose and the drugs you need.
6. Works with Medicaid If you qualify for benefits, Medicaid will pay for most of the gaps in your Medicare coverage. If you have Medicaid, look into suspending your supplemental plan. Before joining an HMO, make sure you can keep your Medicaid benefits and that Medicaid will cover your HMO copayments and premiums. Before joining a PPO, make sure you can keep your Medicaid benefits and that Medicaid will cover your PPO copayments and premiums. Before joining a PFFS, make sure you can keep your Medicaid benefits and that Medicaid will cover your PFFS copayments and premiums.
* Private Medicare plans are not available in all states, so you may not have these choices. Visit medicare.gov to find out what plans are offered in your area.

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