Medicare Options Chart Explained
1. Choice of any doctor
Note: To learn more about Medicare prescription drug coverage, see MRC's page explaining the Medicare prescription drug benefit (Part D).
2. Easy access to specialists without unexpected bills
Original Medicare Only
You can see any doctor, including specialists, anywhere in the country at any time.
Medicare + Supplemental Coverage
You can see any doctor, including specialists, anywhere in the country at any time.
Medicare HMO (Health Maintenance Organization)
You generally can only see doctors in the HMO’s network and service area. Most, but not all, HMOs require that you get a referral from your primary care doctor before you can see a specialist.
Medicare PPO (Preferred Provider Organization)
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.
Medicare PFFS (Private Fee-for-Service Plan)
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.
3. Affordable on a fixed budget
Original Medicare Only
You can go directly to the specialist, but the 20% coinsurance for doctors’ services can lead to unexpectedly high out-of-pocket costs.
Medicare + Supplemental Coverage
You can go directly to the specialist, and with most supplemental coverage the 20% coinsurance is covered so your costs are more predictable.
Medicare HMO (Health Maintenance Organization)
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.
Medicare PPO (Preferred Provider Organization)
You can usually go directly to the specialist. Copays may be higher depending on the type of specialty services you need. Your costs are even higher if you go to out-of-network specialists.
Medicare PFFS (Private Fee-for-Service Plan)
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.
4. Coverage away from home
Original Medicare Only
Coinsurance and deductibles make your out-of-pocket costs as unpredictable as your health care needs.
Medicare + Supplemental Coverage
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.
Medicare HMO (Health Maintenance Organization)
Most, but not all, HMOs require that you get a referral from your primary care doctor before you can see a specialist. Copays may be higher depending on the type of specialty services you need.
Medicare PPO (Preferred Provider Organization)
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.
Medicare PFFS (Private Fee-for-Service Plan)
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.
5. Prescription drug coverage
Original Medicare Only
You can go to any doctor or hospital anywhere in the country.
Medicare + Supplemental Coverage
You can go to any doctor or hospital anywhere in the country.
Medicare HMO (Health Maintenance Organization)
Your care is usually limited to the HMO’s service area.
Medicare PPO (Preferred Provider Organization)
You can go to any doctor or hospital anywhere in the country, but your costs will be higher if you go outside the PPO's network and service area.
Medicare PFFS (Private Fee-for-Service Plan)
You can go to any doctor or hospital anywhere in the country, but you have to make sure the provider will accept the PFFS’s fees, terms and conditions.
6. Works with Medicaid
Original Medicare Only
Starting in 2006 you can get 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.
Medicare + Supplemental Coverage
No Medigap plan supplements Medicare prescription drug coverage. Retiree or coverage from your State Prescription Assistance Program may work with Medicare drug coverage.
Medicare HMO (Health Maintenance Organization)
Starting in 2006 HMOs offer Medicare drug coverage, but your costs will vary widely depending on the plan you choose and the drugs you need.
Medicare PPO (Preferred Provider Organization)
Starting in 2006 PPOs offer Medicare drug coverage, but your costs will vary widely depending on the plan you choose and the drugs you need.
Medicare PFFS (Private Fee-for-Service Plan)
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.
Original Medicare Only
If you qualify for benefits, Medicaid will pay for most of the gaps in your Medicare coverage as long as you see doctors who accept both Medicare and Medicaid.
Medicare + Supplemental Coverage
If you have Medicaid, look into suspending your supplemental plan.
Medicare HMO (Health Maintenance Organization)
Before joining an HMO, make sure you can keep your Medicaid benefits and that Medicaid will cover your HMO copayments and premiums. May help expand your choice of doctors if there are not many doctors in your area who accept Medicaid.
Medicare PPO (Preferred Provider Organization)
Before joining a PPO, make sure you can keep your Medicaid benefits and that Medicaid will cover your PPO copayments and premiums. May help expand your choice of doctors if there are not many doctors in your area who accept Medicaid.
Medicare PFFS (Private Fee-for-Service Plan)
Before joining a PFFS, make sure you can keep your Medicaid benefits and that Medicaid will cover your PFFS copayments and premiums. May help expand your choice of doctors if there are not many doctors in your area who accept Medicaid.