Choosing a Medicare plan

Original Medicare lets you see any provider that accepts Medicare. Preferred Provider Organization (PPO) plans allow you to go out of network. But using network providers typically costs less.

The costs of seeing a provider can vary depending on how you get your Medicare. Original Medicare typically charges you a percentage of the costs (called coinsurance). Original Medicare does not have a limit to what you pay for medical care each year. Medicare Advantage plans often have a set amount per provider visit (called a copay). But they may also have a coinsurance structure. Medicare Advantage plans also limit what you pay for covered medical care each year.

With a Health Maintenance Organization (HMO) plan, unless it’s an emergency, you are usually required to see a provider that’s part of the plan’s network. You may be able to continue seeing your specific provider — be sure to check if your provider is part of a plan's network.

With a PPO plan, you can see an out-of-network provider, but it may cost more.

Even if you do not take any prescriptions, it is highly recommended you still get Part D coverage. Part D acts as protection for you in case you do need a prescription. If your doctor writes you a prescription, generally Original Medicare won’t cover it. So you’ll need to add a separate prescription drug plan. However, if you’d rather have just one plan, you can enroll in a Medicare Advantage plan that includes prescription drug benefits. And those who don’t get Part D when they’re first eligible may pay a lifetime late enrollment penalty.

Each Medicare plan with prescription drug coverage has its own list of covered drugs (formulary). It’s important to check the list to make sure the drug you take is covered.

Each Medicare plan has a network of pharmacies you are required to choose from. However, it’s important to know which pharmacies you can use to get your drugs. Some plans have preferred pharmacies that offer greater savings than others.