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How do I choose my Medicare plans?

Medicare has different “parts” to help pay for your health care.

  • Part A is called “Hospital Insurance.”
  • Part B is called “Supplementary Medical Insurance.”
  • Part A and Part B together is called “Original Medicare.”
  • The federal government runs Original Medicare.
  • Part C is called “Medicare Advantage.” It has special rules, and is run through private insurance companies that have been approved by Medicare.
  • Part D is called “Prescription Drug Coverage.” Private insurance companies, that Medicare has approved, run Part D programs.

Original Medicare – Parts A and B

Original Medicare is Part A: Hospital Insurance and Part B: Supplementary Medical Insurance together.

Part A is called Hospital Insurance

You can choose your own medical providers and you do not have to get referrals. Part A helps pay for:

  • hospital stays,
  • skilled nursing care,
  • hospice for people who are dying, and
  • home health services.

Part B is called Supplementary Medical Insurance

You can choose your own medical providers and you do not have to get referrals. Part B helps pay for:

  • doctors’ services,
  • outpatient care,
  • home health services,
  • some ambulance transportation, and
  • some preventive services  like screenings, tests, and diabetes trainings.

Medicare Advantage – Part C

Instead of Original Medicare, you can choose a Medicare private health plan. These plans are also called Part C or Medicare Advantage.

Medicare Advantage must offer all of the same benefits that Original Medicare does. But Medicare Advantage plans can have different rules and costs. They can also offer extra benefits at an extra cost.

Some employers sponsor a Medicare Advantage plan. If you get health insurance from a union, a current or former employer, you may get a Medicare Advantage plan as soon as you are eligible for Medicare. You can choose if you want the private health care plan or Original Medicare.

It is important to understand your Medicare choices. Pick your plans carefully.

Important

There are different Medicare Advantage plans:
One plan may let you see any doctor you want. Another plan may say you have to choose a doctor from a list. Some Medicare Advantage plans make you choose a primary care doctor or get a referral before you can see a specialist.

Prescription Drug Insurance – Part D

Medicare Part D is the prescription drug insurance part of Medicare. It helps pay for your prescriptions.

To get Medicare drug coverage you have to enroll with a private insurance company that has been approved by Medicare. If you are in a Part C Medicare Advantage plan, your plan may also include a Part D plan.

There are many different Part D plans. Different Part D plans help pay for different drugs, cover different pharmacies, and have different costs and rules. It is important to choose the right prescription drug plan for you.

To compare plans, go to www.medicare.gov. You can use their Medicare Plan Finder to compare plans in your area.

Produced by Greater Boston Legal Services, Massachusetts Legal Assistance Corporation, Community Legal Aid, and Massachusetts Law Reform Institute
Created June 2011

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