What are my Medicare coverage options?

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There are different ways to get Medicare health benefits:

  1. Original Medicare (traditional fee-for-service coverage by the federal government) alone;

  2. Original Medicare with supplemental insurance, like a Medigap or retiree plan; or

  3. A Medicare Private Health Plan (Medicare Advantage plan) like a Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Point of Service (POS) plan, Provider Sponsored Organization (PSO), Private Fee-for-Service (PFFS) plan, Special Needs Plan (SNP) or Medicare Medical Savings Account (MSA).

Most people have Original Medicare. This is the traditional program run by the federal government. It allows you to go to almost any doctor or hospital in the country Original Medicare covers most of the services that you need, from most doctors and hospitals, but it does not cover the full cost of your care.

To fill gaps in Medicare coverage, most people have additional insurance, called supplemental insurance. You can get supplemental insurance from an employer or you can buy it from an insurance company in the form of a Medigap policy that specifically fills gaps in Medicare.

Most people keep Original Medicare, but some people get their Medicare benefits through a Medicare private health plan, instead. These plans must offer at least the same benefits as Original Medicare, but have different rules, costs and coverage restrictions.

If you have health coverage from your union or current or former employer when you become eligible for Medicare, your coverage may automatically convert into a Medicare private health plan. You have the choice to stay with this plan, choose Original Medicare, or switch to another Medicare private health plan. Be aware that if you switch to Original Medicare or another Medicare private health plan instead, the employer or union could terminate or reduce your health benefits, the health benefits of your dependents, and any other benefits you get from your company. Talk to your plan before switching to find out how your health benefits and other benefits will be affected.

If you would like to get the Medicare drug benefit (Part D), you must choose Medicare drug coverage that works with your Medicare health coverage. If you prefer to have 

  • Original Medicare, choose a stand-alone drug plan that just offers drug coverage (PDP).

  • a Medicare private health plan, in most cases you must get drug coverage as part of your health plan's benefits package. (If you join a PFFS without drug coverage, an MSA, or a Cost Plan, you can also have a stand-alone drug plan.)

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How does Original Medicare work?

Guide to Medigap Policies

Filling gaps in Medicare coverage and getting help with Medicare costs

What is a Medicare Advantage plan?

Medicare prescription drug benefit (Part D)

Medicare.gov Medigap (Medicare Supplement) Policies & Guide

MyMedicare.gov: Access your Medicare information

National Association of Area Agencies on Aging (n4a)

State Insurance Department Websites

State Health Insurance Assistance Program (SHIP) Directory

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