There are several differences in costs and coverage between Original Medicare Original Medicare, also known as Traditional Medicare, is the fee-for-service health insurance program offered through the federal government, which pays providers directly for the services you receive. Almost all doctors and hospitals in the U.S. accept Original Medicare. and Health Maintenance Organizations (HMOs). The table below compares these two ways of getting Medicare benefits. If you are interested in joining an HMO, make sure to speak to a plan representative for more information.
Original Medicare |
Medicare HMO |
See any provider and use any facility that accepts Medicare (participating or non-participating) |
See only in-network providers |
Visit doctors anywhere in the U. S. |
Visit doctors only in your plan’s service area, except in emergencies or when care is urgently needed |
Do not need referrals for specialists |
Typically need referrals for specialists |
Does not cover vision, hearing, or dental services |
May cover additional services, including vision, hearing, and dental (additional benefits may increase your premium or other out-of-pocket costs) |
Sign up for a stand-alone prescription drug plan (Part D) |
In most cases, plan provides prescription drug coverage (you may be required to pay higher premium) |
Cost-sharing varies depending on plan |
|
No out-of-pocket limit |
Annual out-of-pocket limit for in-network care (maximum is $8,850 in 2024) |
Remember, if you enroll in an HMO you cannot sign up for stand-alone prescription drug coverage. Make sure your HMO plan provides Part D Part D, also known as the Medicare prescription drug benefit, is the part of Medicare that provides prescription drug coverage. Part D is offered through private companies either as a stand-alone plan, for those enrolled in Original Medicare, or as a set of benefits included with a Medicare Advantage Plan. coverage if you need it.
If you have Original Medicare, you also have the choice to purchase a supplemental insurance policy, or Medigap. Medigap plans cover Medicare cost-sharing Cost-sharing is the portion of medical care costs that you pay yourself, such as a copayment, coinsurance, or deductible, if you have health insurance coverage. See also: Out-of-Pocket Costs. and offer other benefits, charging an additional for this coverage. You cannot enroll in a Medigap plan if you have Medicare Advantage Medicare Advantage, also known as Part C, Medicare Private Health Plan, or Medicare Managed Care Plan, allows you to get Medicare coverage from a private health plan that contracts with the federal government. All Medicare Advantage Plans must offer at least the same benefits as Original Medicare (Part A and Part B), but can do so with different rules, costs, and coverage restrictions. Plans typically offer Part D drug coverage as part of Medicare Advantage benefits. Medicare Advantage Plans include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for-Service (PFFS) plans, Special Needs Plans (SNPs), and Medicare Medical Savings Accounts (MSAs). .