COMPARISON CHART: KEY DIFFERENCES AMONG THE MEDICARE PLANS

Source: AARP.org

  The Original Medicare Plan Medicare Advantage Plans
    Medicare HMO Medicare Private Fee-For-Service (PFFS) Plan
1. Prescription Drugs Does not pay for prescription drugs. May pay for some prescription drugs. May pay for some prescription drugs.
  You can’t use a Medigap policy to help pay for prescription drugs. You can’t use a Medigap policy to help pay for prescription drugs. You can’t use a Medigap policy to help pay for prescription drugs.
  You can buy a Medicare Drug plan that helps pay for prescription drugs. The plans can change their benefits from year to year. The plans can change their benefits from year to year.
      You may pay more for this benefit.
2. Out-Of-Pocket Costs
Premiums You pay a monthly cost (premium) for Medicare Part B. You pay a monthly cost (premium) for Medicare Part B. You pay a monthly cost (premium) for Medicare Part B.
    You may have to pay an additional premium, which will vary by plan. You may have to pay an additional premium, which will vary by plan.
  There are limits on how much the plan can charge for an additional premium. There are limits on how much the plan can charge for an additional premium.
  Some plans may offer you the benefit of paying less than the Part B Premium.
Coinsurance / Copayments You pay a part, called coinsurance, of each service you use. For doctor visits, you usually pay 20% of the Medicare approved amount. You pay a set amount, called a copayment, for each service you use. For doctor visits, this could be $10-20. You pay a part, called coinsurance, of each service you use. The amount you pay depends on the plan.
There is a limit on how much doctors and hospitals can charge you. You do not need and cannot use a Medigap policy. Plan may let doctors and hospitals charge you more though there can be a limit on how much you pay.
      You do not need and cannot use a Medigap policy.
Medicare Supplemental(Medigap) Policy You can buy a Medigap policy to pay for costs the Original Medicare plan doesn’t. You do not need and cannot use a Medigap policy. You do not need and cannot use a Medigap policy.
Medigap plans have monthly premiums. If you already have a Medigap policy, you may want to keep it while you try out a new plan. If you already have a Medigap policy, you may want to keep it while you try out a new plan.
3. Doctor and Hospital Choice You can go to any doctor or hospital in the country that accepts Medicare. Most do. HMO: You can only go to the doctors and hospitals in the plan’s network. If the HMO offers a Point of Service option, you can go to doctors outside the network but you will pay more. You can go to any doctor or hospital that agrees to the plan’s payment.
*In all Medicare plans, if you have an emergency or need urgent care, you can go to the nearest doctor or hospital. PPO: You can go to doctors and hospitals outside the plan’s network, but you will pay more. *In all Medicare plans, if you have an emergency or need urgent care, you can go to the nearest doctor or hospital.
*In all Medicare plans, if you have an emergency or need urgent care, you can go to the nearest doctor or hospital.
4. Specialists You can go directly to a specialist. HMO: You usually need to get a referral from your primary care doctor before going to a specialist. You can go directly to a specialist.
PPO: You can go directly to a specialist.
5. Travel Coverage In the U.S. – You are covered anywhere in the country. In the U.S. – You are only covered in the area served by your plan. In the U.S. – You are covered by any doctor or hospital in the country that accepts the plan’s payment.
You are covered outside the plan’s area if you have an emergency or need urgent care. You are covered if you have an emergency or need urgent care.
Outside the U.S. – In most cases, you are not covered. Outside the U.S. – Some plans may cover you. Check with the plan. Outside the U.S. – Plan may cover you. Check with the plan.
Medigap plans may cover emergency care outside the country. Check with the plan.
6. Financial Incentives Doctors and hospitals have an incentive to provide more service. The health plan has an incentive to restrict services. The health plan has an incentive to restrict services.

Additional Resources

Back to top