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Choosing Medicare coverage shouldn’t begin with an insurance company’s name.
It should begin with understanding how you want your Medicare coverage to work.
Some people prefer Original Medicare with separate coverage that helps with prescription drugs and out-of-pocket costs. Others prefer receiving their Medicare benefits through a Medicare Advantage plan that may combine medical, prescription drug and additional benefits into one plan.
Neither approach is automatically better.
The goal is to understand the structure first — then compare the plans, insurance companies, doctors, medications and costs available where you live.
Independent Medicare guidance • Multiple plan types • Nationwide assistance
Part A + Part B
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Optional Part D
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Optional Medicare Supplement
Part A + Part B through a private Medicare-approved plan
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Usually Part D
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HMO • PPO • HMO-POS • SNP • Other plan structures
There are two primary ways to receive Medicare coverage: Original Medicare or Medicare Advantage.
With Original Medicare, you can generally add a separate Medicare Part D prescription drug plan and may choose Medicare Supplement insurance, also called Medigap, to help with certain out-of-pocket costs.
Medicare Advantage is an alternative way to receive your Part A and Part B benefits through a Medicare-approved private insurance company. Most Medicare Advantage plans also include Part D prescription drug coverage.
The right structure depends on factors such as your doctors, medications, healthcare usage, budget, travel preferences and eligibility.
The plan with the lowest premium, biggest dental allowance or most recognizable insurance company isn’t necessarily the plan that fits you best.
Before comparing plans, start here.
Your primary care physician may be only one part of the picture.
Consider:
Provider access can be especially important when considering different Medicare Advantage network structures.
Write down:
Prescription drug formularies, drug tiers and pharmacy arrangements can vary by plan.
Someone who rarely visits a doctor may evaluate cost differently from someone who routinely sees specialists, receives outpatient treatment or expects ongoing medical care.
Look beyond the monthly premium.
Your preferred coverage structure may be different if you:
Prescription drug formularies, drug tiers and pharmacy arrangements can vary by plan.
Depending on the plan and area, some Medicare Advantage plans may offer additional benefits such as dental, vision, hearing, fitness or other supplemental services.
Those benefits can be useful.
But they should usually be evaluated after your medical coverage, provider access, prescriptions and potential out-of-pocket costs.
Medicaid eligibility, certain chronic conditions, institutional care and programs that help with Medicare costs can materially change which options deserve consideration.
Medicaid eligibility, certain chronic conditions, institutional care and programs that help with Medicare costs can materially change which options deserve consideration.
Instead of treating every Medicare product as if it were competing against every other product, it helps to understand where each option fits.
Original Medicare consists of:
Hospital insurance.
Medical insurance.
People who choose Original Medicare can generally see doctors and hospitals that accept Medicare throughout the United States.
Original Medicare can then be combined with other coverage.
A standalone Part D plan can provide prescription drug coverage.
A Medicare Supplement policy can help pay certain costs left behind by Original Medicare.
This creates a common coverage structure:
Medicare Supplement and Part D are separate types of coverage and are purchased from private insurance companies.
Medicare Advantage, also called Medicare Part C, is another way to receive your Medicare Part A and Part B benefits.
These plans are offered by private insurance companies approved by Medicare.
Most Medicare Advantage plans include prescription drug coverage, and many may offer additional benefits beyond Original Medicare.
But Medicare Advantage isn’t one single type of plan.
Medicare Supplement and Part D are separate types of coverage and are purchased from private insurance companies.
Health Maintenance Organization plans generally use a provider network.
Depending on the plan, you may need to select a primary care physician or follow certain network and referral requirements.
HMO plans can appeal to people who are comfortable receiving most of their healthcare through an established local network.
Preferred Provider Organization plans also have provider networks but generally provide additional flexibility to receive covered care outside the network, usually at a different cost.
For someone comparing an HMO and PPO, the question shouldn’t simply be:
“Which one is better?”
A better question is:
“How much provider flexibility do I need, and what am I willing to pay for it?”
An HMO Point-of-Service plan combines characteristics of an HMO with limited opportunities to receive certain services outside the traditional HMO network.
Exactly which services can be received outside the network and how much they cost depends on the specific plan.
Some Medicare Advantage plans are designed for people with specific circumstances or healthcare needs.
These are known as Special Needs Plans, or SNPs.
Two important categories are:
Designed for qualifying individuals who have both Medicare and Medicaid.
Designed for individuals who meet the plan’s eligibility requirements for certain qualifying chronic or disabling conditions.
The benefits, provider arrangements and eligibility requirements can vary significantly.
Medicare Supplement insurance — often called Medigap — works differently from Medicare Advantage.
Instead of replacing the way you receive Original Medicare benefits, a Medicare Supplement policy works alongside Original Medicare and helps cover certain Medicare cost-sharing.
In most states, Medicare Supplement policies are standardized by letter.
For example:
The medical benefits included in the same standardized letter are generally the same regardless of the insurance company selling the policy.
That means comparing Medicare Supplement insurance involves more than simply asking:
“Which company has better Plan G benefits?”
For standardized Plan G coverage, the more meaningful differences may include:
Medicare Part D helps pay for prescription medications.
You may receive Part D coverage through:
A standalone Medicare Part D plan
A Medicare Advantage plan that includes prescription drug coverage.
or
But prescription drug plans are not interchangeable.
When comparing drug coverage, consider:
Whether your prescriptions are covered
Drug tiers
Deductibles
Copayments or coinsurance
Preferred pharmacies
Coverage rules
Prior authorization
Step therapy
Quantity limits
A low-premium drug plan can become a poor fit if it doesn’t cover an important medication favorably.
A Medicare plan can look attractive on paper and still be wrong for a particular person.
That’s why Medicare Plan Assistance recommends looking at Medicare coverage through six lenses:
Can you continue seeing the doctors, specialists and hospitals you prefer?
How does the plan cover the medications you actually take?
What could you pay in premiums, deductibles, copayments, coinsurance and other out-of-pocket expenses?
What services and benefits does the plan provide — and what restrictions apply?
How does the coverage work when you travel, see providers outside a network or receive care in another area?
Does the plan make sense for your health needs, financial situation and expected use of healthcare?
ACCESS → DRUGS → COST → COVERAGE → FLEXIBILITY → FIT
Benefits tell you what a plan offers. Fit tells you whether the plan makes sense for you.
Once you understand the kind of Medicare coverage you’re looking for, the next step may be researching the insurance companies offering plans in your area.
Medicare Plan Assistance maintains educational carrier guides explaining how major Medicare companies participate in the Medicare market and the types of Medicare products they may offer.
Insurance company availability and the specific Medicare products offered vary by location and eligibility.
Rather than choosing a company based solely on advertising or brand recognition, review the actual plans available where you live and how they fit your individual situation.
Learn about UnitedHealthcare and AARP-branded
Medicare options.
Learn about Mutual of Omaha Medicare Supplement coverage.
Learn about United American Medicare Supplement coverage.
You now know how the major Medicare coverage options fit together.
The next question may be more specific:
That’s exactly what our Medicare comparison library is designed to help answer.
The Medicare Plan Comparison Center breaks common Medicare decisions into side-by-side comparisons so you can understand where the choices are similar, where they’re different and which questions matter before enrolling.
More choices don’t always make Medicare easier.
If dozens of plans are available where you live, comparing every premium, copay, benefit and insurance company at once can create more confusion — not more clarity.
A more practical approach is to narrow the field.
Choose the Medicare coverage structure that makes sense for you.
Identify plans that work with your doctors and prescriptions.
Compare total cost exposure — not only premiums.
Review the benefits that matter to you.
Compare the strongest remaining options side-by-side.
Confirm the details before enrolling.
That’s how Medicare Plan Assistance approaches plan comparisons.
We aren’t trying to make Medicare look like a catalog.
We’re trying to help you make a Medicare decision.
You don’t necessarily need an agent to learn the basics of Medicare.
Medicare.gov provides extensive official information, and people who prefer to research independently can compare available coverage themselves.
Professional guidance may become useful when you need help applying those rules and choices to your specific circumstances.
A licensed Medicare agent can help explain plan information and narrow the available choices based on your circumstances.
Medicare Plan Assistance helps Medicare beneficiaries understand their coverage options, compare available plans and complete enrollment when they decide to move forward.
Nationwide Medicare assistance. Plan availability varies by location and eligibility.
The type of Medicare coverage you choose may remain the same while the individual plan underneath it changes.
Depending on the type of plan, changes may affect things such as:
That’s why Medicare decisions shouldn’t end the day you enroll.
If you’re enrolled in Medicare Advantage or Part D, review the information your plan sends you about changes for the following year and determine whether your coverage still meets your needs.
If you’re approaching Medicare for the first time, don’t begin by comparing insurance companies.
Start with Medicare itself.
Learn:
No. Medicare Advantage is one way to receive your Medicare benefits. Instead of receiving Part A and Part B coverage directly through Original Medicare, you receive Medicare-covered benefits through a Medicare-approved private plan.
No. Medicare Supplement insurance works alongside Original Medicare to help pay certain Medicare cost-sharing. Medicare Advantage is an alternative way of receiving Medicare Part A and Part B benefits. Medicare Supplement policies are not designed to work with Medicare Advantage plans.
Yes. Someone with Original Medicare may have both a Medicare Supplement policy and a separate Medicare Part D prescription drug plan.
Most Medicare Advantage plans include Medicare Part D prescription drug coverage, although plan structures differ.
Both are Medicare Advantage plan structures. HMOs generally rely more heavily on an established provider network, while PPO plans generally provide greater ability to receive covered services outside the network, usually with different cost-sharing.
A Special Needs Plan is a type of Medicare Advantage plan designed for people who meet specific eligibility requirements. Examples include D-SNPs for qualifying people with Medicare and Medicaid and C-SNPs for people with certain qualifying chronic conditions.
There is no Medicare plan that is universally best for everyone. A suitable option depends on the plans available where you live and factors such as your providers, prescriptions, healthcare needs, expected costs, travel preferences and eligibility.
Medicare Advantage and Part D plan availability is based on service areas, so the plans available to you depend on where you live. Medicare Supplement availability and premiums can also vary by state and insurer.
Yes. Medicare Advantage and Part D plans may change costs, coverage, formularies, provider networks and other plan details from one year to another. Beneficiaries should review annual plan information before deciding whether to keep or change coverage.
Yes. You can research plans independently through Medicare and insurance companies, work with programs such as your State Health Insurance Assistance Program, or speak with a licensed Medicare insurance agent. Medicare Plan Assistance helps beneficiaries understand and compare available Medicare coverage options.
A Medicare decision becomes easier when you take it in the right order.
Understand the coverage.
Identify what matters to you.
Narrow the options.
Compare the differences.
Then decide.
Medicare Plan Assistance can help you through that process.
Helping make Medicare easier to understand.
Medicare Plan Assistance is an independent insurance agency and is not affiliated with or endorsed by the U.S. government or the federal Medicare program.
Plan availability, benefits, premiums, provider networks, formularies and eligibility vary by plan and location
Medicare Plan Assistance is not Medicare, the federal government, or endorsed by the U.S. government. We do not offer every plan available in your area. Currently, we represent 20 organizations which offer 66 plans in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.