Medicare Advantage
One plan from a private company that replaces Original Medicare.
Which doctors can you see?
The plan’s network, in your county. Going outside it costs more, or is not covered at all. Networks change every year and a doctor may leave one in the middle of your treatment.
Do you need a referral to see a specialist?
Usually yes on an HMO, usually no on a PPO. Prior authorisation is common either way.
Is there a ceiling on what a bad year can cost you?
Yes. Every Advantage plan must have a yearly out-of-pocket maximum for medical care.
What does it cost each month?
Often nothing beyond your Part B premium, and many plans add dental, vision or a gym. You pay when you use care instead.
How are prescriptions covered?
Usually built into the plan. One card, one formulary, one set of rules.
What if you travel, or live in two states?
Emergencies are covered anywhere. Routine care in the other state usually is not. This is the single most common reason a snowbird regrets an Advantage plan.
Can you change your mind later?
You can leave an Advantage plan in the autumn window, or once between January and March. Getting a Medigap policy afterwards is the hard part.
Original Medicare, a supplement and a drug plan
Three pieces you assemble, which between them leave almost no gap.
Which doctors can you see?
Any doctor or hospital in the United States that takes Medicare, which is most of them. No network, no county, no referral.
Do you need a referral to see a specialist?
No. You may book a specialist directly.
Is there a ceiling on what a bad year can cost you?
Not on its own. Original Medicare has no ceiling at all, which is what a Medigap policy is for: it buys you the ceiling.
What does it cost each month?
A Medigap premium and a Part D premium on top of Part B. You pay more each month and much less when something goes wrong.
How are prescriptions covered?
A separate Part D plan you choose yourself, and can change every autumn.
What if you travel, or live in two states?
It travels with you. Any doctor in the country that takes Medicare, and a Medigap policy follows you across state lines.
Can you change your mind later?
Your six-month Medigap open enrolment does not come back. After it, in most states a company may ask about your health and may say no.