Introduction to Medicare

Prescriptions, Providers & Benefits

When it comes to Medicare, one size definitely does not fit all. So whether you’re enrolling in Medicare for the first time or thinking about changing your coverage, you’ll want to look at your options and what’s important to you. Understanding whether there is coverage for the prescription drugs you take, the providers you see, and extras like wellness programs may be a good place to start.

Will I have prescription drug coverage?

Prescription drugs are not covered by Original Medicare. Once you’ve enrolled in Medicare, there are two main ways to get prescription drug coverage:

Medicare Prescription Drug (Part D) plans	Medicare Advantage (Part C) plans
You can purchase a standalone Medicare Prescription Drug (Part D) plan to help pay for your prescription drug costs if you have Original Medicare or Original Medicare plus a Medicare Supplement insurance plan.	If you’d like the convenience of having your prescription drug coverage in the same plan as your hospital, doctor and other benefits, you may want to look into a Medicare Advantage (Part C) Prescription Drug (MAPD) plan.

Medicare Prescription Drug (Part D) plans	You can purchase a standalone Medicare Prescription Drug (Part D) plan to help pay for your prescription drug costs if you have Original Medicare or Original Medicare plus a Medicare Supplement insurance plan.
Medicare Advantage (Part C) plans	If you’d like the convenience of having your prescription drug coverage in the same plan as your hospital, doctor and other benefits, you may want to look into a Medicare Advantage (Part C) Prescription Drug (MAPD) plan.

Remember: Medicare Advantage plans and Medicare Prescription Drug plans cover a certain set of prescription drugs, so be sure to check each plan’s drug list to see if the prescription drugs you take will be covered. And if you already have prescription drug coverage, you’ll want to make sure your prescriptions will be covered next year, too.

Will I still be able to see my current provider(s)?

[[state-start:AL,AK,AZ,AR,CA,CT,DC,DE,GA,GU,HI,ID,IL,IN,IA,KS,KY,LA,MD,MI,MN,MS,MO,MT,NE,NV,NJ,NM,NC,OH,OK,PA,PR,RI,SC,SD,TN,UT,VT,VA,WA,WV,WI,WY]] When looking at coverage, check to see if your provider needs to be in network. Many Medicare Advantage (Part C) plans have provider networks. In some plans you may need to visit providers within the network for most services while in other plans you may use providers outside the network, but it usually costs more. There are also some Medicare Advantage plans that don't have provider networks and allow you to see any provider who accepts Medicare and agrees to the plan's terms and conditions. And Medicare Supplement plans let you see any provider or specialist without network restrictions, as long as they accept Medicare patients.[[state-end]]

[[state-start:null,AS,CO,FL,ME,NH,NY,ND,OR,TX,VI]]When looking at coverage, check to see if your provider needs to be in network. Many Medicare Advantage (Part C) plans have provider networks. In some plans you may need to visit providers within the network for most services while in other plans you may use providers outside the network, but it usually costs more. There are also some Medicare Advantage plans that don't have provider networks and allow you to see any provider who accepts Medicare and agrees to the plan's terms and conditions.[[state-end]]

When thinking about providers, find out:

Will I have to choose providers from a network?
Will my providers accept the plan’s terms? If not, are there providers near me who will?
Will I need a referral from a primary care provider to see a specialist?

Original Medicare

Medicare Supplement plans

Medicare Advantage plans

Providers: See any provider who accepts Medicare.
Specialist referrals: No referral needed to see a specialist who accepts Medicare.

Providers: See any provider or specialist without network restrictions, as long as they accept Medicare patients.
Specialist referrals: No referral needed to see a specialist.

Providers :

Network plans: If a plan has a provider network (for example an HMO), you can save money by using a provider in the plan's network. Some plans allow you to use providers outside the network, usually for a higher cost.
Non-Network plans: This type of Medicare Advantage plan may not have a provider network and allows you to see any provider that accepts Medicare and the plan’s terms.

Specialist referrals:

Some Medicare Advantage plans require a referral to see a specialist, some do not.

Remember: If a plan has a provider network, that network can change each year. If your current plan has a provider network, be sure to check if your provider will be in the network next year. You may want to switch plans during the Medicare Annual Enrollment Period if your provider won’t be in your plan’s network next year.

Original Medicare	Providers: See any provider who accepts Medicare. Specialist referrals: No referral needed to see a specialist who accepts Medicare.
Medicare Supplement plans	Providers: See any provider or specialist without network restrictions, as long as they accept Medicare patients. Specialist referrals: No referral needed to see a specialist.
Medicare Advantage plans	Providers : Network plans: If a plan has a provider network (for example an HMO), you can save money by using a provider in the plan's network. Some plans allow you to use providers outside the network, usually for a higher cost. Non-Network plans: This type of Medicare Advantage plan may not have a provider network and allows you to see any provider that accepts Medicare and the plan’s terms. Specialist referrals: Some Medicare Advantage plans require a referral to see a specialist, some do not.
Remember: If a plan has a provider network, that network can change each year. If your current plan has a provider network, be sure to check if your provider will be in the network next year. You may want to switch plans during the Medicare Annual Enrollment Period if your provider won’t be in your plan’s network next year.

When thinking about providers, find out:

Will I have to choose providers from a network?
Will my providers accept the plan’s terms? If not, are there providers near me who will?
Will I need a referral from a primary care provider to see a specialist?

Original Medicare

Medicare Advantage plans

Providers: See any provider who accepts Medicare.
Specialist referrals: No referral needed to see a specialist who accepts Medicare.

Providers :

Network plans: If a plan has a provider network (for example an HMO), you can save money by using a provider in the plan’s network. Some plans allow you to use providers outside the network, usually for a higher cost.
Non-Network plans: This type of Medicare Advantage plan may not have a provider network and allows you to see any provider that accepts Medicare and the plan’s terms.

Specialist referrals:

Some Medicare Advantage plans require a referral to see a specialist, some do not.

Original Medicare

Providers: See any provider who accepts Medicare.
Specialist referrals: No referral needed to see a specialist who accepts Medicare.

Medicare Advantage plans

Providers :

Network plans: If a plan has a provider network (for example an HMO), you can save money by using a provider in the plan’s network. Some plans allow you to use providers outside the network, usually for a higher cost.
Non-Network plans: This type of Medicare Advantage plan may not have a provider network and allows you to see any provider that accepts Medicare and the plan’s terms.

Specialist referrals:

Some Medicare Advantage plans require a referral to see a specialist, some do not.

Will I have coverage for additional benefits like vision, dental or hearing aids?

Generally, Original Medicare will not cover routine vision or dental care, eyeglasses, or hearing aids. However, many Medicare Advantage (Part C) plans include these additional benefits. Remember: Costs and benefits can vary from plan to plan. Be sure to take a good look at the additional benefits you may need.

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Medicare Advantage plans and Medicare Prescription Drug plans

Plans are insured through United Healthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a Medicare-approved Part D sponsor. Enrollment in these plans depends on the plan's contract renewal with Medicare.

You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party.

The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premium and/or copayments/ coinsurance may change on January 1 of each year.

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Prescriptions, Providers & Benefits

Will I have prescription drug coverage?

Will I still be able to see my current provider(s)?

When thinking about providers, find out:

When thinking about providers, find out:

Will I have coverage for additional benefits like vision, dental or hearing aids?

See UnitedHealthcare Insurance Company (UnitedHealthcare) Plans Available In Your Area

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Still have questions?

Give Us a Call

Chat with Us Online

Meet with a Licensed Insurance Agent/Producer