Introduction to Medicare
Prescriptions, Providers & Benefits
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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.
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When it comes to Medicare, one size does not fit all. 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.
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Will I have prescription drug coverage?
Will I still be able to see my current provider(s)?
Will I have coverage for additional benefits like vision, dental, or hearing aids?
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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.
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Will I still be able to see my current provider(s)?
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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.
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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.
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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 :
Specialist referrals: Some Medicare Advantage plans require a referral to see a specialist, some do not. |
| Original Medicare |
|
|---|---|
| Medicare Supplement plans |
|
| Medicare Advantage plans |
Providers :
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 :
Specialist referrals: Some Medicare Advantage plans require a referral to see a specialist, some do not. |
| Original Medicare |
|
|---|---|
| Medicare Advantage plans |
Providers :
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.
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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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