There are several differences in costs and coverage among Original Medicare, Private Fee-for-Service (PFFS) plans, and Health Maintenance Organizations (HMOs). The table below compares these three types of Medicare plans. If you are interested in joining a PFFS plan, make sure to speak to a plan representative for more information.
|Original Medicare||Medicare PFFS||Medicare HMO|
|See any provider and use any facility that accepts Medicare (participating or non-participating)||See any provider, but may pay more when seeing out-of-network providers||See only in-network providers|
|Visit doctors anywhere in the U.S.||Visit doctors anywhere in the U.S., but may pay more when seeing out-of-network providers||Visit doctors only in your plan’s service area, except in emergencies or when care is urgently needed|
|Do not need referrals for specialists||Do not need referrals for specialists||Typically need referrals for specialists|
|Does not cover vision, hearing, or dental services||May cover additional services, including vision, hearing, and dental (additional benefits may increase your premium or other out-of-pocket costs)||May cover additional services, including vision, hearing, and dental (additional benefits may increase your premium or other out-of-pocket costs)|
|Sign up for a stand-alone prescription drug plan (Part D)||Plan may provide prescription drug coverage (if it does not, you can join a stand-alone plan)||In most cases, plan provides prescription drug coverage (you may be required to pay higher premium)|
|Charged for standardized Part A and Part B costs (premiums and other cost-sharing for Part D vary depending on plan)||Cost-sharing varies depending on plan||Cost-sharing varies depending on plan|
|No out-of-pocket limit||Annual out-of-pocket limits for in-network and out-of-network care (maximum is $6,700 in 2020)||Annual out-of-pocket limit for in-network care (maximum is $6,700 in 2020)|
If you have Original Medicare, you also have the choice to purchase a supplemental insurance policy, or Medigap. Medigap plans cover Medicare cost-sharing and offer other benefits, but charge an additional premium. You cannot enroll in a Medigap plan if you have Medicare Advantage.
Return to: Medicare Advantage
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