What Medicare Options Are Right for You?

If you qualify for Medicare, some of the choices you need to think about include:

  • Whether you want Original Medicare or a Medicare Advantage plan.
  • If you want Original Medicare, which Part D prescription drug plan to sign up for (if any), whether to decline Part B, and whether to sign up for a Medigap (Medicare Supplemental Insurance) policy.
  • If you want Medicare Advantage, which plan to choose.

People make these choices when Medicare coverage starts, but can change their minds and their Medicare coverage at certain times.

Comparing Original Medicare and Medicare Advantage

To understand what Medicare options are right for you, it’s important to get a sense of how Original Medicare and Medicare Advantage work.

Note: Medicare Advantage is sometimes called Medicare Part C.

With Original Medicare:
  • Part A helps pay for hospitalization. Most people do not pay a monthly premium for Part A.
  • Part B helps pay for outpatient medical care, like when you go to the doctor’s office. Most people pay a $174.70 monthly premium for Part B (or a bit less).
  • Private Part D plans help pay for prescription drugs for people with Original Medicare coverage. You have to pay an extra monthly premium for Part D and the amount depends on which Part D plan you get.
  • Private Medigap policies cover some expenses that Original Medicare doesn't cover. You have to pay an extra monthly premium for these policies, also called Medicare Supplement Insurance.
  • You can visit any doctor or hospital who accepts Medicare payments.
With Medicare Advantage:
  • A private company offers a policy that combines the benefits offered by Part A, Part B, Part D, and Medigap policies into a single plan.
  • There are many plans to choose from in most counties.
  • The exact benefits and the cost of those benefits depend on the plan you choose.
  • You may be restricted to certain hospitals or networks of doctors.
  • There is a $8,850 out-of-pocket maximum each year for expenses besides the premium.
Summary of Differences

Original Medicare

Medicare Advantage

Run by

The federal government

Private companies

Medical providers

Any who accept Medicare

May be a limited provider network


Based on Medicare’s rules

Depends on the plan; has a $8,850 annual out-of-pocket maximum

Services covered

Everything Part A and Part B cover

At least everything Original Medicare covers

Additional Benefits

Not included

May be included with plan

Drug Coverage

With a separate Part D policy

May be included with plan or through a separate Part D policy


More service providers to choose from

Usually lower cost

The bottom line: Both Original Medicare and Medicare Advantage have advantages and are good ways to get Medicare benefits. In California, 48% of Medicare beneficiaries choose Original Medicare and 52% choose Medicare Advantage.

How Other Coverage Can Affect Your Medicare Choices

Having another form of health coverage, such as employer-sponsored coverage or Medi-Cal, is one of the biggest factors that can affect how you should get Medicare. Answer these questions to see how they might affect your Medicare choices.

If you need to talk with someone about these questions, call the Health Insurance Counseling & Advocacy Program (HICAP) at 1-800-434-0222.

Do You Have Private Coverage That Covers What Parts B and D Cover?

If you get employer-sponsored coverage that covers what Medicare Parts B and D cover, you may want to opt out of Parts B and D, so that you don’t have to pay their premiums. (You still have Part A coverage, which usually has no premium.)

However, you might have to pay monthly penalties if you opt out and want Parts B and D later:

  • For Medicare Part B, you can only opt out without paying penalties later if you have an employer-sponsored insurance policy. If you do, make sure to check with your employer or insurer whether it's safe for you to opt out of Part B.
  • If Medicare Part D says the other coverage you have is “creditable,” which means it meets certain standards, you can opt out of Part D and you don’t have to pay a penalty if you decide to sign up for it later within certain time limits.
  • If you opt out of Parts B and D and your coverage doesn't meet these standards, you may have to pay monthly penalties if you want Parts B and D later. The longer you go without coverage, the higher the penalties might be.

Note: If your income is below certain levels, you may qualify for a Medicare Savings Program, which would pay your Part B premium, and the Low Income Subsidy (LIS), which would pay your Part D premium. Look into these before you opt out of any parts of Medicare.

The bottom line: Don’t opt out of any Medicare coverage without carefully researching your options. If you decline Part B, you cannot sign up for Medicare Advantage either. If you have any questions, contact the Health Insurance Counseling & Advocacy Program (HICAP).

Do You Also Have Medi-Cal Coverage?

People who qualify for both Medicare and Medi-Cal coverage are called “dual eligibles.” Most dual eligibles do not have to pay Medicare premiums, because either Medi-Cal (or Medi-Cal's Working Disabled Program) pays them or because the person also qualifies for a Medicare Savings Program. Medi-Cal, including Medi-Cal's Working Disabled Program, may also help pay for Medicare co-insurance and deductibles, as well as some services Medicare doesn’t cover. That’s why you shouldn’t decline Medicare Parts B or D if you also qualify for Medi-Cal.

If you qualify for both Medicare and Medi-Cal, there are different ways to get your medical coverage:

  • You can have separate Original Medicare and Medi-Cal coverage. This gives you more flexibility to choose your medical providers, but some may not accept Medi-Cal or Medicare as payment, which could mean you have to pay more.
  • You can have a Medicare Advantage plan with separate Medi-Cal coverage. This can be a problem if you have a Medi-Cal managed care plan with a different provider network than your Medicare Advantage network.
  • You can have a Medicare Advantage plan that is integrated with Medi-Cal coverage. These are called Dual Special Needs Plans (D-SNPs) or Medi-Medi Plans. With a D-SNP or Medi-Medi Plan, there’s less paperwork (you only have one insurance card) and you don’t have to worry so much about which of your benefits pays for which medical services.

The bottom line: If you like your Medi-Cal managed care program, signing up for its D-SNP or Medi-Medi Plan could make it easier for you to deal with your combined health coverage and may let you get additional benefits that Medicare doesn’t usually offer, such as dental, vision, and hearing aid coverage. However, if you want more flexibility than a managed care program, look into Original Medicare.

If you have Medicare and another insurance at the same time

If you have more than one type of coverage, including Medi-Cal, employer-sponsored coverage, Veterans (VA) health benefits, military (TRICARE) benefits, or any other health coverage, one coverage may pay for costs that your other coverage doesn't pay for, meaning you have to pay less out of your own pocket. If you are in this situation, make sure you understand how Medicare interacts with other types of coverage.

Is Medicare Your Only Health Coverage?

If you do not have any private health insurance, don’t qualify for Medi-Cal, and don’t have any other medical coverage besides Medicare, then you need to make sure that your Medicare coverage will be enough for all of your health needs.

If Medicare is your only health coverage:

The bottom line: If you don’t have other coverage, make sure that your Medicare coverage meets your needs.

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