Coverage options

In Original Medicare, a beneficiary can go to any doctor, hospital, or other health-care provider that takes Medicare. People who join a Medicare Advantage plan have to follow the rules of the plan to get Medicare coverage. For example, some Medicare Advantage plans require members to stay within a network of providers (with which the plan has a contract). Certain plans won’t cover members who go to a doctor’s office or a hospital outside of this network. Other plans might cover people who go outside the network of providers, but they may require the member to pay more out-of-pocket for getting this care out-of-network. Some Medicare Advantage plans also offer Part D prescription drug coverage. Others are “stand-alone” plans that only offer health coverage, and people can buy a Part D drug plan to cover their prescriptions.