Your Medicare Options


Choosing your Medicare plan can be overwhelming.

It can be hard to figure out what you want, or more important, what you need. That’s why we’ve gathered a list of your options. Compare different combinations of Medicare Parts A, B, C, and D. See how they can work for you.

Need a refresher?

Check out our explanation of the Four Parts of Medicare.

Definition of Terms

PPO

A Preferred Provider Organization (PPO) gives you the flexibility of seeing the doctor, specialist and hospital of your choice. If you choose a doctor or hospital out of network, your cost share will be greater than it would be with in network doctors.

HMO

When choosing a Health Maintenance Organization (HMO), you will have a specific network of doctors and hospitals you must use to get your health care benefits paid for. These doctors and hospitals have an agreement with Capital Blue Cross to accept our payment and your cost-sharing amount as payment in full. You also must chose a Primary Care Physician (PCP), if you don’t already have one. If you have a PCP you want to keep seeing, you should call to verify they are part of the Capital Blue Cross HMO network. Our Capital Blue Cross HMO plans do not require a referral for specialty care, so you are free to make appointments with Specialist without your PCP’s consent.

Premium

The amount of money paid monthly for your healthcare insurance benefits.

Deductible

The set amount you pay before Capital Blue Cross begins to cover more of the costs.

Copayment (Copay)

The fixed amount you pay for a health service or prescription in addition to the payment made by Capital Blue Cross. Amounts differ depending on the service. Example: $10 copay for primary doctor visit, $50 copay for an Emergency Room visit.

Out of Pocket Spending Limit

This is the maximum amount of money you will pay out of your own pocket in a given calendar year.

Web Content Viewer - Fixed Context

What are the different types of Medicare health plans?

Original Medicare (Parts A and B)

Original Medicare includes Part A – Hospital coverage, and Part B – Medical coverage. Once you sign up for Medicare, you receive a red, white and blue Medicare card. Once enrolled in Medicare you may be charged a 20 percent copayment for health care services (20% of your health care bill) that Original Medicare does not cover. This is why some seniors chose to enroll in a Medicare Advantage Plan (with or without drug coverage) for additional health care cost coverage. These additional plans help to cover that 20 percent of health care costs that Original Medicare does not cover. You can view a Medicare Card Frequently Asked Questions document here.

Original Medicare with a drug plan (Medicare Part A, Part B and Part D)

There are Medicare Part D Drug Plans available to add to Original Medicare. A Part D Drug Plan will help cover the cost of your prescription drugs. There could be a monthly premium to enroll in a Part D plan.

Medicare Advantage Plan without a drug plan (Medicare Part C)

The government contracts with private insurance companies, like Capital Blue Cross, to offer Medicare Advantage plans. The Medicare Advantage Part C coverage helps pay the 20 percent of health care costs that Original Medicare does not cover. Many Medicare Advantage plans also have limited coverage for dental, hearing and vision services. It can also include other benefits, such as over-the-counter drug reimbursement, fitness classes, and transportation to doctor appointments. These plans may have a monthly premium, and/or a copayment for certain health care services. You can choose a Preferred Provider Organization (PPO) or a Health Maintenance Organization (HMO) plan.

Medicare Advantage Plan with a prescription drug plan (Medicare Part C and Part D)

Some Medicare Advantage Plans offer Part D drug coverage in combination with the Part C benefits mentioned above. These plans may have a monthly premium and a copayment for certain health services and your prescriptions. To learn more about Capital Blue Cross Medicare Advantage options, view our Capital Blue Cross Medicare plans.

Other options to look at.

Medicare Supplement Plan without a drug plan (Part A, Part B and Supplement)

A Medicare supplement plan with a prescription drug benefit covers some of the gaps that Original Medicare does not pay. Original Medicare is your primary insurance. A supplement plan helps cover some health care and additional prescription plan costs like copays, coinsurance and deductibles.

Medicare Supplement Plan with a drug plan (Part A, Part B, Part D and Supplement)

A Medicare supplement plan with a prescription drug benefit covers some of the gaps that Original Medicare does not pay. Original Medicare is your primary insurance. A supplement plan helps cover some health care and additional prescription plan costs like copays, coinsurance and deductibles.

Web Content Viewer - Fixed Context

Updated January 1, 2025

Y0016_25WBST_M