Understanding Medicare
CoxHealth Medicare Advantage
Your Medicare Options
When you first enroll in Medicare and during certain times of the year, you can choose how you get your Medicare coverage. There are 2 main ways to get Medicare:
Original Medicare
- Original Medicare includes Medicare Part A (Hospital Insurance) and Part B (Medical Insurance).
- You can join a separate Medicare drug plan to get Medicare drug coverage (Part D).
- You can use any doctor or hospital that takes Medicare, anywhere in the U.S.
- To help pay your out-of-pocket costs in Original Medicare (like your 20% coinsurance), you can also shop for and buy supplemental coverage.
Includes:
- Part A
- Part B
You can add:
- Part D
You can also add:
- Supplemental coverage This includes Medicare Supplement Insurance (Medigap)
Medicare Advantage
- Medicare Advantage is a Medicare-approved plan from a private company that offers an alternative to Original Medicare for your health and drug coverage. These “bundled” plans include Part A, Part B, and usually Part D.
- In most cases, you’ll need to use doctors who are in the plan’s network.
- Plans may have lower out-of-pocket costs than Original Medicare.
- Plans may offer some extra benefits that Original Medicare doesn’t cover—like vision, hearing, and dental services.
Includes:
- Part A
- Part B
Most plans include:
- Part D
Some plans also include:
- Lower out-of-pocket costs
Original Medicare vs Medicare Advantage
Doctor and Hospital Choice
| Original Medicare | Medicare Advantage (Part C) |
|---|---|
| You can go to any doctor or hospital that takes Medicare, anywhere in the U.S. | In many cases, you’ll need to only use doctors and other providers who are in the plan’s network (for non-emergency care). Some plans offer non-emergency coverage out of network, but typically at a higher cost. |
| In most cases, you don’t need a referral to see a specialist. | You may need to get a referral to see a specialist. |
Cost
| Original Medicare | Medicare Advantage (Part C) |
|---|---|
| For Part B-covered services, you usually pay 20% of the Medicare-approved amount after you meet your deductible. This is called your coinsurance. | Out-of-pocket costs vary—plans may have different out-of-pocket costs for certain services. |
| You pay a premium (monthly payment) for Part B. If you choose to join a Medicare drug plan, you’ll pay a separate premium for your Medicare drug coverage (Part D). | You pay the monthly Part B premium and may also have to pay the plan’s premium. Plans may have a $0 premium and may help pay all or part of your Part B premium. Most plans include Medicare drug coverage (Part D). |
| There’s no yearly limit on what you pay out of pocket, unless you have supplemental coverage—like Medicare Supplement Insurance (Medigap). | Plans have a yearly limit on what you pay out of pocket for services Medicare Part A and Part B covers. Once you reach your plan’s limit, you’ll pay nothing for services Part A and Part B covers for the rest of the year. |
| You can get Medigap to help pay your remaining out-of-pocket costs (like your 20% coinsurance). Or, you can use coverage from a former employer or union, or Medicaid. | You can’t buy and don’t need Medigap. |
Coverage
| Original Medicare | Medicare Advantage (Part C) |
|---|---|
| Original Medicare covers most medically necessary services and supplies in hospitals, doctors’ offices, and other health care facilities. Original Medicare doesn’t cover some benefits like eye exams, most dental care, and routine exams. | Plans must cover all of the medically necessary services that Original Medicare covers. Most plans offer some extra benefits that Original Medicare doesn’t cover—like some routine exams and vision, hearing, and dental services. |
| You can join a separate Medicare drug plan to get Medicare drug coverage (Part D). | Medicare drug coverage (Part D) is included in most plans. In most types of Medicare Advantage Plans, you can’t join a separate Medicare drug plan. |
| In most cases, you don’t have to get a service or supply approved ahead of time for Original Medicare to cover it. | In some cases, you have to get a service or supply approved ahead of time for the plan to cover it. |
Foreign Travel
| Original Medicare | Medicare Advantage (Part C) |
|---|---|
| Original Medicare generally doesn’t cover care outside the U.S. You may be able to buy a Medicare Supplement Insurance (Medigap) policy that covers emergency care outside the U.S. | Plans generally don’t cover care outside the U.S. Some plans may offer a supplemental benefit that covers emergency and urgently needed services when traveling outside the U.S. |
Initial Enrollment Period
You can first sign up for Part A and/or Part B during the 7-month period that begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65.
If you enroll in Part A and/or Part B during the first 3 months of your Initial Enrollment Period, in most cases, your coverage begins the first day of your birthday month. However, if your birthday is on the first day of the month, your coverage will start the first day of the prior month.
If you enroll in and are paying for Part A and/or Part B the month you turn 65 or during the last 3 months of your Initial Enrollment Period, the start date for your Part B coverage will be delayed.
Special Enrollment Period
You can make changes to your Medicare Advantage coverage if certain events happen in your life such as moving or a loss of coverage. These events result in a chance to change in coverage called a Special Enrollment Periods (SEPs). Rules for when you can make changes and the type of change you make are different for each SEPs.
To learn more about SEPs visit medicare.gov.
Important Dates
| October 1, 2025 | Start comparing your current coverage with other options. You may be able to save money or get extra benefits. Visit Medicare.gov/plan-compare. |
|
October 15 to December 7, 2025 |
Change your Medicare health or drug coverage for 2026, if you decide to. You can join, switch or leave a Medicare Advantage Plan or a Medicare drug plan during this Open Enrollment Period each year. |
| January 1, 2026 | New coverage begins if you made a change. If you kept your existing coverage and your plan’s costs or benefits changed, those changes also start on this date. |
|
January 1 to March 31, 2026 |
If you’re in a Medicare Advantage Plan, you can change to a different Medicare Advantage Plan or switch to Original Medicare (and join a separate Medicare drug plan) once during this time. Any changes you make will be effective the first of the month after the plan gets your request. |
Each year, it’s important to review your Medicare health and drug coverage and make changes if it no longer meets your needs, or see if you could lower your out-of-pocket costs. You don’t need to enroll in Medicare each year, but you should still review your options.
