You keep Medicare. You still have Medicare and still pay your Part B premium. The plan handles your coverage instead of Original Medicare.
Many plans have a $0 monthly premium. You pay copays and coinsurance when you get care.
There’s a yearly limit on your costs. For 2027, a plan’s limit can be no higher than $9,850 for in-network care. PPO plans can have a combined limit of up to $14,800 for in-network and out-of-network care. Many plans set their limits lower. Original Medicare has no limit.
Drug costs have their own limit. In 2027, you won’t pay more than $2,400 for covered Part D drugs. That’s separate from the medical limit above.
Networks matter. HMO plans usually cover care only from doctors in the plan’s network, and you may need a referral to see a specialist. PPO plans let you go outside the network, but you’ll pay more.
Some care needs approval first. Plans may require prior authorization for certain tests, procedures or hospital stays.
Plans change every year. Premiums, copays, networks and drug lists can all change on January 1. Watch for your Annual Notice of Change in the mail each September.
It doesn’t work with a Medicare Supplement. You can have one or the other, not both.
