Key Takeaways
- Compare Original Medicare and Medicare Advantage before changing coverage.
- Confirm that your primary care provider accepts your exact Medicare coverage.
- Review every prescription, drug tier, formulary and preferred pharmacy.
- Compare total yearly costs instead of focusing only on monthly premiums.
- Check provider networks, referrals and prior-authorization requirements.
- Passion Health accepts Original Medicare and select Medicare Advantage plans.
Switching Medicare plans may affect your doctors, prescriptions, medical costs, and access to healthcare services. Before changing coverage, consider how each option supports your current health needs—not only its monthly premium or advertised benefits.
Medicare beneficiaries may receive coverage through Original Medicare—Part A and Part B—or a Medicare Advantage plan, also called Part C. People with Original Medicare may also choose separate Part D prescription coverage and Medicare Supplement Insurance, commonly called Medigap.
This article provides general educational information for people considering switching Medicare plans. Passion Health Advanced Primary Care does not sell, compare, recommend, or enroll patients in insurance plans.
Understand Your Main Medicare Options
Original Medicare
Original Medicare includes Part A and Part B. Part A helps cover eligible hospital services, while Part B helps cover eligible physician visits, outpatient services, preventive care, and durable medical equipment.
People with Original Medicare can generally receive covered care from healthcare providers throughout the United States who accept Medicare. However, Original Medicare usually does not cover routine outpatient prescriptions.
Beneficiaries may purchase a separate Part D plan for prescription coverage. Some also purchase Medigap coverage to help pay eligible deductibles, copayments, and coinsurance.
Medicare Advantage
Medicare Advantage plans provide Part A and Part B benefits through private insurance companies approved by Medicare. Many plans include Part D coverage and may offer dental, vision, hearing, or wellness benefits.
However, Medicare Advantage plans may use provider networks. Some plans also require referrals or prior authorization for certain medical services.
What Should You Gather Before Comparing Coverage?
Before switching Medicare plans, gather information that reflects how you currently use healthcare. Accurate information will help you compare provider access, prescription coverage, and potential expenses.
Collect:
Your Medicare card and current coverage information
Your Annual Notice of Change
A complete medication list with dosages
The names of your doctors and specialists
Your preferred hospitals, laboratories, and pharmacies
Information about upcoming tests or procedures
Records of premiums and recent healthcare expenses
Details about Medicaid, VA, TRICARE, employer, or union benefits
Also consider any healthcare services you expect to use during the coming year.
1. Does the Coverage Match Your Current Health Needs?
Begin with your health rather than a plan advertisement. Consider new diagnoses, prescriptions, specialists, treatments, and medical tests from the past year.
Someone with diabetes may need laboratory testing, medication management, and eye examinations. A person with heart disease may require cardiology appointments, imaging, and regular medical monitoring.
When switching Medicare plans, compare how Original Medicare and available Medicare Advantage plans handle the care you expect to need. Review primary care, specialist visits, hospital care, rehabilitation, diagnostic testing, and medical equipment.
2. Can You Continue Seeing Your Doctors?
Provider access represents one of the most important factors to check.
With Original Medicare, you can generally visit any provider who accepts Medicare. Ask whether your doctor accepts Medicare and whether the doctor accepts assignment. Accepting assignment generally means the provider agrees to accept the Medicare-approved amount for an eligible service.
Medicare Advantage plans may limit non-emergency care to a provider network. One insurance company may offer several plans with different networks, so knowing only the company’s name may not provide enough information.
When switching Medicare plans, confirm the complete plan name and identification number with your primary care provider, specialists, preferred hospitals, and insurance carrier.
Important: Acceptance may vary by Passion Health provider, location, and specific Medicare Advantage plan. Always confirm participation before scheduling your appointment.
3. Will Your Prescriptions Remain Covered?
Original Medicare generally does not cover routine outpatient prescriptions. Therefore, beneficiaries who choose Original Medicare may need a separate Part D plan.
Many Medicare Advantage plans include Part D coverage, but not every plan does. Formularies, drug tiers, pharmacy networks, and out-of-pocket costs can differ.
Before switching Medicare plans, check every medication for:
Formulary inclusion
Drug tier
Deductible
Copayment or coinsurance
Preferred-pharmacy requirements
Prior authorization
Step therapy
Quantity limits
Enter your medications, dosages,s and preferred pharmacies into the official Medicare Plan Finder for a personalized comparison.
4. What Could You Pay During the Entire Year?
A low or $0 Medicare Advantage premium does not mean all healthcare services will cost nothing. Most beneficiaries must continue paying the Medicare Part B premium.
With Original Medicare, consider Part A and Part B deductibles, Part B coinsurance, Part D costs, and any Medigap premium. Original Medicare alone does not provide an annual out-of-pocket maximum for Part A and Part B services.
With Medicare Advantage, compare the plan premium, deductibles, copayments, coinsurance, hospital costs, and annual out-of-pocket limit.
Before switching Medicare plans, estimate your potential yearly costs according to the services you expect to use. The lowest monthly premium may not always result in the lowest total expense.
5. Are Referrals or Prior Authorizations Required?
Original Medicare usually does not require a primary care referral before you visit a specialist. However, the specialist must accept Medicare for Medicare to cover eligible services.
Some Medicare Advantage plans require referrals or prior authorization for:
Specialist appointments
Advanced imaging
Outpatient procedures
Rehabilitation
Home healthcare
Medical equipment
Certain prescriptions
People considering switching Medicare plans should ask how the new coverage handles frequently used services. Understanding these requirements may help reduce unexpected delays.
6. How Do Medigap and Additional Benefits Fit In?
Medigap works with Original Medicare. A Medigap policy may help pay some eligible deductibles, copayments, and coinsurance that Original Medicare does not fully cover.
Medigap does not replace Original Medicare or provide routine prescription coverage. You cannot use Medigap to pay Medicare Advantage deductibles, copayments, or coinsurance.
Your six-month Medigap The open enrollment period generally begins when you have Medicare Part B and are age 65 or older. Outside protected enrollment situations, medical underwriting may apply where permitted.
When switching Medicare plans, do not assume that returning to Original Medicare guarantees access to every Medigap policy. Confirm eligibility before ending existing coverage.
Medicare Advantage plans may offer dental, vision, hearing, transportation, or fitness benefits. Review their provider restrictions, allowances, and service limits before including them in your decision.
7. Can You Change Your Coverage Now?
Medicare does not allow every beneficiary to make every change at any time.
Medicare Open Enrollment runs from October 15 through December 7. During this period, eligible beneficiaries may switch between Original Medicare and Medicare Advantage or change Medicare Advantage and Part D plans. New coverage generally starts January 1.
Medicare Advantage Open Enrollment runs from January 1 through March 31. It applies to people already enrolled in Medicare Advantage. Eligible beneficiaries may change Medicare Advantage plans or return to Original Medicare and join a separate Part D plan.
Certain circumstances may also create a special enrollment period.
Before switching Medicare plans, confirm your eligibility, enrollment deadline, and coverage effective date through Medicare or a licensed Medicare professional.
Medicare Primary Care in North Texas
Passion Health Advanced Primary Care accepts Original Medicare and participates in select Medicare Advantage plans at its North Texas locations.
Available primary care services may include:
Medicare Annual Wellness Visits
Preventive health screenings
Medication reviews
Blood pressure care
Care coordination
Passion Health provides healthcare services; it does not sell Medicare plans. Our team can confirm whether your provider and clinic accept Original Medicare or participate in your specific Medicare Advantage plan.
Make Healthcare Access Your Priority
Switching Medicare plans involves more than comparing premiums or additional benefits. Review your doctors, prescriptions, expected medical services, travel needs, and possible yearly costs before changing coverage.
For official coverage comparisons and enrollment guidance, visit Medicare.gov, contact Texas HICAP, or consult a licensed Medicare professional.
Find Medicare Primary Care in North Texas
Passion Health Advanced Primary Care accepts Original Medicare and select Medicare Advantage plans at participating North Texas locations. Contact us with your coverage details to confirm acceptance, choose a preferred provider, and request your primary care appointment.
Find Medicare Primary Care in North Texas
Passion Health Advanced Primary Care accepts Original Medicare and select Medicare Advantage plans at participating North Texas locations. Contact us with your coverage details to confirm acceptance, choose a preferred provider, and request your primary care appointment.
Frequently Asked Questions
1. What should I check before switching Medicare plans?
Review your doctors, specialists, hospitals, prescriptions, provider network, expected costs, prior-authorization rules, and enrollment eligibility before making a change.
2. Does Passion Health accept Original Medicare?
Passion Health Advanced Primary Care accepts Original Medicare. Confirm acceptance with your specific provider and clinic before your appointment.
3. Does Passion Health accept Medicare Advantage?
Passion Health participates in select Medicare Advantage plans. Provide the complete plan name and identification number when contacting the clinic.
4. Is Original Medicare the same as Medicare Advantage?
No. Original Medicare is the federal Part A and Part B program. Medicare Advantage is a private-plan alternative that provides Part A and Part B benefits.
5. Can I use Medigap with Medicare Advantage?
No. Medigap works with Original Medicare and cannot supplement Medicare Advantage coverage.
6. Can Passion Health help me select a Medicare plan?
Passion Health can provide general educational information and confirm whether a provider or location accepts your coverage. It does not sell, compare, recommend, or enroll patients in Medicare plans.
Disclaimer
This article provides general educational information about Medicare and healthcare access. It does not offer insurance, legal, or enrollment advice or recommend a specific plan. Coverage, costs, formularies, provider participation, and enrollment rights may vary by person, location, year, and plan. Confirm current information through Medicare.gov, the insurance carrier, Texas HICAP, or a licensed Medicare professional.
