We help you sort out your options, which will depend on any number of factors.

Medicare is a topic that's a constant in most physicians' lives. You treat Medicare patients, accept assignment in your practice, or perhaps you're part of a Medicare PPO, HMO, or private fee-for-service plan. But if you're approaching 65, do you know what options are available to you as a Medicare recipient? The facts may come as a surprise. But before we get into the details, let's review what Medicare consists of:

Part A (hospital insurance) helps cover your inpatient care, including acute care hospitals and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home healthcare. As long as you or your spouse paid Medicare taxes for at least 10 years, you're covered under Part A at no charge.

Part B (medical insurance) helps cover your doctors' services and outpatient care. It also pays for some other medical services that Part A doesn't, such as some physical and occupational therapy, laboratory services, preventive services, durable medical equipment, and home healthcare. Medicare Part B costs $78.20 per month in 2005, and it's deducted from the payments you receive from Social Security. In addition, you also pay a $110 annual deductible.

Information on Medicare, including the handbook, Medicare & You 2005, is available at www.medicare.gov.

"How do I enroll in Medicare?"

However, if you or your spouse is still working when you turn 65, and you get health insurance through that job, you may want to delay signing up for Medicare Part B, and you can do so without penalty as long as you sign up while you're still covered by the employer plan or during the eight months following the month when employer group health plan coverage ends, or when the employment ends, whichever is first. Your decision on timing may be affected by the size of the employer and who would be the primary payer.

If 20 or more people work for your practice or at your spouse's company, the practice's group health plan is the primary payer of your medical bills.

If fewer than 20 people work for your practice or at your spouse's company, you should talk to the employee health benefits administrator before making any decision not to take Medicare Part B. Medicare would be your primary payer and your group insurance would be the secondary payer.

If you're retired and have health insurance from a former job, sign up for Medicare when you turn 65. If you have retiree benefits, they'll coordinate with Medicare.

"How do I choose the right plan for me?"

Once you've assessed your health needs, you can choose the Medicare option that best suits them. The two basic options are:

Original Medicare (also known as traditional or regular Medicare) is the fee-for-service program. The government pays for part of each service you get. When you sign up for Medicare, you're automatically enrolled in this plan. You can use almost any doctor or hospital in the country, whenever you need to. But unless you have supplemental coverage in the form of a Medigap policy, you'll pay a large hospital deductible that will run several hundred dollars per benefit period, a $110 annual deductible for doctors' visits or other visits not covered by other parts of Medicare, and 20 percent of the cost of most outpatient medical care. Original Medicare doesn't cover most outpatient prescription drugs, routine dental care, hearing aids, vision care (it will cover glaucoma testing if you're in a group at high risk), routine foot care, or long-term care.

Medicare Advantage is the new name (it used to be Medicare + Choice) for private health plans that the government contracts with to provide Medicare benefits to individuals who join them. Most of these plans are HMOs, but there are some PPOs and private fee-for-service plans. Some people choose these plans because they may offer benefits such as limited drug coverage, preventive care, eyeglasses, and hearing aid discounts in addition to regular Medicare-covered services. If your plans include travel, remember that the HMO is obligated to pay for any emergency or urgent care you receive from out-of-network providers. But once your condition stabilizes, your HMO may refuse to cover your care in the out-of-network facility. You may not be covered for emergency care at all if you travel outside the US. Check with the HMO regarding its policy.

You must have both Medicare Part A and Part B to join a Medicare Advantage plan and you must continue to pay your Medicare Part B monthly premium. A Medicare HMO will only give you access to certain doctors or hospitals within your area unless you have an emergency. You must choose a primary care physician from the network. That doctor would give you a referral to see a specialist. Even though you may think it's silly for you, as a doctor, to have to check out other physicians, you may wish to if you're considering a Medicare Advantage plan. You can check their credentials on the HMO's Web site, with the AMA (www.ama-assn.org),click on Doctor Finder under For Patients, and with the American Board of Medical Specialties (www.abms.org/login.asp). Your public library may have the AMA or ABMS directories in hard copy if you don't have access to the Internet. Or, you could contact your state medical society. You'll find a list of state medical societies' Web sites at www.ama-assn.org/ama/pub/category/7630.html .

While the perks of a Medicare HMO might appeal to you, some plans charge a monthly premium in addition to the Part B premium. Medicare Advantage plans are available in most areas of the country, but many people stick with original Medicare because, despite the fact that some doctors are no longer accepting Medicare patients, it still has a wide choice of doctors and hospitals nationwide.

Unfortunately, no matter which Medicare option you choose, you'll likely have gaps in coverage. If you have original Medicare, you can fill many gaps through retiree coverage or Medigap policies. If you're in a Medicare HMO and don't have retiree coverage, you'll likely have to pay any additional HMO premium and copayments out of pocket.

There are 10 different types of Medigap plans, labeled A-J. Plan A offers the fewest benefits and is usually the least expensive; Plan J offers the most benefits and is usually the most expensive. All the plans must include the following basic benefits: hospital coinsurance coverage; 365 days of full hospital coverage over the patient's lifetime as a Medicare enrollee after you use all Medicare hospital benefits; 20 percent of the cost of your medical care that Medicare doesn't pick up after you pay the $110 deductible; and the first three pints of blood you need each year. As you move up the ladder, depending on which Medigap plan you choose, you can get extra coverage for hospital deductibles; skilled nursing facility coinsurance; emergency care outside the US; costs associated with recovering at home; Part B excess charges; preventive care; and limited prescription drug coverage.

Federal regulations require that all Medigap policies of the same type offer the same benefits. (However, Massachusetts, Minnesota, and Wisconsin require Medigap policies that are specific to each of those states.) That's why when you're deciding which company to buy from, the most important factors to consider are cost and the company's financial stability. A larger organization with a national reputation will usually be on a firmer footing than a smaller company you've never heard of. If in doubt, check with a ratings service such as A.M. Best (www.ambest.com) or Weiss Ratings (www.weissratings.com). To review the benefits of each plan, go to www.medicarerights.org/medigap_a-j.html , or look at the Medicare Personal Plan Finder available at www.medicare.gov , or print the publication Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare at www.medicare.gov/Publications/Pubs/pdf/02110.pdf.

Internist Richard R. Grayson of Geneva, IL, purchased his supplemental policy through the AMA. GP Patricia L. Elliott, who practices in Rapidan, VA, a rural area, purchased hers from Anthem Blue Cross and Blue Shield through her local Farm Bureau because it was cheaper than the AMA's Medigap policy. "Shop around," Elliott warns. "See if the groups you're affiliated with offer Medigap policies." Your state department of insurance can give you a list of companies that sell Medigap coverage in your state. You can find the Web site for your state's department of insurance at the National Association of Insurance Commissioners Web site: www.naic.org/state_contacts/sid_websites.htm. You can also call your State Medical Assistance Office, which can be found at (www.medicare.gov/Contacts/Include/DataSection/Questions/SearchCriteria.asp?) or call (800-MEDICARE) for free help.

If you sign a private contract with your doctor, you'll have to pay whatever he or she charges you and you won't be able to file a claim with Medicare. (Medicare won't pay even if you do.) Your Medigap policy, if you have one, won't pay for privately contracted services either.

Before providing a service to you, a nonparticipating physician must tell you whether Medicare would pay for it if you got it from a participating physician. And your doctor must tell you if he or she has voluntarily opted out of, or been excluded from, the Medicare program.

Another option is to have your spouse start a Health Savings Account (HSA). The money in these tax-free accounts can be used to pay for medical expenses incurred by you, your spouse, or your dependents. Tax-deductible contributions may be made up to a maximum of $2,650 for individuals and $5,250 for families. Amounts distributed from an HSA aren't taxable as long as they are used to pay for qualified medical expenses, in connection with health insurance plans that have an annual deductible of at least $1,000 for individuals and $2,000 for families.

As Richard Grayson discovered, "I recently became acquainted with HSAs when my wife changed jobs. After her COBRA expired, she opened an HSA through State Farm and enrolled in a high deductible Blue Cross Blue Shield plan." For more information on HSAs, see "Tame Your Health Insurance Costs," in our Feb. 4, 2005 issue and available at www.memag.com/memag/article/articleDetail.jsp?id=144769.