Original Medicare (Parts A & B)
The foundation of Medicare coverage
Original Medicare is the traditional fee-for-service program run directly by the federal government. It's the starting point for most people's Medicare coverage.
Part A (Hospital Insurance):
- Hospital stays
- Skilled nursing facility care
- Hospice care
- Some home health care
- Usually premium-free if you worked 10+ years
Part B (Medical Insurance):
- Doctor visits
- Outpatient care
- Medical equipment
- Preventive services
- Monthly premium (standard: $185 in 2025)
ā Advantages:
- Go to any doctor that accepts Medicare
- No referrals needed for specialists
- Consistent coverage nationwide
- No network restrictions
ā Limitations:
- No prescription drug coverage
- No annual out-of-pocket maximum
- Deductibles and coinsurance add up
- Limited coverage for dental, vision, hearing
Medicare Advantage (Part C)
All-in-one alternative to Original Medicare
Medicare Advantage plans are offered by private insurance companies approved by Medicare. They include everything Original Medicare covers, plus usually prescription drugs and extra benefits.
What's Included:
- Parts A & B coverage
- Usually Part D (prescription drugs)
- Often dental, vision, hearing aids
- Sometimes wellness programs
- Annual out-of-pocket maximum
Plan Types:
- HMO (Health Maintenance Organization)
- PPO (Preferred Provider Organization)
- Special needs plans
- Premiums often $0-$50/month
ā Advantages:
- Lower monthly premiums
- Prescription drug coverage included
- Extra benefits like dental and vision
- Annual out-of-pocket maximum
- Coordinated care
ā Limitations:
- May have network restrictions
- Not accepted by all doctors and hospitals
- May need referrals for specialists
- Prior authorization requirement
- Coverage area restrictions
- Plans can change annually
Medicare Part D
Know what to expect and feel good about it
Medicare Part D helps cover the cost of prescription drugs, and offered by private companies approved by Medicare
Key Points:
- Offered to everyone with Medicare
- Various plans to choose from
- List of covered drugs ("formulary")
- Different drug "tiers"
- Can change plans yearly
Costs:
- Monthly premium
- Copayments for medications
- Annual deductible
- Higher cost in the "donut hole"
ā Advantages:
- Wide range of plans to fit your needs
- Helps pay for brand-name and generic
- Protection against high drug costs
- Can choose a plan with preferred pharmacies
ā Limitations:
- Plans vary in drug coverage
- You must live in the plan's area
- Possible coverage restrictions
- Penalty if you delay enrollment
Medicare Supplement (Medigap)
Fills the gaps in Original Medicare
Medigap policies are sold by private insurance companies to help pay for costs that Original Medicare doesn't cover, like copayments, coinsurance, and deductibles.
What It Covers:
- Medicare Part A & B deductibles
- Copayments and coinsurance
- Excess charges from doctors
- Emergency travel coverage
- Predictable healthcare costs
Popular Plans:
- Plan F (comprehensive, pre-2020 enrollees)
- Plan G (most popular for new enrollees)
- Plan N (lower premium, some cost-sharing)
- Premiums: $100-$400+ per month
ā Advantages:
- Predictable healthcare costs
- Go to any doctor that accepts Medicare
- No referrals needed
- Guaranteed renewable
- Travel anywhere in the U.S.
- No prior authorization required
ā Limitations:
- Higher monthly premiums
- No prescription drug coverage
- Need separate Part D plan
- Limited extra benefits
Which Plan Might Be Right for You?
Everyone's situation is different, but here are some general guidelines based on common scenarios:
If you want flexibility...
You like to choose your own doctors and don't mind paying more for freedom of choice.
If you want to save money...
You're comfortable with a network of doctors and want lower monthly costs.
If you travel frequently...
You spend time in different states or travel internationally.
If you have chronic conditions...
You see specialists regularly and want predictable costs.
If you're generally healthy...
You don't visit doctors often and want basic coverage with extras.
If you take expensive medications...
Your prescription costs are high and you need comprehensive drug coverage.
Disclaimer:
* The information provided is for general informational purposes only and is not intended to be a complete description of coverage or plan options. Always consult with a licensed Medicare insurance professional to evaluate your individual needs and circumstances. Jenell Sobas assumes no responsibility or liability for any errors, omissions, or outcomes resulting from the use of this content.