Compare Medicare Plans and Costs Easily

Medicare helps cover a portion of healthcare costs in retirement and for certain individuals with qualifying disabilities. Most people choose among three main paths: Original Medicare (Parts A & B), Original Medicare + Part D + Medigap, or Medicare Advantage (Part C). This guide compares how each path works, what affects cost and access, and how to choose a configuration that aligns with your health needs and budget—without hype or unrealistic promises.

 The Building Blocks (A Quick Refresher)

• Part A (Hospital Insurance): Inpatient hospital care, skilled nursing facility care under specific conditions, hospice, and some home health services.
• Part B (Medical Insurance): Outpatient care, preventive services, certain medical supplies, and some home health services.
• Part C (Medicare Advantage): Private plans approved by Medicare that include Part A and Part B and often Part D; rules, networks, and costs vary.
• Part D (Prescription Drugs): Standalone drug plans for Original Medicare or drug coverage embedded in many Medicare Advantage plans.
• Medigap (Supplement): Private policies that may help cover certain out-of-pocket costs under Original Medicare (not the same as Medicare Advantage).

Three Common Configurations

• Original Medicare (A & B) alone
  • Add Part D separately if you need prescription coverage.
  • You pay Part B premiums and cost sharing (deductibles/coinsurance).
  • No annual out-of-pocket maximum; there is no MOOP under Original Medicare.
• Original Medicare + Part D + Medigap
  • Medigap may help cover some out-of-pocket costs from Parts A and B (plan designs vary by state and policy).
  • Part D remains a separate plan for prescriptions.
  • Typically broader national provider access where Medicare is accepted.
• Medicare Advantage (Part C)
  • Bundles A and B; many plans include Part D.
  • Uses networks (HMO, PPO, etc.); rules like prior authorization or referrals may apply.
  • Has an annual Maximum Out-of-Pocket (MOOP) for Part A/B services within the plan.
  • Benefits, costs, and extra features (e.g., routine vision/dental) vary by plan and county.

 Cost Considerations: Look Beyond the Premium

• Premiums: Everyone typically pays Part B; high-income enrollees may pay an income-adjusted amount per federal rules. Medicare Advantage may have an extra premium; Medigap and Part D have separate premiums.
• Deductibles and Coinsurance: Original Medicare includes cost sharing. Medigap can help cover certain amounts depending on the policy. Medicare Advantage sets copays/coinsurance by service within the plan.
• MOOP: Medicare Advantage plans include an annual MOOP for Part A/B services within the plan network; Original Medicare has no MOOP (Medigap can reduce exposure).
• Prescriptions: Part D costs depend on plan premiums, formularies, tiers, and pharmacies. Medicare Advantage plans that include drug coverage have their own formularies and rules.

Tip: Estimate total annual cost—premiums + likely copays/coinsurance + medications—based on your expected usage, not just the monthly premium.

Access and Networks: Keeping Your Doctors

• Original Medicare (with or without Medigap): Typically accepted by a wide range of providers who take Medicare.
• Medicare Advantage: Uses networks. Verify that your doctors, hospitals, and specialists participate and confirm rules for referrals and prior authorization. If you travel frequently or split time across states, check out-of-area coverage before you enroll.

Prescription Drug Coverage: Part D vs. MA-PD

• Part D (standalone): Pair with Original Medicare (with or without Medigap). Each plan has a formulary, tiers, and preferred pharmacies. Late enrollment penalties can apply if you delay without other creditable coverage.
• MA-PD (Medicare Advantage with drug coverage): Many MA plans include Part D-like benefits. Formularies, tiers, and pharmacy networks are plan-specific and can change annually.

Create a simple list of your medications (name, dosage, frequency) and verify coverage in the plan you’re considering.

Enrollment Windows: Timing Matters

• Initial Enrollment Period (IEP): 7-month window around your 65th birthday month.
• Annual Enrollment Period (AEP): Generally Oct 15 – Dec 7 for changes effective the next plan year.
• Medicare Advantage Open Enrollment Period (MA OEP): Generally Jan 1 – Mar 31 for people already in MA to switch plans or return to Original Medicare and join a Part D plan.
• Special Enrollment Periods (SEPs): Certain events (moving, loss of employer coverage, Extra Help eligibility, and others) may allow changes outside standard windows.

Rules and dates can vary; always confirm your eligibility and deadlines before making changes.

Medigap Nuances (High-Level)

Medigap policies are standardized in many states but not all. Pricing methods, eligibility windows, and guaranteed-issue rights differ by location and timing. Some states have special rules for switching or for people under 65 who qualify for Medicare due to disability. Medigap does not include Part D; you must add a separate drug plan for prescription coverage.

Decision Framework: Which Path Fits?

1. List your providers and facilities. If keeping specific doctors is a priority, confirm acceptance (Original) or network participation (MA).
2. Inventory prescriptions. Check each plan’s formulary and pharmacy network for your current medications.
3. Estimate usage. How often do you see specialists? Expect imaging or therapies? Build a simple 12-month cost model.
4. Consider travel and split-residence patterns. Original Medicare offers broad national access; MA networks vary.
5. Weigh predictability vs. flexibility. Medigap can reduce some variability under Original Medicare; MA caps A/B spending with a MOOP but may require authorizations and networks.
6. Review plan changes annually. Formularies, networks, premiums, and copays can change each year.

There is no universal “best.” The right choice depends on your health profile, budget, and preferences.

Common Mistakes to Avoid

• Choosing on premium alone. Low premiums can coincide with higher cost sharing elsewhere.
• Skipping drug coverage when needed. Delays can lead to penalties if you lack creditable coverage.
• Assuming your doctor is covered. Always verify networks and participation before enrolling.
• Ignoring plan rules. Prior authorizations, referrals, or out-of-area limitations can affect convenience and cost.
• Not reviewing annually. Needs evolve and plans change; revisit during AEP.