Medicare Plan Types
There are several ways to get Medicare coverage. Here's what each one means for you.
Medicare Advantage (Part C)
Replaces Original Medicare. Offered by private insurers. Often includes drug coverage and extra benefits like dental and vision.
Medicare Supplement (Medigap)
Works alongside Original Medicare to cover your out-of-pocket costs like copays, coinsurance, and deductibles.
Part D Drug Plans
Standalone prescription drug coverage to pair with Original Medicare or Medigap. Avoid the late enrollment penalty.
Medicare Advantage Plans
Medicare Advantage plans are offered by private insurers approved by Medicare. They bundle hospital, medical, and often drug coverage into one plan.
What Medicare Advantage Covers
- All Original Medicare (Part A & B) benefits
- Prescription drug coverage (most plans)
- Dental, vision, and hearing (many plans)
- Fitness benefits like gym memberships
- Transportation to medical appointments (some plans)
- Over-the-counter allowances (some plans)
Key Facts
- Many plans have $0 monthly premium
- Must use plan's network of doctors
- Referrals required for specialists (HMO plans)
- Out-of-pocket maximum protects you from large bills
- Plans vary significantly by ZIP code
Best for: People who want an all-in-one plan with extra benefits and don't mind using a network.
Medigap Plans
Medigap fills the gaps in Original Medicare — covering copays, coinsurance, and deductibles so you're not hit with unexpected bills.
How Medigap Works
You keep Original Medicare (Parts A & B) and add a Medigap policy from a private insurer. When you get care, Medicare pays first and Medigap covers what's left — sometimes up to 100% of your costs.
- See any doctor that accepts Medicare — no networks
- No referrals needed for specialists
- Standardized plans (Plan G, Plan N most popular)
- Guaranteed renewable — can't be cancelled for health reasons
- Add a separate Part D plan for drug coverage
Most Popular Plans
| Plan | Part A Coins. | Part B Coins. | Part B Ded. |
|---|---|---|---|
| Plan G | ✓ | ✓ | ✗ |
| Plan N | ✓ | ✓* | ✗ |
| Plan F | ✓ | ✓ | ✓ |
*Plan N has copays up to $20 for office visits. Plan F only for those eligible before Jan 1, 2020.
Medicare Part D Plans
Part D adds prescription drug coverage to Original Medicare or Medigap. Without it, you could face a lifetime penalty for late enrollment.
What You Need to Know About Part D
- Covers brand-name and generic prescription drugs
- Each plan has a formulary (list of covered drugs)
- Plans vary by premium, deductible, and drug costs
- Low-income subsidy (Extra Help) available for qualifying individuals
- Late enrollment penalty if you don't sign up when first eligible
Don't Miss Your Enrollment Window
If you don't enroll in Part D when first eligible and don't have other creditable drug coverage, you'll pay a permanent late enrollment penalty added to your monthly premium for as long as you have Part D.
Medicare Eligibility
Most Americans qualify for Medicare at 65, but there are other qualifying situations.
Age Eligibility
You're eligible for Medicare when you turn 65, whether or not you're retired. Enrollment begins 3 months before your 65th birthday.
Disability Eligibility
If you've been receiving Social Security Disability Insurance (SSDI) for 24 months, you automatically qualify for Medicare regardless of age.
Kidney Disease
People with End-Stage Renal Disease (ESRD) or ALS (Lou Gehrig's disease) qualify for Medicare at any age.
Medicare Enrollment Periods
Initial Enrollment Period
7-month window — starts 3 months before you turn 65, includes your birthday month, and ends 3 months after. Best time to enroll.
Annual Enrollment Period
October 15 – December 7 each year. Switch between Medicare Advantage and Original Medicare, or change your Part D plan.
Special Enrollment Period
If you delayed Medicare because you had employer coverage, you get a Special Enrollment Period when that coverage ends.