Medicare Plans
The main pieces of Medicare, what each one handles, and what I check before any plan earns a spot on your shortlist.
The Pieces of Medicare I Walk You Through
Medicare is really a handful of separate programs and policies. Here is what each one does, in the words I would use across the table from you.
Hospital coverage
The hospital side of Original Medicare. It helps with inpatient stays, skilled nursing care after a hospital visit, hospice and some home health care.
Medical coverage
The medical side handles doctor visits, outpatient care, lab work, screenings and equipment your doctor orders. Most people pay a monthly premium for it.
Medicare Advantage
Private plans that bundle hospital and medical coverage together, often with drug coverage and extras. Most rely on a network, so where you get care matters.
Prescription drug plans
Stand alone drug coverage for people who keep Original Medicare. Every plan has its own list of covered medicines and its own set of price tiers.
Medicare Supplement
Policies that sit beside Original Medicare and pick up costs it leaves behind, like deductibles and coinsurance. They are standardized, so the same type buys the same benefits.
Help with costs
Savings programs and extra help with drug costs exist for people on tighter incomes. I check whether you might qualify before any comparison begins.
Original Medicare or a Bundled Plan
Original Medicare Route
The government run program, usually paired with a supplement policy and a separate drug plan.
- See any doctor in the country who accepts Medicare
- Higher monthly premiums, fewer surprises at the counter
- Drug coverage bought as its own plan
- No referral needed to see a specialist
Medicare Advantage Route
A private plan that rolls hospital, medical and usually drug coverage onto a single card.
- Monthly premiums that are often lower
- Doctor networks and sometimes referrals
- Copays as you go, with a limit on what you pay out of pocket
- Extras such as dental, vision or hearing on many plans
Neither road is better for everyone. The right one depends on your doctors, how often you travel and how you prefer to pay for care.
Not Sure Which Road Fits You?
Share your doctors and medicines with me and I will hold both routes up against them for you.
Send Your DetailsWhat I Check Before a Plan Makes the List
A plan only reaches your shortlist once it clears every one of these. If it fails one, I tell you which and why.
Your doctors, one by one
Each doctor and specialist you see gets looked up in the plan network. If a favorite doctor sits outside it, that plan drops off the list.
Every medicine you take
I look at the tier, any quantity limits and whether an approval step stands between you and each prescription.
Your preferred pharmacy
Some plans reward certain pharmacies with lower prices. I make sure the one closest to you is not the costly option.
Cost across a whole year
Premiums tell only part of the story. I add up deductibles, copays and drug costs to show what an ordinary year might really cost.
Travel and time away
If you spend part of the year somewhere else, I check how a plan treats care away from home before going further.
Extras that matter to you
Dental, vision and hearing benefits vary widely between plans. I only weigh them when you tell me they matter.
When You Can Sign Up or Switch
Medicare only opens its doors at certain times. Knowing which window applies to you keeps penalties and gaps away.
When you first qualify
A window opens around the month you become eligible. Signing up during it keeps late enrollment penalties off the table for most people.
The fall review season
Each fall, anyone with Medicare can switch plans, drop a plan or add drug coverage, with the changes taking effect as the new year begins.
A second look for Advantage
If a Medicare Advantage plan is not working out, there is a window early in the year to change plans or return to Original Medicare.
After something big happens
Moving, losing job based coverage or qualifying for help with costs can open a special window outside the usual seasons.