The Parts of Medicare

Medicare is built from several parts, each covering a different aspect of your healthcare. Here is what each one helps pay for.

A

Medicare Part A

Hospital Insurance
Part A helps cover the cost of:
Inpatient hospital stays
Skilled nursing facility care after a qualifying hospital stay
Hospice care
Limited home health services
Most people pay no monthly premium if they or their spouse worked and paid Medicare taxes for at least 10 years.
Keep in mind: Part A still has deductibles and coinsurance.
B

Medicare Part B

Medical Insurance
Part B covers:
Doctor visits & specialist appointments
Outpatient surgery
Preventive services
Lab work and diagnostic tests
Durable medical equipment
Physical therapy & many other outpatient services
Part B requires a monthly premium and generally includes an annual deductible and 20% coinsurance for most covered services.
D

Medicare Part D

Prescription Drug Coverage
Part D helps pay for:
Brand-name medications
Generic medications
Many vaccines and pharmacy benefits
Costs vary depending on the plan, the medications you take, and your pharmacy.
Original Medicare (Parts A + B)

Original Medicare (Parts A + B)

Original Medicare gives you broad access to providers nationwide who accept Medicare. However, it does not cover everything. You'll generally be responsible for deductibles, copayments, and coinsurance, and there is no annual out-of-pocket maximum for Parts A and B.

Broad access to any provider that accepts Medicare
You pay deductibles, copays, and coinsurance
No annual limit on out-of-pocket spending

Because of these gaps, many people choose additional coverage.

Two Ways to Fill the Gaps

Most people add one of these options to Original Medicare. Here's how they compare.

Option 1

Medicare Supplement (Medigap)

Medicare Supplement plans work alongside Original Medicare to help pay many of the out-of-pocket costs.
Advantages
Freedom to see any Medicare provider nationwide
Predictable medical costs
Excellent for frequent travelers or maximum provider flexibility
Lower out-of-pocket expenses when medical care is needed
Considerations
• Higher monthly premiums
• Usually requires a separate Part D prescription drug plan
• Dental, vision, hearing, and fitness benefits generally not included
Best for people who:
Visit doctors frequently • want predictable costs • travel often • prefer maximum provider choice.
Option 2

Medicare Advantage

Offered by private insurers approved by Medicare. Plans combine Part A and Part B, and many also include:
Prescription drugs
Dental
Vision
Hearing
Fitness benefits
Transport / OTC allowances
Advantages
Often low or $0 plan premiums (you still pay the Part B premium)
Extra benefits not included in Original Medicare
Annual maximum out-of-pocket limit for covered medical services
Considerations
• Provider networks may apply (HMO or PPO)
• Referrals may be required with some plans
• Out-of-pocket costs can rise if you need significant medical care
Best for people who:
Are generally healthy • want lower premiums • appreciate extra benefits • are comfortable using a network.

Which Option Is Better?

There isn't a one-size-fits-all answer — the right choice depends on your priorities.

Medicare Supplement may fit if you:

Want the broadest provider access
Travel frequently
Prefer predictable healthcare expenses
Expect ongoing medical care

Medicare Advantage may fit if you:

Want lower monthly premiums
Value extra benefits like dental and vision
Are comfortable with provider networks
Want an annual limit on covered medical expenses

Medicare Enrollment Periods

Knowing when you can sign up — or make changes — helps you avoid gaps in coverage and lifetime penalties.

1

Initial Enrollment Period (IEP)

Your first chance to sign up
A 7-month window centered around your 65th birthday:
The 3 months before the month you turn 65
The month of your 65th birthday
The 3 months after the month you turn 65
Tip: Signing up during the 3 months before you turn 65 ensures coverage starts on the first day of your birth month.
2

General Enrollment Period (GEP)

If you missed your IEP
If you missed your Initial Enrollment Period and don't qualify for a Special Enrollment Period:
When: January 1 – March 31 each year
Coverage starts: the first day of the month after you sign up
Note: You may have to pay a lifetime late-enrollment penalty for Part B and/or Part D if you delay.
3

Special Enrollment Period (SEP)

Qualifying life events
Enroll outside standard windows without penalty after a qualifying life event — most commonly, having employer-sponsored group coverage based on current employment when you turn 65.
When: anytime while covered by the group plan, or during the 8-month period beginning the month after employment or group coverage ends (whichever is first)
Other events: moving out of your plan's service area, losing Medicaid eligibility, or leaving incarceration
4

Annual Election Period (AEP)

Open Enrollment
Once enrolled in Medicare, you can change your coverage for the following year:
When: October 15 – December 7 each year
Switch between Original Medicare and Medicare Advantage, or change/add a Part D plan
Coverage starts: January 1 of the following year
5

Medicare Advantage Open Enrollment

A one-time change
If you are already enrolled in a Medicare Advantage plan, you have a dedicated window to make one change:
When: January 1 – March 31 each year
Switch to a different Advantage plan, or drop it and return to Original Medicare (adding a standalone Part D plan)

The Bottom Line

Choosing Medicare isn't about finding the "best" plan — it's about finding the best plan for your needs. Consider:

Your health conditions
Prescription medications
Preferred doctors & hospitals
Travel habits
Budget
Long-term healthcare goals

Get a Personalized Review

A licensed Medicare advisor can help you compare available plans in your area and determine which option aligns with your healthcare and financial needs.

Ready to Choose With Confidence?

The coverage decisions you make today shape your healthcare and finances tomorrow. Let our licensed advisors guide you toward informed Medicare choices.

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