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Before You Begin
Before we get started, we recommend reviewing our brief Medicare overview to help you understand your options. This is completely optional, but many of our clients find it helpful.
Medicare Quick Guide
Tap each section below to learn more about the different parts of Medicare.
Medicare is the federal health insurance program for people 65 and older, and certain younger people with disabilities.
Part A (Hospital Insurance) covers hospital stays, hospice care, and skilled nursing facility care. Most people pay no premium for Part A if they or their spouse paid Medicare taxes for at least 10 years.
Part B (Medical Insurance) covers doctor visits, specialist visits, and outpatient services. The 2026 standard monthly premium is $202.90, with an annual deductible of $283.
Important: Original Medicare (Parts A & B) only covers about 80% of your medical expenses. It does not cover prescription drugs, dental, vision, or hearing.
Medicare Advantage (also called Part C) is an alternative to Original Medicare offered by private insurance companies approved by Medicare.
- Low or no monthly premiums — the government pays into these plans through taxes.
- Copays for doctor visits, specialists, and hospital stays instead of the 20% coinsurance.
- Can include extras like dental, vision, hearing, and over-the-counter (OTC) benefits.
- Many plans include prescription drug coverage (called MAPD plans).
- Max out-of-pocket protection — limits your total yearly costs.
- Network-based — HMO plans have lower copays; PPO plans offer more flexibility.
- No medical underwriting — you cannot be denied coverage.
Medigap (Medicare Supplement) plans help pay the costs that Original Medicare does not cover, like copays, coinsurance, and deductibles.
- No networks — see any doctor or specialist that accepts Medicare, anywhere in the country.
- Higher monthly premiums than Medicare Advantage, but generally lower out-of-pocket costs when you receive care.
- Plan G is the most popular — covers nearly everything except the annual Part B deductible ($283).
- Plan N has a lower premium but includes copays of up to $20 for doctor visits and $50 for ER visits.
- Medical coverage only — you will need a separate Part D plan for prescriptions.
- Guaranteed Issue for the first 6 months after enrolling in Part B. After that, medical underwriting may apply.
Part D is Medicare's prescription drug coverage. It is offered by private insurance companies approved by Medicare.
- Helps cover the cost of prescription medications.
- Each plan has its own list of covered drugs (called a formulary) and its own costs.
- If you have a Medigap/Medicare Supplement plan, you will need a standalone Part D plan for drug coverage.
- Many Medicare Advantage plans already include Part D coverage (MAPD).
- Premium
- The monthly amount you pay for your insurance coverage, regardless of whether you use medical services.
- Deductible
- The amount you pay out of pocket before your insurance starts to cover costs. For example, the 2026 Part B deductible is $283 per year.
- Copay
- A fixed amount you pay for a covered service, like $20 for a doctor visit or $40 for a specialist.
- MOOP (Maximum Out-of-Pocket)
- The most you will pay for covered services in a year. After you reach this limit, your plan pays 100% of covered services.
- Star Rating
- Medicare rates plans on a scale of 1 to 5 stars based on quality and performance. Plans with 4 or more stars are considered high quality.
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