Medicare plans, explained.
The whole system in plain English — the four parts of Medicare, the two ways to put your coverage together, and how to choose the path that fits your doctors, your prescriptions, and your budget. No jargon, no pressure. Just clarity.
The four parts of Medicare
Medicare comes in four parts, each covering a different kind of care. Learn what each letter does and the rest of the system falls into place. Parts A and B together are called Original Medicare; Parts C and D are the private pieces you add.
Your hospital coverage. Most people pay no premium for it.
- Inpatient hospital stays
- Skilled nursing care
- Hospice care
- Some home health
Your everyday outpatient care. Has a monthly premium.
- Doctor visits
- Preventive screenings
- Lab tests & equipment
- Outpatient procedures
An all-in-one private alternative to Original Medicare.
- Includes Parts A & B
- Usually includes drugs
- Often adds extras
- Uses a network
Prescription drug coverage through private plans.
- Covers medications
- Each plan has a drug list
- Stand-alone or bundled
- Penalty if you delay
Parts A and B are the government foundation. From there you either add a drug plan and a supplement, or you pick one private Medicare Advantage plan that bundles it all — that single choice is the whole decision.
Original Medicare is where everyone starts
Original Medicare is Parts A and B together, run by the federal government and accepted by nearly every doctor and hospital in the country that takes Medicare. It pays a large share of your care — but it has two gaps that shape your next decision.
The 20% with no cap
After your deductibles, you generally pay 20% of most Part B costs — and Original Medicare puts no yearly limit on that. A serious illness can get expensive fast.
No drug coverage
Original Medicare doesn’t include prescriptions. You add Part D — on its own, or built into a Medicare Advantage plan.
How you fill the gaps
You either keep Original Medicare and add coverage on top, or replace it with an all-in-one plan. Those are the two paths — next.
Two ways to complete your Medicare
Once you have Parts A and B, you choose one of these two paths — not both. Here’s how each is built, then a side-by-side of how they actually differ.
- Built by: keeping Original Medicare and adding a Part D drug plan plus a Medicare Supplement (Medigap).
- Doctors: any provider nationwide that accepts Medicare — no networks.
- Costs: very predictable — the supplement pays most of what Medicare leaves.
- Best for: freedom to see any doctor and the most predictable bills.
- Built by: one private plan that replaces Original Medicare and bundles it together.
- Doctors: usually a network (HMO or PPO); referrals may be required.
- Costs: often a low plan premium, with copays as you go up to a yearly maximum.
- Best for: bundled extras and being comfortable using a network.
| How they compare | Original Medicare + MedigapPath 1 | Medicare AdvantagePath 2 · Part C |
|---|---|---|
| How it works | Adds to Original Medicare and pays its gaps | Replaces Original Medicare with one private plan |
| Doctors & hospitals | Any that accept Medicare, nationwide | Usually a network (HMO or PPO) |
| Referrals | Not needed | May be required for specialists |
| Prescription drugs | A separate Part D plan you choose | Usually built into the plan |
| Dental, vision, hearing | Added through separate coverage | Often included |
| Cost pattern | Predictable — premium, then little else | Lower premium, copays as you use care |
| Yearly out-of-pocket cap | Effectively handled by the supplement | Built-in maximum |
| Travel-friendly | Works anywhere in the U.S. | Best within the plan’s service area |
You can’t combine the two — a Medigap policy can’t be used with a Medicare Advantage plan. It’s one path or the other, and we’ll help you weigh which one fits your life.
Where Part D fits in
Part D is prescription drug coverage, offered through private plans. Because each plan covers a different list of drugs, the right one depends on the exact medications you take.
Two ways to get it
As a stand-alone plan alongside Original Medicare, or built into a Medicare Advantage plan. You generally won’t have both at once.
It’s about your drug list
Each plan has a formulary — its covered drugs in cost tiers. Matching your prescriptions to the right formulary is where the savings are.
Sign up on time
Going without creditable drug coverage after you’re eligible can bring a lifelong penalty — even if you don’t take many prescriptions yet.
How to actually choose your path
There’s no single “best” way to do Medicare — only the best fit for you. These four questions usually point the direction.
How much doctor freedom do you want?
If keeping any doctor nationwide with no networks matters, that points one way.
→ Lean Original Medicare + MedigapDo you want extras bundled in?
If built-in dental, vision, and hearing appeal to you, that points the other.
→ Lean Medicare AdvantagePredictable costs, or lower premium?
Pay a bit more monthly for very few bills, or less monthly with copays as you go?
→ Predictable? Path 1. Lower premium? Path 2.Do you travel or split states?
Frequent travel favors coverage that works anywhere; staying local opens more options.
→ Travel a lot? Lean Original Medicare + MedigapYour 6-month Medigap Open Enrollment Period — starting the month you’re 65 and enrolled in Part B — is the one window when no carrier can deny you or charge more for your health. If you might ever want a supplement, this window is the safest time to get it. Missing it can mean health questions later.
The enrollment windows that matter
Medicare runs on specific windows — and missing one can mean lifelong penalties. Here are the key ones; we’ll map your exact dates.
Initial Enrollment Period
A 7-month window around your 65th birthday — the 3 months before your birthday month, that month, and the 3 months after.
Medigap Open Enrollment
A one-time 6-month window starting when you’re 65 and on Part B — buy any supplement with no health questions.
Annual Enrollment Period
Change your Medicare Advantage or Part D coverage for the coming year — a great time for a plan review.
Advantage Open Enrollment
Already in a Medicare Advantage plan? You get one chance to switch or return to Original Medicare.
Every piece, one line each
Not sure which path is right? Let’s figure it out together.
Tell us about your doctors, your prescriptions, and your budget, and we’ll compare both paths and 30+ A-rated carriers — then recommend the best fit for you. No cost, no pressure, no carrier bias. Just a straight answer.
May River Medicare Insurance is an independent agency and is not affiliated with or endorsed by the U.S. government, the federal Medicare program, or CMS. We do not offer every plan available in your area; any information we provide is limited to the plans we offer. Plan availability, benefits, premiums, and provider networks vary by ZIP code and carrier, and you must continue to pay your Medicare Part B premium. For a complete list of your options, contact Medicare.gov or 1-800-MEDICARE.