Medicare is the Federal Health Insurance program for people 65 years and older as well as younger people with special circumstances. While funded in part by taxes, Medicare is not free and it doesn’t cover everyone’s needs.
We’re here to help you navigate everything you need to know about Medicare — from what it covers, to what it doesn’t, when to enroll, and how to choose the best plan for you.
Original Medicare consists of two parts that provide a good foundation for hospital and medical expenses.
Part A (Hospital Insurance)
Covers hospital stays, skilled nursing care, hospice care, and some home health care. Most people don’t pay a premium for Part A if they or their spouse paid Medicare taxes while working.
Part B (Medical Insurance)
Covers outpatient services, such as doctor visits, lab tests, and preventive services. Part B typically requires a monthly premium.
What’s Missing from Original Medicare?
Parts A and B don’t account for important services like dental, vision, and hearing. They also don’t limit out-of-pocket expenses, and can can become costly due to deductibles and coinsurance.
Medicare Supplement (Medigap) or Medicare Advantage plans are designed to:
Making the right choice will depend on your age, healthcare needs, budget, and preferences.
Maximize Your Medicare Benefits
Explore and compare the most common ways retirees get additional coverage alongside Medicare
Do You Have Medicare & Medicaid? Or Chronic Illness?
You may qualify for additional health benefits at lower premiums.
A Medicare Special Needs Plan (SNP) is a type of Medicare Advantage Plan (like an HMO or PPO). SNPs offer tailored benefits and services to individuals with specific chronic conditions, severe diseases, particular healthcare needs or those who are also eligible for Medicaid.
Most common is a Dual Eligible SNP (DSNP), which may provide additional vision and hearing coverage plus other benefits with lower premiums. To be eligible you must be enrolled or eligible for Medicare Part A and meet certain income and asset requirements.
When To Enroll in Medicare
You can enroll in Medicare at different times, depending on your situation.
Your IEP begins 3 months before you turn 65, includes the month you turn 65, and ends 3 months after your 65th birthday.
This is your first chance to enroll in Medicare when you first become eligible. You can sign up for Part A (hospital insurance) and Part B (medical insurance) during this 7-month window. If you don’t enroll during this period, you may face late enrollment penalties or gaps in coverage.
GEP occurs every year from January 1 to March 31.
If you missed your Initial Enrollment Period, you can sign up for Medicare Part A and Part B during the General Enrollment Period. However, if you enroll during the GEP, your coverage will begin July 1, and you may face late enrollment penalties.
If you are already enrolled in a Medicare Advantage plan, this period — from January 1 to March 31 each year — allows you to switch to another Medicare Advantage plan or return to Original Medicare with or without a Part D plan.
OEP happens annually from October 15 to December 7.
During this period, you can make changes to your Medicare Advantage (Part C) or Part D prescription drug plan, such as switching plans, enrolling in a new plan, or dropping your current plan. The changes you make will take effect on January 1 of the following year.
SEP applies if you have delayed enrollment due to employer-sponsored insurance (either your own or a spouse’s). It allows you to sign up for Medicare Part A and/or Part B any time you are still covered by the employer insurance, or during the 8-month period after the employment or insurance ends.
You won’t face late enrollment penalties if you enroll during this period. The SEP also applies to people who have been working past 65 and had employer health coverage.
A Brief Overview of Medigap Insurance
Original Medicare doesn’t pay the entire cost of covered health care services and supplies. A Medigap policy is an insurance policy that helps fill “gaps” in Original Medicare. Sold by private companies, Medigap policies help cover otherwise out-of-pocket expenses, like copayments, coinsurance, and deductibles.
Some Medigap policies also offer coverage for services that Original Medicare doesn’t cover, like medical care when you travel outside the U.S.
Frequently Asked Questions
Below are answers to the most common questions people have about Medigap.
Yes. You must have Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance).
The best time to buy a Medigap policy is during your Medigap Open Enrollment Period. This period lasts for 6 months and begins on the first day of the month you are 65 or older and enrolled in Medicare Part B.
During your Medigap Open Enrollment Period, you have the right to buy any Medigap policy offered in your state. In addition, you generally will get better prices and more choices among policies. If you apply for Medigap coverage after your Open Enrollment Period, there’s no guarantee that an insurance company will sell you a Medigap policy if you don’t meet the medical underwriting requirements.
A Medigap policy is different from a Medicare Advantage Plan because those plans are another way to get your Part A and Part B benefits, while a Medigap policy only helps pay for the costs that Original Medicare doesn’t cover. Insurance companies generally can’t sell you a Medigap policy if you have coverage through a Medicare Advantage Plan or Medicaid.
All Medigap policies must follow federal and state laws designed to protect you, and policies must be clearly identified as “Medicare Supplement Insurance.” Medigap policies are standardized, and in most states are named by letters, Plans A-N. Each standardized Medigap policy under the same plan letter must offer the same basic benefits, no matter which insurance company sells it. A licensed agent can walk you through each plan to select the best one for you.
Although some Medigap policies sold in the past covered prescription drugs, Medigap policies sold after January 1, 2006 aren’t allowed to include prescription drug coverage. If you want drug coverage, you can join a Medicare Part D drug plan offered by private companies approved by Medicare.
If you have a Medicare Advantage Plan but are planning to return to Original Medicare, you can apply for a Medigap policy before your coverage ends. The Medigap insurance company can sell it to you as long as you’re leaving the Medicare Advantage Plan. Ask that the new Medigap policy start when your Medicare Advantage Plan enrollment ends, so you’ll have continuous coverage.
Original Medicare vs. Medicare Advantage
There are two main ways to get Medicare. Original Medicare includes Medicare Part A (Hospital Insurance) and Part B (Medical Insurance). Medicare Advantage is a Medicare-approved plan that offers an alternative to Original Medicare for your health and drug coverage — these “bundled” plans include Part A, Part B, and usually Part D. See the key differences below.
Original Medicare
Medicare Advantage
Original Medicare
Medicare Advantage
Original Medicare
Medicare Advantage
Original Medicare
Original Medicare generally doesn’t cover care outside the U.S. You may be able to buy a Medicare Supplement Insurance (Medigap) policy that covers emergency care outside the U.S.
vs.
Medicare Advantage
Plans generally don’t cover care outside the U.S. Some plans may offer an additional benefit that covers emergency and urgently needed services when traveling outside the U.S.
Which Type of Plan Is Right for You?
Choosing between Medigap and Medicare Advantage depends on your specific healthcare needs, preferences, and financial situation. Here’s a quick comparison:
| Medicare Supplement (Medigap) | Medicare Advantage | |
|---|---|---|
|
Coverage |
Fills gaps in Original Medicare (Parts A & B). |
Combines Parts A, B, and D, plus extra benefits (dental, vision, etc.). |
|
Prescription Drugs |
Requires a separate Part D plan. |
Typically includes Part D coverage. |
|
Out-of-Pocket Costs |
Generally higher premiums, but fewer out-of-pocket costs for services. |
Lower premiums but out-of-pocket costs for services (copayments, coinsurance). |
|
Flexibility |
No network restrictions; see any doctor that accepts Medicare. |
Typically requires you to use network providers (except PPO plans). |
|
Additional Benefits |
No extra benefits; covers only what Medicare doesn’t. |
Includes additional benefits (dental, vision, hearing, wellness). |
|
Travel Coverage |
Some plans cover emergency care abroad. |
Limited coverage abroad. |
|
Plan Type |
Supplementary; works alongside Original Medicare. |
All-in-one plan that replaces Original Medicare. |
Unpack the differences between Medigap and Medicare Advantage, see how they each work, and decide which path meets your goals best in our guide: Supplemental Insurance vs Medicare Advantage: Which Is Right for You?
Don’t do it alone. In addition to educating yourself about your Medicare options, discuss your needs and priorities with a licensed agent before deciding on your Medicare strategy.
My Guide to Retirement helps you find your own path to a healthier retirement by explaining all of your Medicare options and alternatives — so you can discover a strategy that will work best for you.
Discover the key differences between Medicare Advantage and Supplemental Insurance (Medigap). Learn how each option works and which might be best for your healthcare needs.
Learn about Medicare supplement insurance costs, including premiums and out-of-pocket expenses, to better budget your healthcare needs.
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