Medicare is a federal health insurance program designed for older adults and younger people with certain disabilities. Its purpose is to make sure you can afford the medical care you need to age well—such as doctor visits, hospital stays, and medications. While Medicare is important, it’s not always straightforward. In this article, we explain the different parts of Medicare, the costs to consider, and how to decide what coverage is right for you.

Original Medicare and Part D vs. Medicare Advantage

When you enroll in Medicare, there are three options that will providde you iwth broad medical and prescription drug coverage:

• Parts A and B (original Medicare), Part D (prescription drug coverage), and potentially Medigap (supplemental coverage)
• Medicare Advantage (Part C) and Part D
• Medicare Advantage

When comparing coverages, it is important to look at the two main options first: original Medicare and Medicare Advantage. Note that Medicare Advantage plans are sold by private insurers and come in many types (the most common are HMO and PPO). These plans must cover the same benefits as original Medicare and often provide additional benefits as well.

You'll also want to consider the potential benefits of adding a Medigap policy to original Medicare, since it can help you cover some of the out-of-pocket costs of Parts A and B. It is not possible to have both a Medigap policy and a Medicare Advantage plan.

Part D is the Medicare standalone prescription drug benefit that, like Medicare Advantage, is sold by private insurers.

Costs and coverages differ between the various Medicare plans. It's a good idea to take a "big picture" look at all your options, taking into account desired coverage, premiums, and routine out-of-pocket costs. When deciding which Medicare coverage option to choose, here are some questions to ask: 

Which option is more stable from year to year? 

Each year, Medicare Advantage plans choose if they want to stay in the. Medicare program. They can also change their costs, health care providers, and benefits each calendar year. Original Medicare will always be there, but its deductibles and premiums may increase each year. 

How can I measure quality for the various plans? 

Medicare uses a five-star rating system to review the quality of Medicare Advantage and Part D plans:

• Five stars is "excellent"
• Four stars is "above average"
• Three stars is "average"

These ratings are based on a variety of factors, including how well the plans help members manage chronic diseases, member satisfaction and how often members get screening exams and vaccines, among others. The ratings are posted on the Medicare plan finder at Medicare.gov.

What are the cost differences? 

If you have original Medicare, your out-of-pocket costs include the Medicare Part A deductible and coinsurance and the Part B premium, deductible, and coinsurance. Part B coinsurance is generally 20% of the cost for a service.

If you’re enrolled in Part D, your costs may include the Part D premium, deductible, and copayments. Many beneficiaries purchase supplemental Medigap insurance to cover some of their out-of-pocket costs. 

If you're enrolled in a Medicare Advantage plan, your out-of-pocket costs may include the Medicare B premium, Medicare Advantage premium, copayments, and deductibles. The costs of these plans vary, as do the benefits they offer. Medicare Advantage plans may have lower out-of-pocket costs than original Medicare because they have a cap on annual out-of-pocket spending. But limits vary by plan and can be fairly high. The maximum out-of-pocket limit is $8,850 in 2024. This limit generally does not include Part D prescription drugs costs. 

How do I get fair, unbiased Medicare advice?

If you’re wondering, “Who can help me choose the right Medicare plan?”, the good news is there are several ways to get impartial guidance from people who know the program inside and out. We’ve outlined some options below.

Medicare Brokers That Meet NCOA’s Standards of Excellence

If you’re wondering, “Who can help me choose the right Medicare plan?”, NCOA can help. One option is reaching out to one of the licensed Medicare advisors who meet NCOA's strict Medicare Standards of Excellence.

We’ve partnered with trustworthy Medicare brokers who can help you be confident in the enrollment choices you make. Each one has gone through our intensive training and certification process, allowing them to provide in-depth Medicare education and practical decision-making support. Best of all? Talking to one of our broker partners costs you nothing. Learn more.