Medicare Basics: What You Need to Know About Medicare Advantage & Supplemental Plans

Navigating Medicare can feel overwhelming at first—but it doesn’t have to be. Whether you're approaching age 65 or helping a loved one understand their options, knowing the basics can help you make confident decisions about healthcare coverage. In this article, we'll break down what Medicare is, what it covers, and why many people choose to add a Medicare Advantage or Medicare Supplement (Medigap) plan for more complete protection.

What Is Medicare?

Medicare is a federal health insurance program primarily for:

• People age 65 and older

• People under 65 with certain disabilities

• Individuals with End-Stage Renal Disease (ESRD)

It’s divided into four parts:

Part	What It Covers
Part A	Hospital insurance (inpatient care, skilled nursing, hospice)
Part B	Medical insurance (doctor visits, outpatient care, durable medical equipment)
Part C	Medicare Advantage (an alternative to Original Medicare with extra benefits)
Part D	Prescription drug coverage

Why Original Medicare May Not Be Enough

Original Medicare (Parts A & B) provides essential coverage, but it doesn’t cover everything. It has:

• No out-of-pocket maximum (which means you don't have a cap on what you could owe in a catastrophic event).

• No prescription drug coverage

• No coverage for dental, vision, or hearing

• 20% coinsurance on most Part B services, with no cap

That’s why many beneficiaries look at either a Medicare Advantage Plan (Part C) or a Medicare Supplement Plan (Medigap) to fill the gaps.

Option 1: Medicare Advantage (Part C)

A Medicare Advantage Plan is a private insurance plan approved by Medicare that replaces your Original Medicare coverage. These plans often bundle hospital, medical, and drug coverage into one plan—and may offer additional benefits.

✅ Pros:

• Includes Part A, Part B, and usually Part D

• May offer extra benefits like dental, vision, hearing, gym memberships, or transportation

• Many plans have $0 premiums

• Annual out-of-pocket max (unlike Original Medicare)

⚠️ Considerations:

• You must use the plan’s network of doctors

• You may need referrals for specialists

• Coverage and costs vary by location and plan

  
  

Option 2: Medicare Supplement Plans (Medigap)

Medigap plans work alongside Original Medicare to help cover costs like copayments, coinsurance, and deductibles. They do not include drug coverage, so you’ll need a Part D plan separately.

✅ Pros:

• See any doctor nationwide who accepts Medicare

• Predictable out-of-pocket costs

• Great for people who travel frequently or need flexibility

⚠️ Considerations:

• Higher monthly premiums

• Must buy Part D separately

• Medigap plans do not include extras like dental, vision, or wellness

Enrollment Timing Matters

You have a 7-month Initial Enrollment Period (IEP) starting 3 months before the month you turn 65 and ending 3 months after. Missing deadlines could mean penalties or limited options.

There’s also the Annual Enrollment Period (AEP) from October 15 to December 7, where you can switch or enroll in Medicare Advantage or Part D plans.

Final Thoughts

Understanding your Medicare options is key to protecting your health and finances. Whether you’re exploring Medicare Advantage for all-in-one convenience or a Supplement plan for greater flexibility, there’s no one-size-fits-all approach—it depends on your health, lifestyle, and budget.

Need Help Navigating Medicare? As a licensed insurance professional, I specialize in simplifying the Medicare process and helping you choose the plan that fits your needs. I’ll walk you through your options, explain the fine print, and ensure you're making the best choice for your future.

Contact me today for a consultation or Medicare review.