Updated on 3/13/2023

Medicare 101

Below are the parts of Medicare; what they are and what they cover.  By clicking on each part's associated link, you'll be able to dive deeper into the details of each part including your out of pocket expenses for each covered service.  A little further down this page we explain your plan choices and give you the pros and cons of each plan type.

Not sure which Medicare option is right for you? 

Let's take a closer look at the pros and cons of Medicare supplements and Medicare Advantage plans.

Pros and Cons of Medicare Supplement (a.k.a. "Medigap") plans

Medicare supplement plans do exactly what the name suggests: they supplement the health care costs not covered by Medicare. Some people mistakenly assume that Medicare supplement plans offer benefits beyond what Medicare covers. The truth is that Medicare supplement plans follow Medicare benefits like a train and caboose. If Medicare covers a procedure or service, then a Medicare supplement plan will cover the same procedure or service - paying the portion that you are responsible for up to plan limits. Medicare supplement plans are standardized, meaning they offer the same benefits and provider choices regardless of the insurance company.  Medicare supplement plans are identified by letters A through N (click here for an overview of Medicare supplement plans and benefits). Premiums are the only difference between Medicare supplement plans with the same letter sold by different insurance companies. The main reason why these plans are popular is because of their portability in that a policy holder can take their plan anywhere in the U.S. to any provider who accepts Medicare.  There are no network restrictions and there are no referrals required to see specialist doctors. Medicare supplement plans in general offer more freedom and flexibility compared to Medicare Advantage plans.

Click here to get a free quote for Medigap plans offered in your area.

Things to consider regarding Medicare supplements

Medicare supplement plans have premiums that tend to be higher than Medicare Advantage plans and the premiums typically increase as you get older. You will also need to enroll in a standalone prescription drug plan in order to receive Part D prescription drug benefits (click here to find out more about Part D). 

Pros and Cons of Medicare Advantage plans

Medicare Advantage plans have become popular over the years for a variety of reasons. Most notably the premiums can be considerably lower than Medicare supplement plans and most include Part D coverage - so there is no need to purchase a standalone drug plan. Copays are fairly nominal under most plans for everything from doctor office visits to diagnostic testing, rehabilitation, outpatient surgeries and inpatient hospitalization. Plus they may also include extra benefits for things that Medicare doesn’t cover like dental, vision, chiropractic and acupuncture. Many also have free gym memberships to help keep their members active and healthy. Some Medicare Advantage plans will also offer free transportation to and from doctor office visits and other medically related appointments (including to and from the pharmacy).

Things to consider regarding Medicare Advantage plans

With a few exceptions, Medicare Advantage plans are network based plans. A majority of Medicare Advantage plans are HMO’s which tend to be very network restrictive. As with most HMO plans, if you go out of the network for routine care you will be responsible for the entire cost (NOTE: emergency care is covered in-network for all Medicare plans regardless of where it occurs). There are Medicare Advantage PPO plans offered in a few areas, but they tend to have higher premiums and out-of-pocket costs (i.e.: deductibles, copays and co-insurance) compared to their HMO counterparts.  Even though PPO plans will cover you in the event that you want to see an out of network provider, the out of network costs are typically 50% of charges – which could be too steep for some people. One other thing you want to be especially aware of is the “Out of Pocket Maximum” (sometimes referred to as the "Annual Out of Pocket Maximum" or "Maximum Out of Pocket", etc.). This is the most you could be responsible for in a given year for health care costs.  Ideally, if you do choose a Medicare Advantage plan you will want a plan with an Out of Pocket Maximum as low as possible. 

A word of caution

By now you've probably seen a barrage of advertisements in which an older celebrity or ex-athlete is telling you to "call the number on your screen to get the extra Medicare benefits your deserve".  It's what these advertisements are not telling you which you should be concerned about.  Those toll free numbers go to a call center somewhere (some of them are even out of the U.S.) where you'll be pressured into enrolling in a plan that may not be in your best interest.  Medicare Advantage isn't right for everyone and without proper guidance you could find yourself in a situation where none of your doctors will accept your plan and your prescription drug costs could soar.  This is why it is so important to speak with a licensed agent who is also certified annually to offer Medicare Advantage plans.  A good agent will research your preferred medical providers as well as your prescription drug costs to make sure there are no obstacles for you to receive the best health care possible.  Your premiums and out of pocket costs will be the same no matter if you enroll with an agent, direct with an insurance carrier or through any other source.

To speak to an unbiased, licensed and certified health insurance agent about your Medicare plan options, click here or call (877) 888-6315.  It's free and there's never any pressure or obligation to enroll.  We are located in Glendale, CA; we service California, Arizona, Nevada, Oregon and Washington State.

Medigap or Medicare Advantage?  Find out which plan option is best for you by answering these quick questions:

Have Questions?

We’re here to help guide you through the Medicare Maze!

Call now: (877) 888-6315