Navigating Medicare: How to Choose the Right Coverage

Navigating Medicare: How to Choose the Right Coverage

Choosing the right Medicare coverage is a critical decision for older adults. When you first become eligible for Medicare (typically at age 65), you have two main options: Original Medicare (Parts A and B) or a Medicare Advantage plan (Part C). The best choice depends on your healthcare needs, budget, and preferences. Below, we break down key considerations and steps to navigate your Medicare options.

Understanding Your Medicare Options

Original Medicare includes Part A (hospital insurance) and Part B (medical insurance). It covers a broad range of services but does not include prescription drugs, dental, vision, hearing aids, or long-term care. You can purchase supplemental coverage for these.

Medicare Advantage is an “all-in-one” alternative offered by private insurers, often bundling Part A, Part B, and Part D (drug coverage), along with extra benefits like dental, vision, and wellness programs. However, these plans typically use provider networks and may require referrals.

Original Medicare offers nationwide provider access and no need for referrals, but lacks a cap on out-of-pocket costs. Medicare Advantage must include an annual out-of-pocket limit—$8,850 in-network for 2025.

Compare plans here.

Costs and Supplemental Coverage

Original Medicare requires a monthly Part B premium (standard $164.90 in 2023) and out-of-pocket costs like deductibles and 20% coinsurance. Many people add a Medigap policy to help cover these costs. Medigap plans only work with Original Medicare—not Medicare Advantage—and have their own premiums.

Medicare Advantage plans may offer $0 premiums and help pay your Part B premium, but you’ll likely face copays and higher costs if you go out of network. If provider choice or travel is important to you, Original Medicare with Medigap may offer more flexibility.

Learn more about Medigap eligibility here.

Prescription Drug Coverage (Part D)

Neither Original Medicare nor Medigap includes drug coverage. You’ll need to enroll in a standalone Part D plan, or choose a Medicare Advantage plan with drug coverage (MA-PD).

Not enrolling when first eligible can result in a late enrollment penalty unless you have other creditable coverage. Use Medicare’s Plan Finder to check if a plan covers your prescriptions affordably.

Learn more about Part D here.

Other Benefits and Considerations

Medicare Advantage plans often include extras like dental, vision, hearing, and fitness benefits. However, coverage levels vary and may not meet all needs. If these benefits matter to you, compare plans carefully or consider standalone policies with Original Medicare.

Care coordination is more structured under Medicare Advantage. If you prefer working with the same doctors across different locations, Original Medicare may be better—especially for those who travel or live in multiple states.

Most Medicare plans don’t cover international care. If you travel abroad, look into Medigap policies with emergency foreign travel benefits or buy separate travel insurance.

Getting Help and Making Your Decision

Medicare can be complex, but you don’t have to navigate it alone. Speak with a SHIP counselor in your state for free, unbiased advice. You can also use Medicare.gov's Plan Finder to compare coverage options based on your prescriptions, doctors, and budget.

Some people benefit from healthcare advocacy services that offer personalized support. For example, services like Breezly connect you with Medicare experts who explain coverage and help with enrollment.

You can switch plans annually during Medicare Open Enrollment (Oct 15–Dec 7). There’s also a Medicare Advantage Open Enrollment period (Jan 1–Mar 31) for those already in a Medicare Advantage plan.

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Bottom line: If you want the broadest provider access and are willing to pay more for coverage stability, Original Medicare plus Medigap and Part D may be ideal. If you prefer convenience, extra benefits, and lower premiums, a Medicare Advantage plan could be the right fit. Review your needs annually and get advice when needed—your health and financial well-being depend on it.