How It Works and Your Coverage Options
Medicare is the federal health insurance program for people age 65 and older, and for younger individuals with certain disabilities. It provides essential healthcare coverage — but understanding how it all fits together can be confusing at first.
Let’s break down the basics of Original Medicare, and then explain how Medicare Advantage and Medicare Supplement (Medigap) plans connect to it.
What is Original Medicare?
Original Medicare is made up of two parts:
Part A (Hospital Insurance): Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.
Part B (Medical Insurance): Covers doctor visits, outpatient care, preventive services, durable medical equipment, and some home health services.
Important: Original Medicare does not cover 100% of your medical costs. You are responsible for deductibles, coinsurance, and copayments — with no out-of-pocket maximum to protect you.
What Does Original Medicare Cover?
Medicare Part | What It Covers | Your Costs |
|---|---|---|
Part A | Hospital stays, skilled nursing facility care, hospice, limited home health care | Deductibles, daily coinsurance for extended stays |
Part B | Doctor visits, outpatient care, preventive services, lab work, durable medical equipment | Monthly premium, deductible, 20% coinsurance |
Key points:
Most people get Part A premium-free if they worked and paid Medicare taxes for at least 10 years.
Everyone pays a Part B premium, which can vary based on income.
What Are the Standard Costs for Medicare?
Medicare Part | Coverage | 2025 Standard Costs |
|---|---|---|
Part A | Inpatient hospital care, skilled nursing facility care, hospice care | $1,632 deductible per benefit period; Days 1–60: $0 coinsurance; Days 61–90: $419/day; Lifetime reserve days: $838/day |
Part B | Doctor visits, outpatient services, preventive care | $185 standard monthly premium; $257 annual deductible; 20% coinsurance after deductible |
Part C | Medicare Advantage (private insurance plans) | Premiums vary by plan and location; copays and network restrictions may apply |
Part D | Prescription drug coverage | Premiums vary by plan; higher-income individuals may pay more (IRMAA surcharge) |
Note: Medicare costs are updated annually by the federal government. Individual costs may vary based on income and location.
What’s Not Covered by Original Medicare?
Original Medicare does not cover:
Prescription drugs (you need a separate Part D plan)
Routine dental, vision, and hearing care
Long-term custodial care
Care outside the United States (except limited emergencies)
Because of these gaps, many people choose additional coverage to protect themselves.
Make the Right Medicare Choice With Confidence
Choosing between Medicare plans can be confusing. Our experienced team will walk you through your options and help you make a confident, informed decision. Book your one-on-one consultation today.
Book Your AppointmentYour Options After Enrolling in Original Medicare
Once you have Part A and Part B, you have two main ways to get more complete coverage:
Add a Medicare Supplement (Medigap) Plan
Helps pay for out-of-pocket costs like deductibles, coinsurance, and copayments.
Allows you to see any doctor who accepts Medicare nationwide.
Requires a separate Part D prescription drug plan for medications.
Medigap premiums are paid in addition to your Part B premium.
Think of Medigap as an extra shield that protects you from high medical bills while keeping the freedom of Original Medicare.
Switch to a Medicare Advantage (Part C) Plan
An “all-in-one” alternative to Original Medicare.
Must cover everything Parts A and B cover — often includes extra benefits like dental, vision, hearing, fitness memberships, and sometimes prescription drug coverage.
Operates through private insurance companies with their own provider networks (HMO or PPO plans).
Has an annual out-of-pocket maximum, unlike Original Medicare.
Think of Medicare Advantage as bundling your hospital, medical, and sometimes drug coverage into a single private plan with extra perks.
How They Connect: The Medicare Ecosystem
Feature | Original Medicare | Medicare Supplement (Medigap) | Medicare Advantage (Part C) |
|---|---|---|---|
Core Coverage | Provided by federal government (Parts A & B) | Supplements Original Medicare | Replaces Original Medicare with private coverage |
Provider Flexibility | See any provider accepting Medicare | See any provider accepting Medicare | Use plan network providers (varies by plan) |
Prescription Drugs | Separate Part D plan needed | Separate Part D plan needed | Often included |
Out-of-Pocket Limits | No annual cap | No cap (but reduces out-of-pocket costs) | Annual out-of-pocket maximum required |
Extra Benefits | Limited | None beyond medical coverage | Often includes dental, vision, fitness, travel |
Final Thoughts
Understanding how Medicare works — and how Medicare Advantage and Medicare Supplement plans connect to it — helps you make confident decisions about your healthcare.
Whether you prefer the flexibility of Original Medicare plus a Medigap plan or the simplicity of a Medicare Advantage plan, the right path depends on your needs, lifestyle, and budget.
At Bobby Brock Insurance, we help you compare all your Medicare options to find the coverage that fits you best.
