Medicare 101

Medicare Overview

Navigating Medicare doesn’t have to be overwhelming. Whether you’re turning 65 or exploring new plan options, Med66 is here to help you understand your choices and find the coverage that fits your life.

What is Medicare?

Medicare is a federal health insurance program for people 65 and older, and for some younger individuals with disabilities. Understanding your options is the first step to getting the coverage that fits your needs.

The 4 Parts of Medicare

Part A: Hospital Insurance

Part A helps pay for inpatient care in hospitals, skilled nursing facilities, hospice care, and some home health care.

Part B: Medical Insurance

Part B covers outpatient care like doctor visits, preventive services, lab tests, durable medical equipment, and some home health care.

Part C: Medicare Advantage

Medicare Advantage (Part C) plans bundle Part A and B (and usually Part D) into one plan offered by private companies approved by Medicare. Many include extra benefits like dental, vision, and wellness perks.

Part D: Prescription Drug Coverage

Part D plans cover the cost of prescription drugs and are offered by private insurers. You can add a Part D plan to Original Medicare or get it included with a Medicare Advantage plan.

Medicare Supplement (Medigap) Plans

Extra Coverage to Help Fill the Gaps

Medigap plans are offered by private insurance companies to help pay for out-of-pocket costs not covered by Original Medicare, such as deductibles, copayments, and coinsurance. These plans work alongside Part A and Part B and can provide greater financial predictability. In Minnesota and Wisconsin, Medigap plans are standardized differently than in other states—our experts can help you navigate your options.

Medicare Original vs. Medicare Advantage

Medicare Original

Coverage Includes: Part A (Hospital) and Part B (Medical)
Provider Choice: Any provider that accepts Medicare
Referral Needed for Specialist? No
Prescription Drug Coverage: Not included – must add a separate Part D plan
Extra Benefits: (Dental, Vision, etc.) Not included
Out-of-Pocket Limits: No annual limit (but Medigap can help)
Medigap Eligibility: Can add a Medigap plan for extra coverage
Monthly Costs: Part B premium + optional Medigap/Part D
Administered By: Federal Government

Medicare Advantage

Coverage Includes: Part A and B, often includes Part D (Rx)
Provider Choice: In-network providers (HMO or PPO plans)
Referral Needed for Specialist? Often yes (depends on plan type)
Prescription Drug Coverage: Usually included
Extra Benefits: (Dental, Vision, etc.) Usually included
Out-of-Pocket Limits: Yes – annual out-of-pocket maximum
Medigap Eligibility: Cannot combine with Medigap
Monthly Costs: Part B premium + possible plan premium
Administered By: Private insurance companies approved by Medicare

Medicare Costs

Original Medicare Monthly Costs

Part A (Hospital Insurance): $0 (if you or your spouse worked ≥10 years)
Part B (Medical Insurance): $174.70 (standard in 2024)*
Part D (Prescription Drug Plan): Varies – typically $10–$50+
Medigap (Supplement Plan): Varies – often $100–$250+

*Higher-income beneficiaries may pay more for Part B and Part D (IRMAA surcharge).

Medicare Advantage (Part C) Monthly Costs

Part B Premium: $174.70 (same as Original Medicare)
Medicare Advantage Plan Premium: Varies – many $0 plans available**
Part D (Prescription Drug Plan): Usually included in the plan (no extra cost)
Out-of-Pocket Costs: Copays, coinsurance, and deductibles vary

**Even $0-premium Advantage plans still require you to pay the standard Part B premium.

Next Section: Eligibility

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