What It Is

Medicare Advantage (Part C) is an all-in-one alternative to Original Medicare offered by private insurers. You still have Medicare, but your Part A and Part B are provided through the plan; many include Part D and extra benefits.

What It May Include

• Part D drug coverage (MAPD)
• Dental, vision, hearing
• Fitness programs
• OTC allowances, transportation, post-discharge meals (plan-specific)

Costs & Rules — Big Picture

Premiums/copays vary by plan and county. Plans set an annual in-network maximum out-of-pocket for Part A/B services. Most plans use provider networks (HMO/PPO), and some services require prior authorization.

Medigap vs. Advantage

You can’t have both at the same time. Choose Medigap if you want predictable costs and broad provider choice; choose Advantage if you want lower premiums and extras and your doctors/pharmacies are in-network.

Compare Advantage vs. Medigap

MEDICARE PART D – PRESCRIPTION DRUG COVERAGE

What It Is

Part D provides prescription coverage through private plans. You can enroll in a stand-alone Part D plan with Original Medicare or pick a Medicare Advantage plan that includes drug coverage.

What It Covers

Plans use a formulary (drug list) organized by tiers (generic to specialty). Many vaccines recommended by ACIP may be covered at $0.

How Costs Work

• Monthly premium (varies by plan)
• Annual deductible (plans may waive for lower tiers)
• Copays/coinsurance vary by tier and pharmacy network
  Coverage Stages: Deductible → Initial Coverage → Coverage Gap (“donut hole”) → Catastrophic

What This Really Means

Skipping Part D without other creditable drug coverage can trigger a lifetime penalty added to your premium. Because formularies and networks differ, the “right” plan can save hundreds per year.

Medigap & Part D

Medigap doesn’t cover prescriptions. Pair your Medigap with a stand-alone Part D plan.

Find a Part D Plan for Your Meds