Medicare
Coverage Options
Medicare Part A and Part B (Original Medicare) do not cover all medical expenses. Obtaining additional coverage can help you better manage or reduce your out-of-pocket costs.
Parts of Medicare
While the Medicare system might feel overwhelming at first glance, it becomes much easier to navigate once you break it down into its four foundational pieces.
Each "Part" (A, B, C, and D) is designed to handle a specific area of your healthcare.
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Your Options
Medicare Advantage
(Part C)
Provides all Medicare Part A and Part B benefits, along with additional services like wellness programs, hearing aids, and vision
services.
Prescription Drug Coverage
(Part D)
Is an option for those with Original Medicare, providing coverage for prescription drug costs.
Note: Individuals enrolled in Medicare Advantage plans typically do not need to purchase a separate Part D plan, as prescription drug coverage is often included in
Medicare Advantage plans.
Medigap
(Medicare Supplement)
Is an option for individuals with Original Medicare, covering out-of-pocket costs for health expenses not typically covered by Medicare Parts A and B (Original Medicare).
Note: Those enrolled in Medicare Advantage plans typically do not need to purchase a Medigap plan, as Medicare Advantage often provides similar coverage.
Part A (Hospital Insurance)
What it covers:
Inpatient hospital stays
Skilled nursing facility (short-term)
Hospice care
Home health care
What you'll pay:
For most people, the premium is $0 (if you or your spouse worked 10+ years paying Medicare taxes). There is a deductible per benefit period, and daily coinsurance kicks in for hospital stays lasting longer than 60 days.
Why it matters:
Part A is your primary safety net against catastrophic hospital bills, helping cover major medical events (like surgeries or extended hospital stays) that could otherwise cost thousands of dollars out of pocket.
Part B (Medical Insurance)
What it covers:
Services from doctors and other health care providers
Outpatient care
Home health care
Durable medical equipment (like wheelchairs, walkers, hospital beds, and other equipment)
What you'll pay:
For most people, the premium is $0 (if you or your spouse worked 10+ years paying Medicare taxes). There is a deductible per benefit period, and daily coinsurance kicks in for hospital stays lasting longer than 60 days.
Why it matters:
Part A is your primary safety net against catastrophic hospital bills, helping cover major medical events (like surgeries or extended hospital stays) that could otherwise cost thousands of dollars out of pocket.
Part C (Medicare Advantage)
What it covers:
Inpatient hospital stays
Skilled nursing facility (short-term)
Hospice care
Some home healthcare
What you'll pay:
For most people, the premium is $0 (if you or your spouse worked 10+ years paying Medicare taxes). There is a deductible per benefit period, and daily coinsurance kicks in for hospital stays lasting longer than 60 days.
Why it matters:
Part A is your primary safety net against catastrophic hospital bills, helping cover major medical events (like surgeries or extended hospital stays) that could otherwise cost thousands of dollars out of pocket.
Part D (Prescription Drug Coverage)
What it covers:
Prescription medication
Many recommended shots or vaccines
What you'll pay:
Premiums vary by plan and location. The deductible can be up to $615, and copays depend on your specific medications. Starting in 2026, your yearly out-of-pocket spending on drugs is capped at $2,100.
Why it matters:
Original Medicare (Parts A and B) does not cover your daily prescriptions at the pharmacy counter. Part D provides essential protection against the rising costs of your medications.
Medicare Supplemental Insurance (Medigap)
What it covers:
Your share of the costs for healthcare services that are approved by Original Medicare (Part A and Part B)
Your copayments, which are the fixed amounts required after your deductibles are met
Your coinsurance, which is the percentage of the medical bill you are normally required to pay out-of-pocket
May help cover your deductibles, which is the upfront money you must spend on health care before Medicare begins to pay
May cover specific services that Original Medicare does not cover at all, such as emergency medical care when you travel outside the United States
What you'll pay:
You will pay a separate monthly premium to a private insurance company, which is in addition to your standard Medicare Part B premium. Because all Medigap plans with the same letter offer identical medical coverage, your exact costs will vary solely based on your location, the insurance carrier you choose, and whether you apply during your penalty-free open enrollment window.
Why it matters:
Medigap shields you from surprise medical bills by covering the expensive out-of-pocket gaps left behind by Original Medicare. It also provides ultimate flexibility, allowing you to see any doctor or specialist in the United States who accepts Medicare without worrying about network restrictions or referrals.
Comparison of Your Options
Plan
Medicare Advantage
(Part C)
Prescription Drug Coverage (Part D)
Medigap
(Medicare Supplement)
Premium
All Medicare Advantage plans require that you continue to pay your Part B insurance premium.
You may also have a separate monthly insurance premium for your Medicare Advantage plan.
Most Part D plans require a monthly premium. These premiums may change each year.
You will be notified of these changes in the fall prior to the annual Open Enrollment Period.
All Medigap plans require that you continue to pay your Part B premium and a separate premium for Medigap coverage.
Deductible
Some plans have deductibles.
Some plans have deductibles.
Some plans have deductibles.
Copays
There may be copayments that apply to specific services.
Many Part D plans require a fixed copayment each time you fill a prescription.
There may be copayments that apply to specific services.
Coinsurance
May apply to specific services.
Some plans require that you pay coinsurance for a medication every time you fill a prescription.
Coinsurance varies depending on the plan.
Coverage Gap
All plans have an annual limit on your out-of-pocket expenses.
Most Medicare Part D plans incorporate a cost-sharing feature commonly referred to as a coverage gap or "donut hole."
The coverage gap represents a temporary threshold wherein you are accountable for covering all of your drug expenses until you reach the plan's annual out-of-pocket limit. Once you reach this limit, you will only be responsible for paying a small portion of your prescription costs for the remainder of the year.
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Akroamatik Financial is not connected with or endorsed by the U.S. government or the federal Medicare program. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov, 1-800-MEDICARE (TTY users should call 1-877-486-2048), or your local State Health Insurance Program (SHIP) to get information on all of your options.
Akroamatik Financial is committed to serving you at the highest level with all your Medicare needs.
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DISCLAIMER: We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
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