My Mom was 87 years old when I was studying for my insurance license. She passed in 2021 at the ripe old age of 92. Still sharp as a tack until the day the Good Lord called her home. I had just turned 59 and Medicare was not on my radar yet. The truth is, I was having trouble understanding the way the books in my insurance class were trying to explain the details of how Medicare worked.
When I told her what I was doing, she said “Tell me about it”. So, we talked about Medicare. Mom understood it. After all, she had been on it for over 20 years.
The way I explain Medicare today started with how Mom laid it out for me sitting at her kitchen table with a notepad and pen. It finally made sense to me. I hope it does to you. Thanks Mom.
Most people walk in thinking Medicare works like a Chinese menu — pick one from Column A, a couple from Column B, build your own combination. It doesn’t work that way, and that one mix-up is where all the confusion starts.
The fork
Almost everything about Medicare hangs on a single decision. There are two ways to get your coverage. You pick one.
This is the government’s program: Part A for hospital coverage and Part B for medical coverage. Original Medicare leaves deductibles, copayments, and coinsurance. Many people add a Medigap policy to help with specified cost-sharing and a separate Part D plan for prescriptions. You may use any doctor or hospital that accepts Medicare.
This is the private road. Instead of the government’s plan plus add-ons, you get one bundled plan from an insurance company that takes the place of Original Medicare. It usually rolls hospital, doctor, and drug coverage into a single plan — and often adds extras Original Medicare doesn’t cover, like dental, vision, and hearing. Many cost little or nothing extra a month. The trade-off — you work inside a network of doctors, you may need referrals and approvals, and your care is steered a bit more. You trade some freedom for a lower monthly cost and one simple plan.
| Road A — Original Medicare | Road B — Medicare Advantage | |
|---|---|---|
| How it’s built | A+B plus Medigap + Part D | one bundled Part C plan |
| Doctors | any that take Medicare, nationwide | a network |
| Referrals/approvals | no | often yes |
| Drugs | add a Part D plan | usually included |
| Extras like dental/vision | no — add separately | often included |
| Monthly cost | higher, more predictable | often low or $0, more variable |
| Best if you value | freedom & predictability | low upfront cost & simplicity |
Neither road is “the best.” The right one depends on your doctors, your prescriptions, your budget, and how much freedom matters to you. That’s the conversation worth having — and it’s exactly the one I sit down and have with you.
You can’t ride both roads at once. If you choose Medicare Advantage, you can’t also carry a Medigap policy — they’re two different systems and they don’t stack.
A, B, C and D
People try to memorize A, B, C, D like a shopping list, and it never sticks — because nobody gave them the map first. Here’s the map:
Your inpatient hospital coverage. Part of Original Medicare, and built into Advantage too.
Your doctor visits and outpatient care. Also part of Original Medicare, also built into Advantage.
The letter that trips everyone up. Part C isn’t a piece you add on — it’s the entire second road. When someone says “Part C,” they mean the whole Advantage plan that replaces A and B.
Your prescription coverage. On Road A you buy it on its own; on Road B it’s usually baked in.
The second alphabet
In most states, policies with the same letter provide the same basic benefits, although premiums can differ by company. Massachusetts, Minnesota, and Wisconsin standardize Medigap differently.
| Plan | Basic description |
|---|---|
| A | Core benefits, including Part A hospital coinsurance and Part B coinsurance or copayments. |
| B | Plan A’s core benefits plus the Part A deductible. |
| C | Broad benefits including the Part B deductible; available only to people eligible for Medicare before January 1, 2020. |
| D | Broad benefits, but not the Part B deductible or Part B excess charges. |
| F | The broadest standardized benefits, including Part B excess charges and the Part B deductible; eligibility is restricted to people eligible for Medicare before January 1, 2020. |
| G | Nearly the same standardized benefits as Plan F, except it does not cover the Part B deductible. |
| K | Pays 50% of several cost-sharing benefits and has a $8,000 out-of-pocket limit in 2026. |
| L | Pays 75% of several cost-sharing benefits and has a $4,000 out-of-pocket limit in 2026. |
| M | Pays 50% of the Part A deductible and includes foreign-travel emergency coverage, subject to plan limits. |
| N | Pays Part B coinsurance except for certain office-visit and emergency-room copayments; it does not cover Part B excess charges. |
Source: Medicare.gov — Compare Medigap Plan Benefits. Limits shown are for 2026.
One conversation at a time
That depends on you: the doctors you want to keep, the drugs you take, what you can spend, and how much you value going anywhere versus paying less. There’s no universal right answer — there’s a right answer for you. That’s what I’m here for. I’ll look at your situation and lay it out in plain English, one road against the other, until it’s obvious which one fits.