Who this is for
Older adults, caregivers, healthcare workers, and families comparing Medicare options or helping someone enroll.
60-second summary
Medicare is not one simple plan. Original Medicare is Part A and Part B through the federal government. Medicare Advantage, also called Part C, is a private plan alternative for receiving Part A and Part B benefits. Part D helps pay for outpatient prescription drugs. Medigap can help pay some Original Medicare cost-sharing. Medicaid is separate and may help people with limited income, resources, or long-term care needs.
Fact sheet
Original Medicare
The federal Medicare program made up of Part A hospital insurance and Part B medical insurance.
- Usually lets a person see any doctor or hospital that accepts Medicare nationwide.
- Often paired with a standalone Part D prescription drug plan.
- May be paired with a Medigap policy to reduce some Original Medicare cost-sharing.
- Does not have a built-in yearly out-of-pocket maximum for Part A and Part B services by itself.
Medicare Advantage
A private Medicare-approved plan, also called Part C, that provides Part A and Part B benefits through the plan.
- Must cover medically necessary services that Original Medicare covers.
- Often uses provider networks, referrals, prior authorization, and plan-specific cost-sharing.
- Often includes Part D drug coverage and may include extra dental, vision, hearing, transportation, or fitness benefits.
- Has a yearly limit on what the person pays for covered Medicare services.
Part D
Medicare outpatient prescription drug coverage, offered through private plans.
- Can be a standalone plan with Original Medicare.
- Can be bundled into many Medicare Advantage plans.
- Plans vary by premium, deductible, copay, coinsurance, pharmacy network, and formulary.
- Medication lists should be checked every year because plan details can change.
Medigap
Private supplemental insurance that works with Original Medicare to help pay some deductibles, copays, and coinsurance.
- Works with Original Medicare, not Medicare Advantage.
- Does not replace a Part D drug plan.
- Can reduce some cost-sharing exposure for services Medicare covers.
- Availability and underwriting rules can depend on timing and state rules.
Medicaid
A joint federal-state program for people who qualify under state income, resource, disability, family status, or medical need rules.
- Separate from Medicare.
- May help with premiums, deductibles, coinsurance, or services Medicare does not fully cover for people who qualify.
- May help with long-term services and supports under state rules.
- People with both Medicare and Medicaid are often called dual eligible.
The long-term care gap
The mismatch between needing daily help and having Medicare coverage for that help.
- Medicare may cover limited skilled care when strict rules are met.
- Medicare generally does not pay for most long-term custodial care.
- Custodial care includes help with bathing, dressing, toileting, meals, supervision, and transportation over time.
- Medicaid may become important when long-term care is the real need.
Two Medicare paths
One person chooses Original Medicare plus Part D and Medigap because they travel often and want broad provider access. Another chooses Medicare Advantage because their doctors are in-network, the plan includes drugs, and they value a single plan with a covered-service out-of-pocket limit. Neither choice is automatically better. The better fit depends on doctors, medications, costs, travel, plan rules, and long-term care risk.
Medicare Cost Exposure Tool
Common mistakes
- Assuming Medicare means care is free.
- Choosing Medicare Advantage without checking doctors, hospitals, drugs, referrals, prior authorization, and travel coverage.
- Using Original Medicare without understanding deductibles, coinsurance, and the lack of a built-in yearly Part A and Part B out-of-pocket cap.
- Assuming Medigap works with Medicare Advantage.
- Assuming Medicare pays for most long-term custodial care.
Key takeaway
Pick the Medicare structure first, then compare specific plan details. The right choice is the one that fits the person’s providers, prescriptions, health needs, travel habits, total yearly cost, and long-term care risk.
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Sources
- Medicare.gov· Medicare costs
Official Medicare premiums, deductibles, coinsurance, and cost-sharing amounts.
- Medicare.gov· Compare Original Medicare & Medicare Advantage
Official comparison of provider access, referrals, drug coverage, and plan rules.
- Medicare.gov· Medigap basics
Official explanation of how Medicare Supplement insurance works with Original Medicare.
- Medicare.gov· Long-term care coverage
Official coverage guidance for long-term and custodial care.
- Medicaid.gov· Long-term services and supports
Federal overview of Medicaid long-term services and supports, with state-administered coverage.
- KFF· A Snapshot of Sources of Coverage Among Medicare Beneficiaries
Independent context on Medicare Advantage, Traditional Medicare, supplemental coverage, and dual eligibility.