Medicare Made Simple

Understand the structure first. Then compare the financial risk, provider access and prescription coverage that come with each path.

Written and reviewed by James KauferIndependent Medicare Agent · NPN 15374945Updated August 19, 2026

Start with Original Medicare

Part A helps cover inpatient hospital care, skilled nursing facility care under Medicare rules, hospice and some home health services. Part B covers physician services, outpatient care, durable medical equipment and many preventive services.

Original Medicare gives broad provider access, but it also leaves deductibles and coinsurance. Most importantly, Original Medicare alone does not provide a simple annual cap on your out-of-pocket spending for Part A and Part B services.

Then choose how you want to manage the gaps

Original Medicare + Medigap + Part D

You keep Original Medicare as primary coverage. A Medigap policy can help pay specified Medicare cost-sharing, and a separate Part D plan generally handles outpatient prescriptions.

Medicare Advantage

You receive Medicare-covered benefits through a private Medicare Advantage plan. Most plans include drug coverage, use provider networks and place a yearly limit on what you pay for covered Medicare services.

James Kaufer presenting a Medicare education seminar
Medicare education should make the choices easier to compare, not bury the differences in jargon.

Five questions that matter more than a headline premium

  1. Are your doctors and hospitals accessible? Provider access can matter more than a $0 premium.
  2. How are your prescriptions covered? Check the formulary, tier, pharmacy and utilization rules.
  3. What could a bad health year cost? Compare deductibles, copays, coinsurance and maximum exposure.
  4. How much do you travel? Frequent travel can change how important network flexibility is.
  5. What happens if you want to change later? Medigap eligibility outside protected periods can involve underwriting in many situations.

Frequently asked questions

What are the four parts of Medicare?

Part A generally covers inpatient hospital care, Part B covers medical and outpatient services, Part C is Medicare Advantage, and Part D is prescription drug coverage.

Does Original Medicare have an annual out-of-pocket maximum?

Original Medicare by itself does not have a yearly limit on what you pay out of pocket. Supplemental coverage can change that exposure.

Is Medicare Advantage the same as Medigap?

No. Medicare Advantage is an alternative way to receive Medicare-covered benefits through a private plan. Medigap supplements Original Medicare.

Primary sources

This guide is based on current information from Medicare.gov and CMS. Rules can change, so verify time-sensitive details before acting.