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Deciding on various Medicare plans can be overwhelming. We understand that there are so many choices and our goal is to make it as easy as possible. Whether you’re looking for MediGap plans, Medicare Advantage plans, or just prescription Part D plans, let one of our Medicare Pros guide you at no cost to you.
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Options Explained by the Pros
An Introduction
Medicare Part A and Part B are government-provided health insurance plans. Part A covers
hospital stays and skilled nursing care, while Part B covers doctor visits and outpatient services.
Who Qualifies For It?
Eligibility includes people aged 65 or older who have worked and paid Medicare taxes for at
least 10 years (40 quarters). It also covers certain individuals under 65 with qualifying
disabilities, such as those receiving Social Security Disability Insurance for 24 months or
diagnosed with End-Stage Renal Disease.
When Can I Register?
You can enroll during the Initial Enrollment Period, a 7-month window starting 3 months before
you turn 65, including your birth month, and ending 3 months after. If you miss this, the General
Enrollment Period runs from January 1 to March 31 each year, with coverage starting the first
day of the month after you sign up (e.g., enroll in February 2025, coverage begins March 1,
2025). Missing these periods may lead to higher premiums if you buy additional insurance later.
Alternatively, if you or your spouse have employer-provided coverage and it ends, you qualify
for a Special Enrollment Period, which begins when that coverage expires and lasts 8 months.
What Does It Charge?
Part A is free for those who paid Medicare taxes for 10 years (40 quarters). However, there’s a
$1,676 deductible per benefit period in 2025. If hospitalized beyond 60 days in a benefit period,
you’ll pay $419 per day for days 61–90, and $838 per day for lifetime reserve days. Multiple
hospitalizations in a year may require a new deductible each time.
In 2025, Part B costs $185.00 per month, with an annual deductible of $257. After meeting the
deductible, you’ll pay 20% of the cost for doctor visits and other Part B services. Higher earners
may face additional premiums based on income, ranging from $259.00 to $628.90 monthly.
How Do I Apply?
further information, visit medicare.gov.
An Introduction
Medigap, also known as Medicare Supplemental Insurance, is offered by private insurers to fill
gaps in Original Medicare (Parts A and B), such as deductibles and coinsurance. There are 10
standardized plans, labeled A through N, though not all insurers offer every plan, and Plans C
and F are unavailable to new enrollees since 2020. Benefits for each plan type are consistent
nationwide, but premiums vary by insurer, plan, and location.
Should I Go for Medigap Insurance?
Many choose Medigap to offset costs Original Medicare doesn’t cover, such as hospital
deductibles or doctor visit coinsurance, reducing out-of-pocket expenses. For instance, an
extended hospital stay (beyond 60 days) or frequent outpatient care can get expensive – Medigap
can help cover these, making it a valuable option. Some plans (like D, G, M, N) also offer
emergency coverage abroad, typically 80% of costs after a deductible, which is useful for
travelers. Review each plan’s benefits to ensure it fits your needs.
Who Can Enroll in Medigap?
To enroll in Medigap, you must already have Medicare Parts A and B and not be enrolled in a
Medicare Advantage plan.
Where Could I Register?
The Medigap Open Enrollment Period is a one-time, 6-month window that starts the month
you’re 65 and enrolled in Medicare Part B. During this time, insurers must offer you any plan
regardless of health conditions. Those under 65 with disabilities may qualify, though federal
rules don’t guarantee the same protections – some states provide additional options. You must
already have Parts A and B to enroll. Missing this period doesn’t end your eligibility, but
insurers can deny you or raise premiums based on pre-existing conditions unless you have a
special guaranteed-issue right, like losing other coverage.
What Does It Charge?
Medigap premiums depend on the plan you pick, your state, your age, and the insurer’s pricing
method. For 2025, monthly costs typically range from $50–$100 for plans like K or L (with
higher out-of-pocket limits) to $120–$200 or more for popular options like Plan G. Prices vary
by ZIP code and company, so compare quotes for accurate rates.
How Can I Apply for Medigap?
You may explore different options for Medigap plans here at Medicare-Pros.org. And after your
choice, simply input your ZIP Code and tell us about yourself to begin the enrollment process
and one of our licensed agents can go over all of your options with you.
An Introduction
Medicare Advantage, or Part C, is offered by private insurers and includes all benefits of
Medicare Parts A and B, plus extras like prescription drugs, dental, vision, and hearing – services
not covered by Original Medicare. These plans often cap your annual out-of-pocket costs,
providing financial predictability. Options include Health Maintenance Organizations (HMOs),
which limit you to a network of providers and usually require referrals to specialists, and
Preferred Provider Organizations (PPOs), which offer broader networks and no referral
requirement at a higher cost. Resembling employer-sponsored insurance, Medicare Advantage
varies by plan, so review details carefully to match your needs.
Why Should I Apply for It?
Medicare Advantage often offers broader coverage than Original Medicare (Parts A and B)
alone, which leaves you paying 20% of outpatient costs, hospital coinsurance after 60 days, and
no prescription drug coverage. Many Advantage plans cover these expenses, include drugs and
extras like dental or vision, and set an annual out-of-pocket maximum (e.g., up to $8,850 in-
network for 2025), potentially lowering your costs. Unlike Medigap, which supplements Original
Medicare, Advantage plans replace it entirely, appealing to those who prefer a single,
comprehensive plan. Coverage and limits vary, so compare plans to ensure affordability and
access to your preferred providers.
Who Can Qualify for It?
To qualify for Medicare Advantage, you must be enrolled in Medicare Parts A and B and live in
the plan’s service area. This includes people 65 or older, as well as those under 65 with
disabilities (e.g., after 24 months on SSDI) or End-Stage Renal Disease.
Where Can I Sign Up?
You can enroll in Medicare Advantage during three key periods. The Initial Enrollment Period
spans 7 months: 3 months before you turn 65, your birthday month, and 3 months after. If you
miss it, the Annual Enrollment Period runs October 15 to December 7 each year (e.g., 2024 for
2025 coverage), letting you join or switch plans, effective January 1. The Special Enrollment
Period is for specific events like moving or losing other coverage, with short windows (e.g., 2
months after the event) – ask an agent for details. Already enrolled? From January 1 to March 31,
2025, you can switch Advantage plans or return to Original Medicare during the Medicare
Advantage Open Enrollment Period.
What Does the Plan Charge?
Medicare Advantage costs vary by plan and location. In 2025, average monthly premiums are
around $18, though many plans charge $0, relying on copays or coinsurance instead. You’ll still
pay the Part B premium ($185/month). Out-of-pocket limits differ – up to $8,850 in-network
annually, though some plans cap it lower (e.g., $4,000–$6,000). Contact an agent for exact costs
in your area.
How Can I Apply for Medicare Advantage?
To enroll in Medicare Advantage Plan, examine the different options you have here. And once
you’re ready, let us know your ZIP Code and a bit about yourself or you can call and speak to
one of our licensed agents.
An Introduction
Medicare Parts A and B don’t cover outpatient prescription drugs, leaving you to pay pharmacy
costs yourself. Medicare Part D, offered by private insurers, fills this gap. It comes in two forms:
Medicare Advantage Prescription Drug Plans (MA-PDs), which bundle drug coverage with
Medicare Advantage (Part C), and Standalone Prescription Drug Plans (PDPs), which add drug
coverage to Original Medicare (Parts A and B). You can choose between: 1) Parts A and B with
a PDP, or 2) Medicare Advantage with an MA-PD.
Why Should I Apply for It?
Prescription drugs can cost hundreds monthly without coverage, making Part D a smart choice to
lower expenses. These plans cover a range of medications through premiums, copays, or
coinsurance, offering affordability and predictability. For 2025, benefits include a $35 cap on
insulin and a $2,000 annual out-of-pocket maximum, reducing your financial risk significantly.
Who Can Apply?
To enroll in a Standalone Prescription Drug Plan (PDP), you need Medicare Part A or Part B and
must live in the plan’s service area. For a Medicare Advantage Prescription Drug Plan (MA-PD),
you need both Parts A and B through a Part C plan.
When Can I Apply?
The best times to enroll in Medicare Part D—either a Standalone Prescription Drug Plan (PDP)
or Medicare Advantage Prescription Drug Plan (MA-PD)—are the Initial Enrollment Period and
Annual Enrollment Period. The Initial Enrollment Period covers 7 months: 3 months before you
turn 65, your birthday month, and 3 months after. The Annual Enrollment Period runs October
15 to December 7 each year (e.g., 2025 for 2026 coverage), allowing you to join, switch, or drop
plans, effective January 1. A Special Enrollment Period is available for major life events like
moving or losing coverage, with short windows (e.g., 2 months after the event)—don’t rely on
this, as missing IEP or AEP delays your coverage.
What Does the Plan Charge?
Medicare Part D costs vary by insurer, state, and your medications. For 2025, Standalone
Prescription Drug Plans (PDPs) average $40–$50 monthly, with deductibles up to $590, plus
copays or coinsurance based on your drugs’ formulary tier. Medicare Advantage Prescription
Drug Plans (MA-PDs) may have $0 premiums beyond Part B ($185/month), bundling drug costs.
A new $2,000 annual out-of-pocket cap applies to all Part D plans in 2025, covering deductibles
and copays. Speak with an agent for plan-specific pricing in your area.
How Can I Apply?
To ensure you make the right decision, you must compare the different prescription plans
effectively. Doing so is easy as we provide this service for you. Contact a licensed agent today.
How Much Do Health Insurance Plans Charge?
Medicare Enrollment Periods
Who Is It For?
Newly eligible individuals for Medicare, typically those turning 65 or qualifying due to a disability.
When Is It?
This period spans 7 months, beginning 3 months before your 65th birthday, including the month of your birthday, and continuing for 3 months afterward.
What Can You Do?
During the IEP, you can sign up for Medicare for the first time. If you’re already enrolled in Medicare Part A and Part B, you can also join a Medicare Advantage plan.
Who Is It For?
Individuals who are already enrolled in Medicare and want to make changes to their coverage, such as switching plans or joining a new Medicare Advantage or Part D prescription drug plan.
When Is It?
This period runs from October 15 to December 7 each year, allowing people to review and adjust their Medicare options for the upcoming year.
What Can You Do?
During the AEP, you can enroll in, switch, or drop a Medicare Advantage plan, join or change a Part D prescription drug plan, or return to Original Medicare from a Medicare Advantage plan.
Who Is It For?
People who experience certain life events or qualifying circumstances, such as moving to a new area, losing other coverage, or becoming eligible for Medicaid.
When Is It?
These periods vary in length and timing, depending on the specific life event or change in circumstances, but they provide a window outside the standard enrollment periods to make changes.
What Can You Do?
During an SEP, you can enroll in or switch Medicare Advantage plans, join or change Part D prescription drug plans, or return to Original Medicare, depending on your situation and eligibility.
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Which is the Best Option for You?
The concept of a perfect insurance plan differs from person to person. It all depends on the magnitude and criterion of your health care needs and the budget you have available. Rest assured, one of our licensed agents will be able to find the right plan that fits your needs!
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.
Medicare has neither reviewed nor endorsed this information. Not connected with or endorsed by the United States government or the federal Medicare program.
