Your Medicare choices

Once you have Part A and Part B, you choose how to get the rest of your coverage. There are two main paths. Each one fits different people. The right choice depends on your doctors, your drugs, your budget and how you like to get care.

Path 1: Original Medicare, plus Medigap and Part D

• Original Medicare (Part A and Part B) is run by the federal government. You can see any doctor or hospital in the U.S. that takes Medicare. You usually don't need a referral to see a specialist.
• Original Medicare doesn't have a yearly limit on what you pay. Part B usually pays 80% after your deductible, and you pay the other 20%.
• Medigap (Medicare Supplement Insurance) is sold by private insurance companies. It helps pay costs Original Medicare doesn't, like the 20%. You pay a separate monthly premium.
• Part D is a separate drug plan from a private insurance company. You pay a separate monthly premium.

Medigap Open Enrollment: You get a one-time, 6-month Medigap Open Enrollment Period. It starts the first month you have Part B and are 65 or older. During this time, an insurance company can't turn you down or charge you more because of your health. After it ends, in most states, insurers can use your health to decide whether to sell you a policy and what to charge. Some states give extra rights.

Path 2: Medicare Advantage (Part C)

• Medicare Advantage plans are offered by private insurance companies approved by Medicare. They cover everything Part A and Part B cover, and most include drug coverage.
• Many plans use a network of doctors and hospitals. You may need referrals, or pay more to see providers outside the network.
• Each plan has a yearly limit on what you pay for covered services in the network.
• Some plans include extra benefits, such as dental, vision or hearing. Benefits and costs vary by plan and by area.
• You still pay your Part B premium. Some plans also charge their own premium.
• You can't use a Medigap policy with a Medicare Advantage plan.

If you try Medicare Advantage first: If you join a Medicare Advantage plan when you first get Medicare at 65, and you leave it within the first 12 months, you have a right to buy certain Medigap policies. After that, you may not be able to buy a Medigap policy, or it may cost more, depending on your state and your health.

Drug coverage and the Part D late penalty

• If you don't get Part D or other drug coverage that's at least as good as Medicare's ("creditable coverage") when you're first eligible, and you go 63 days or more without it, you may pay a Part D late penalty.
• The penalty is 1% of the national base premium for each month you went without coverage. You pay it for as long as you have Medicare drug coverage.
• Ask your Marketplace plan whether its drug coverage is creditable. You can avoid the question by signing up for drug coverage when your Medicare starts.
• In 2027, Part D plans can have a deductible of up to $700. Your out-of-pocket costs for covered drugs are capped at $2,400 for the year.

When you can make changes later

• Medicare Open Enrollment runs October 15 – December 7 each year. You can switch between Original Medicare and Medicare Advantage, or change plans. Changes start January 1.
• Medicare Advantage Open Enrollment runs January 1 – March 31. If you're in a Medicare Advantage plan, you can switch to a different plan or go back to Original Medicare one time.
• These dates are different from the Marketplace's Open Enrollment, which is for people who don't have Medicare.

More Medicare topics

Medicare and Marketplace rules can change. Check Medicare.gov, SSA.gov or HealthCare.gov for the latest rules.

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