Start with what you actually use

The best Medicare plan for you depends on three things: which doctors and hospitals you want to use, how much you expect to spend on prescriptions, and how much you can afford to pay each month. There is no single "best" plan — only the best one for your specific situation. The choice comes down to comparing what each plan costs you and what it covers.

Before you compare plans, write down the medications you take regularly, the doctors you see, and any hospitals or specialists you prefer. Then check whether those doctors and pharmacies are in-network for each plan you are considering. A plan with a low monthly premium might cost you far more if your doctor is out-of-network or if your pharmacy is not included.

Key Takeaways

  • Original Medicare (Part A and Part B) covers hospital and doctor visits but not prescription drugs, and you pay a percentage of costs after your deductible.
  • Medicare Advantage plans (Part C) bundle hospital, doctor, and prescription coverage into one plan with a monthly premium, but they limit you to in-network providers.
  • Medigap policies pair with Original Medicare to cover costs you would otherwise pay out-of-pocket, but they do not cover prescriptions.
  • You must add prescription coverage (Part D) to Original Medicare yourself, or it comes automatically with Medicare Advantage.
  • Your annual enrollment period is October 15 through December 7, and changes take effect January 1 — missing this window locks you into your current plan for a year.

The three main paths: Original Medicare, Medicare Advantage, or Medigap

Original Medicare is run directly by the federal government. It covers hospital stays (Part A) and doctor visits, lab work, and outpatient care (Part B). You pay a monthly premium for Part B, a deductible when you use the service, and then a percentage of the cost (called coinsurance). You can see any doctor or hospital that accepts Medicare — there is no network restriction. The trade-off is that you pay a share of every bill, and those costs add up if you have a chronic condition or need frequent care.

Medicare Advantage (Part C) is sold by private insurance companies. It bundles hospital, doctor, and prescription coverage into one monthly premium. Most plans have a $0 or low premium. The catch is that you must use doctors and hospitals in the plan's network, and you usually need a referral to see a specialist. If you go out-of-network, you pay much more or nothing is covered. Medicare Advantage plans often include dental, vision, or hearing coverage that Original Medicare does not.

Medigap is a supplemental policy you buy from a private insurer to pair with Original Medicare. It covers the deductibles, coinsurance, and copays that Original Medicare leaves you responsible for. You still see any doctor who accepts Medicare, and Medigap does not restrict your network. The downside is that Medigap does not cover prescription drugs — you must add Part D separately — and the monthly premium for Medigap can be high.

How to compare costs: premium, deductible, and out-of-pocket maximum

Every plan has three costs to track: the monthly premium, the annual deductible, and the out-of-pocket maximum. The monthly premium is what you pay whether you use the plan or not. The deductible is the amount you pay before the plan starts to help. The out-of-pocket maximum is the most you will pay in a year for covered services — after you hit that number, the plan covers 100 percent.

A plan with a low premium might have a high deductible and high out-of-pocket costs. A plan with a high premium might have a low deductible and lower out-of-pocket costs. The right choice depends on how much medical care you expect to use. If you see doctors frequently or take multiple medications, a higher premium plan with lower out-of-pocket costs usually saves you money overall. If you are generally healthy, a lower-premium plan might be cheaper even if the deductible is higher.

Use the Medicare Plan Finder tool on Medicare.gov to enter your medications and doctors, then see the total estimated cost for each plan side by side. This tool shows you not just the premium, but what you would actually pay for your specific situation — including prescription costs and specialist visits.

Prescription drug coverage: Part D with Original Medicare, or included with Advantage

If you choose Original Medicare, you must add prescription coverage (Part D) separately, either by itself or as part of a Medigap plan. Part D is sold by private insurers and covers a list of approved medications. Each plan has a different formulary — the list of drugs it covers — and different copays for each drug. If your regular medication is not on a plan's formulary, you will pay full price or need to switch medications.

Part D has a coverage gap called the "donut hole." Once you and the plan have spent a certain amount on prescriptions in a year, you enter the gap and pay a higher percentage of the cost until you reach your out-of-pocket maximum. The amounts change each year. This gap matters most if you take expensive medications or multiple prescriptions.

Medicare Advantage plans include prescription coverage automatically, so you do not choose Part D separately. The prescription costs and formulary are built into the plan. Some Advantage plans have lower copays for common medications than Part D plans do, but you are limited to the plan's pharmacy network.

Network restrictions: in-network versus out-of-network costs

Original Medicare has no network — you can see any doctor or hospital that accepts Medicare, anywhere in the country. Medigap also has no network restriction because it works alongside Original Medicare. This flexibility matters if you travel, if you have a specialist you want to keep seeing, or if you live in a rural area with few providers.

Medicare Advantage plans have a network of doctors and hospitals. If you see a provider outside the network, you pay much more or nothing is covered (except in emergencies). Some Advantage plans offer a point-of-service option that lets you see out-of-network providers for a higher copay, but this is not standard. Before you choose an Advantage plan, check whether your current doctors are in-network. If your primary care doctor is not, you will need to switch.

Network size varies by plan and by region. In urban areas, most Advantage plans have large networks. In rural areas, networks may be small, and you might have fewer Advantage options or need to travel farther to see an in-network provider.

When to choose each path based on your situation

Choose Original Medicare if: You want to keep your current doctors and do not want to switch. You travel frequently or live part of the year in different states. You have a chronic condition and see specialists regularly. You are willing to pay higher out-of-pocket costs for flexibility. You want to add Medigap to cover most of your costs after the premium.

Choose Medicare Advantage if: You want a low or $0 monthly premium. You are comfortable using a network of doctors and hospitals. You want prescription coverage, dental, vision, or hearing benefits included. You do not mind getting a referral to see a specialist. You are generally healthy and do not expect high out-of-pocket costs.

Choose Medigap if: You want Original Medicare's flexibility but want to reduce your out-of-pocket costs. You are willing to pay a higher monthly premium for predictable costs. You do not want to worry about deductibles or coinsurance. You want to keep your current doctors without restriction.

Your enrollment window and what happens if you miss it

You can change your Medicare plan once a year during the Annual Enrollment Period, which runs from October 15 through December 7. Any changes you make take effect on January 1. If you miss this window, you are locked into your current plan for the entire next year, unless you have a may have access to life event like moving to a new state, losing other insurance, or getting married.

If you miss the important date and have a may have access to event, you have 60 days from the event to make a change. may have access to events are specific — moving to a new address, losing employer coverage, or becoming may be able to access for Medicaid all count. Changing your mind about your plan does not count as a may have access to event.

Mark October 15 on your calendar each year. Review your current plan's costs and coverage before the enrollment period opens. Check whether your doctors are still in-network, whether your medications are still covered, and whether the plan's costs have changed. Even if you were happy with your plan last year, costs and networks change, and a different plan might save you money.

Frequently Asked Questions

Can I switch from Medicare Advantage back to Original Medicare anytime?

You can switch during the Annual Enrollment Period (October 15 to December 7) or if you have a may have access to life event. Outside these windows, you are locked in. If you switch to Original Medicare, you have 63 days to add Medigap or Part D, or you may face a penalty on premiums later.

What if my doctor is not in the Medicare Advantage plan I want?

Contact the plan directly and ask whether your doctor is in-network. If not, you can either choose a different plan that includes your doctor, or switch to Original Medicare with Medigap to keep your current provider. Do not assume the plan's website is complete — call to confirm.

Do I have to choose a plan when I turn 65?

You must enroll in Part A and Part B when you turn 65 or you face a permanent penalty on your premiums. If you delay Part B because you have employer coverage, you must enroll within 8 months of losing that coverage. If you do not, your Part B premium increases by 10 percent for each year you delayed.

How much does Medicare cost per month?

Part B premiums vary by income and change each year — in 2024 they range from about $175 to over $500 per month depending on your income. Part D premiums vary by plan and region. Medicare Advantage premiums range from $0 to several hundred dollars per month. Check Medicare.gov for current premiums in your area.

What if I cannot decide between Original Medicare and Medicare Advantage?

Use the Medicare Plan Finder tool on Medicare.gov and enter your doctors, medications, and preferred pharmacies. The tool shows you the total estimated cost for each option based on your actual situation, not a general comparison. This usually makes the choice clearer than reading about the plans in the abstract.