Medicare, explained by someone who isn't rushing you

The three decisions

Almost everything in Medicare comes down to three choices, and they interact. Getting them in the right order saves most of the confusion.

1. Original Medicare, or Medicare Advantage?

Original Medicare (Parts A and B) is the federal programme. Medicare Advantage (Part C) is a private plan that replaces it and usually bundles drug coverage. Advantage plans often have lower premiums and extra benefits; they also use networks and require referrals more often. Neither is better in the abstract. It depends on your doctors, your prescriptions and how much you travel.

2. If Original Medicare — do you add a Supplement?

Original Medicare has no annual out-of-pocket cap. A Medicare Supplement (Medigap) covers most of what Medicare doesn't. Supplements are standardised by letter, so a Plan G is a Plan G whichever company sells it — what differs is price and how the company raises it over time. That second part matters more than the first-year premium, and it is the part most comparisons skip.

3. Drug coverage

Part D plans differ in which drugs they cover and at what tier. A plan that is cheapest on premium is regularly the most expensive once your actual prescriptions are priced through it. We check your specific medication list, not a general estimate.

What we check before you enrol

• Whether each of your current doctors is in the plan's network
• Every prescription you take, priced through that plan's formulary
• Whether a drug needs prior authorisation or step therapy
• What happens if you travel or spend part of the year elsewhere
• Whether you have a guaranteed issue right — this is time-sensitive and easy to lose

Timing

Your Initial Enrolment Period runs for seven months around your 65th birthday. The Annual Enrolment Period is 15 October to 7 December each year. There are also Special Enrolment Periods triggered by life events such as losing employer coverage or moving. Missing a window can mean a permanent penalty, so if you are not sure which applies to you, call and ask before the date passes.