“An ounce of prevention is worth a pound of cure.”
-Benjamin Franklin
What are the different Medicare “Parts”?
Part A (Hospitalization):
Covers inpatient hospital stays, skilled nursing, and limited home health care. No premium if you qualify for Social Security benefits, but deductibles per occurrence, copays, and even all costs apply after certain limits.
Part B (Medical Insurance):
Covers doctor visits, outpatient care, labs, ER, infusions, and some medical equipment. Costs $185/month in 2025 (higher with IRMAA), with 80/20 coverage after deductible and no limit on out-of-pocket costs.
Part D (Prescriptions):
Offered through private insurers with a list of covered drugs and drug tiers. Out-of-pocket costs are capped at $2,000 in 2025, including deductibles and copays.
Medigap vs Medicare Advantage
Medigap (Supplemental Insurance):
You keep Original Medicare (Parts A & B) and buy a Medigap plan from a private insurance company to cover the 20% Medicare doesn’t pay. You also need to add a separate Part D prescription plan.
Pros:
- Lower co-pays and deductibles
- Nationwide access
- No prior authorizations
Cons:
- Higher monthly premiums
- Must buy Part D separately
- Limited guaranteed issue window except for some states
- one of them being Massachusetts.
Medicare Advantage (Part C):
This is an “all-in-one” plan offered by private insurance companies that replaces Original Medicare. Most Advantage plans include Part D drug coverage, and many offer benefits like dental, vision, and hearing, although that is subject to change for 2026. Costs and provider networks vary, and many plans function like employer-style HMO or PPO coverage.
Pros:
- Low or $0 premiums
- Built-in Part D, added dental/vision/hearing benefits
Cons:
- Deductibles & co-pays
- Provider networks
- Require prior authorizations
- Benefits vary by plan and region.
What if I am still working?
If your employer has 20+ employees, you can delay enrollment in Part B without penalty if coverage is creditable. With fewer than 20 employees, you must enroll at 65 as Medicare will be your primary insurance payer. A common mishap is assuming all employer plans are creditable – always confirm to avoid late penalties and uncovered hospital and medical bills.
Resources
Next Stage Benefits
Ted Wallus
(617) 659-5542
[email protected]
Medicare
1-800-Medicare
(633-4227)
www.medicare.gov
State Health Insurance Assistance Program (SHIP)
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