Medicare starts with Parts A (hospital) and B (medical). You’ll pay the Part B premium ($185 in 2025) and face deductibles and coinsurance. To limit costs, choose Medigap or Medicare Advantage. Medigap keeps Medicare’s broad network and low bills (Plan G plus the $257 Part B deductible in 2025). Advantage plans often cost $0 monthly but use HMO/PPO networks, prior authorizations, and have $3,000–$10,000 out-of-pocket caps. You’ll see how these choices affect costs, access, and control next.
Key Points
- Original Medicare includes Part A (hospital) and Part B (medical); expect deductibles, coinsurance, and no out-of-pocket maximum.
- Medigap supplements Original Medicare, preserving broad provider access and minimizing bills; Plan G averages $150–$180 monthly plus a $257 deductible in 2025.
- Medicare Advantage (Part C) bundles A, B, usually D; you still pay the $185 Part B premium in 2025.
- Advantage plans often have $0 premiums but use HMO/PPO networks, require authorizations, and cap annual costs around $3,000–$10,000.
- HMO needs a PCP and referrals; PPO offers more flexibility and out-of-network access at higher costs.
Understanding Original Medicare: Parts A and B
Even before you compare plan add-ons, start with Original Medicare: Part A (hospital insurance) and Part B (medical insurance).
Part A generally costs $0 in premiums for most people and helps cover inpatient hospital stays, skilled nursing facility care, hospice, and some home health.
Part B costs a standard $185 monthly premium in 2025 and covers doctor visits, outpatient services, preventive care, labs, imaging, and durable medical equipment.
You’ll still face deductibles, coinsurance, and no cap on out-of-pocket costs, creating financial risk.
Understand what’s covered, what isn’t, and how billing works so you can anticipate expenses and avoid surprises.
Filling the Gaps: Medigap vs. Medicare Advantage
While Original Medicare lays the foundation, you’ll need to decide how to fill its gaps: a Medigap (Supplement) plan or a Medicare Advantage (Part C) plan.
With Medigap, you keep Original Medicare’s open network—about 98% of doctors accept it—no referrals or pre-authorizations, and predictable costs. Popular Plan G pairs a $150–$180 monthly premium with the Part B deductible of $257 in 2025.
Medicare Advantage trades higher predictability for lower premiums, often $0. You’ll use HMO or PPO networks, accept prior authorizations, and pay copays up to a plan’s maximum out-of-pocket, typically $3,000–$10,000.
Choose based on flexibility, budgeting style, and health needs.
Inside Medicare Advantage (Part C) and Drug Coverage
Think of Medicare Advantage (Part C) as an all-in-one alternative to Original Medicare that bundles hospital (Part A), medical (Part B), and usually drug coverage (Part D) into a single plan.
You’ll keep paying your Part B premium ($185 in 2025), and many plans add a low or $0 plan premium. Most include extras like dental, vision, hearing, fitness, and telehealth.
Drug coverage follows a formulary with tiers, preferred pharmacies, and rules like prior authorization or step therapy.
Review each plan’s copays, deductibles, and annual maximum out-of-pocket limit (often $3,000–$10,000). Confirm your prescriptions, dosages, and pharmacies are covered to avoid surprise costs.
HMO and PPO Networks: How They Work
Before you pick a Medicare Advantage plan, understand how HMO and PPO networks steer your care and costs.
In an HMO, you choose a primary care provider (PCP) who coordinates your care. You typically need referrals to see specialists, and you must stay in-network, except for emergencies. This structure keeps care organized within a defined provider list.
With a PPO, you can see any in-network doctor without referrals and may use out-of-network providers for higher costs. You don’t designate a PCP.
Both HMOs and PPOs can include Part D and extras like dental or vision, and both may require prior authorizations.
Comparing Costs, Access, and Control
As you compare Medicare options, focus on three levers: what you’ll pay, how easily you can see providers, and how much control you keep over care decisions.
Costs: Original Medicare plus a Medigap G plan trades a higher monthly premium for minimal bills—only the Part B deductible in 2025.
Medicare Advantage often has $0 premiums but uses copays and caps with maximum out-of-pocket limits.
Access: Medigap’s open network lets you see nearly any doctor accepting Medicare.
Advantage relies on HMO or PPO networks.
Control: Medigap rarely needs pre-authorization or referrals; Advantage commonly requires both, affecting speed and autonomy in your care path.
Choosing the Right Path for Your Health and Budget
Ready to choose? Start with your priorities.
If you want nationwide access and predictable costs, pair Original Medicare with a Medigap G plan. You’ll pay the Part B premium ($185 in 2025), a G premium ($150–$180), and only the Part B deductible ($257).
Prefer lower monthly costs? Consider Medicare Advantage (Part C). Many plans have $0 premiums and include Part D, dental, and vision.
Check network type: HMO (PCP, referrals, in-network only) or PPO (more flexibility, higher out-of-network costs). Review co-pays, prior authorizations, and the plan’s maximum out-of-pocket ($3,000–$10,000).
Match your health needs, travel habits, and budget tolerance.
Frequently Asked Questions
When and How Do I Enroll to Avoid Late Penalties?
Enroll during your Initial Enrollment Period: three months before to three months after your 65th birthday month. If you’re covered by credible employer insurance, use a Special Enrollment Period. Enroll via Social Security online, phone, or in person.
Can I Delay Part B if I Have Employer Coverage?
Yes, you can delay Part B if you’re covered by active employer group insurance. Enroll in Part B within eight months after that coverage or employment ends to avoid penalties. Get your employer’s CMS-L564 form completed.
How Do Medicare Savings Programs Help With Premiums and Costs?
They lower your Medicare costs by paying Part B premiums, sometimes Part A, and reducing deductibles, copays, and coinsurance. You’ll qualify based on income and assets. Apply through your state Medicaid office; you shouldn’t miss potential Extra Help, too.
Are My Retiree or TRICARE Benefits Affected by Medicare Choices?
Yes—think of two interlocking keys. With retiree plans, your Medicare choice can shift primary/secondary payers and premiums. With TRICARE, you must enroll in Part B to keep TRICARE For Life; Advantage plans can complicate coordination and networks.
What Happens When I Move to a Different State?
You’ll trigger a Special Enrollment Period. You can switch Medicare Advantage or Part D to plans available in your new ZIP code. Medigap stays portable nationwide. Update Social Security. Compare HMO vs. PPO networks, premiums, and provider access before switching.
