Insurance is confusing — it doesn't have to be. We've put together everything you need to know about Medicare, individual health plans, and more, all in plain English. No jargon, no fine print headaches.
Medicare is the federal health insurance program for people 65 and older, and for some younger people with disabilities or specific conditions like End-Stage Renal Disease (ESRD). It's been around since 1965, and today it covers over 65 million Americans.
You qualify for Medicare if you meet any of these criteria:
If you or your spouse paid Medicare taxes for at least 10 years (40 quarters), you're entitled to premium-free Part A when you turn 65. Part B is available for a monthly premium.
If you've been receiving Social Security Disability Insurance (SSDI) for 24 months, you're automatically enrolled in Medicare Parts A & B — regardless of your age.
People with End-Stage Renal Disease (permanent kidney failure) or ALS (Lou Gehrig's disease) qualify for Medicare at any age, often with no waiting period for ALS.
Together, Parts A and B make up "Original Medicare" — the foundation everything else builds on.
Part A covers inpatient care — the things that happen when you're admitted to a facility.
Cost: Most people pay $0 for Part A if they (or their spouse) worked and paid Medicare taxes for 10+ years. If you don't qualify for premium-free Part A, you can buy it.
Part B covers outpatient care — doctor visits and preventive services you get outside the hospital.
Cost: The standard Part B premium is approximately $202.90/month in 2026 (income-dependent). After meeting your deductible, Medicare typically pays 80% and you pay 20%.
Important: Original Medicare (A + B) does NOT cover dental, vision, hearing aids, or long-term custodial care. That's where additional coverage comes in — read on.
Once you have Original Medicare (Parts A & B), you have two main paths to build out your coverage. Understanding the difference is one of the most important decisions you'll make.
Medicare Advantage plans are offered by private insurance companies approved by Medicare. They replace Original Medicare — you get all your A & B coverage through the plan, plus usually extra benefits.
Best for: People who want all-in-one coverage, are comfortable using a network of doctors, and want extra benefits like dental and vision included.
Medigap plans work alongside Original Medicare. They help pay the "gaps" — copays, coinsurance, and deductibles that A & B don't cover. You keep Original Medicare and add the supplement on top.
Best for: People who want maximum flexibility to see any doctor, travel frequently, or want the most predictable out-of-pocket costs.
Medigap plans are standardized by the government and labeled by letter. Each letter covers the same benefits no matter which company sells it — only the price differs.
Covers nearly everything: Part A coinsurance, hospital costs, Part B coinsurance, first 3 pints of blood, skilled nursing coinsurance, Part A & B deductibles (except Part B deductible), and foreign travel emergency. You only pay the Part B deductible out of pocket.
Typical premium: $120–$250/month depending on age and location.
Similar to Plan G but with lower premiums. The trade-off: you pay small copays for office visits (up to $20) and ER visits ($50 if not admitted). Doesn't cover Part B excess charges.
Typical premium: $80–$180/month depending on age and location.
Less commonly sold but available in many states. They offer different combinations of coverage at different price points. Plans C and F are available only to those who became Medicare-eligible before January 1, 2020.
Linda, age 67, Portland, OR: Linda chose a Plan G supplement. Her monthly costs: $202.90 (Part B premium) + $165 (Plan G premium) + $25 (Part D drug plan) = $392.90/month total. She can see any doctor in the country and has virtually no surprise bills.
Compare to Advantage: Her neighbor chose a $0-premium Medicare Advantage plan. She pays $202.90 (Part B premium) + $0 (Advantage premium) = $202.90/month — but has copays for doctor visits, a $5,000 out-of-pocket max, and must stay in-network.
Neither choice is "wrong" — it depends on your priorities. That's why we're here to help you decide.
Part D covers prescription medications. If you have Original Medicare + a Medigap supplement, you'll need a standalone Part D plan for drug coverage. If you have a Medicare Advantage plan, Part D is usually built in.
Each Part D plan has its own formulary (list of covered drugs) and pharmacy network. Costs depend on the drugs you take and the plan you choose.
Monthly premium: Ranges from $0 to $100+/month depending on the plan.
Deductible: Up to $590 (2026) before your plan starts paying — some plans waive this.
Copays/Coinsurance: You pay a share of each prescription. Generic drugs cost far less than brand-name.
Coverage Gap ("Donut Hole"): After total drug costs reach a certain amount, you pay a capped amount for prescriptions until catastrophic coverage kicks in.
Pro tip: Don't just pick the cheapest Part D premium. Enter your specific medications and pharmacy into a plan comparison tool — or let us do it for you. The cheapest premium often isn't the cheapest total cost.
A Dual Eligible Special Needs Plan (D-SNP) is a special type of Medicare Advantage plan designed for people who qualify for both Medicare and Medicaid (called "dual eligibles"). These plans combine the benefits of Medicare and Medicaid into one plan with extra coordination of care.
You may be eligible for a D-SNP if you have both Medicare (Part A and/or B) and your state's Medicaid program. This includes people with low income who receive Extra Help, QMB, SLMB, or full Medicaid benefits.
A D-SNP plan acts as your Medicare Advantage plan. It replaces Original Medicare for your day-to-day coverage and coordinates with your Medicaid benefits. Here's what that looks like in practice:
Maria, age 72, Denver, CO: Maria qualifies for both Medicare and Medicaid. Through her D-SNP plan, she gets $0-premium Medicare Advantage coverage with $0 copays for primary care, $0 generic prescriptions, free dental cleanings, free rides to her doctor, and an over-the-counter health allowance. Her Medicaid continues to cover her in-home aide services.
You still have options. The ACA marketplace and individual health plans offer affordable coverage for you and your family — and you might qualify for more help than you think.
Explore ACA & Individual Plans →Health insurance covers the big things — but life has a way of throwing smaller (and not-so-small) curveballs. Ancillary plans fill in the gaps with affordable protection that pays cash directly to you.
If you end up in the hospital, your health insurance covers the medical bills — but who covers the mortgage, groceries, or gas while you're recovering? Hospital indemnity plans pay a lump sum directly to you for each day you're admitted.
Janet, age 68, has a Medicare Advantage plan. She has hip replacement surgery and spends 3 days in the hospital. Her hospital indemnity plan pays her $250/day × 3 = $750 cash, plus a $500 admission benefit = $1,250 total. She uses it for groceries and help around the house while recovering.
Original Medicare doesn't cover dental or routine vision. Even many Advantage plans have limited dental benefits. Standalone dental and vision plans keep your teeth and eyes healthy without breaking the bank.
Tom, age 70, pays $35/month for dental. He gets 2 free cleanings per year, and when he needed a crown ($1,200 retail), his plan covered 50% after a short waiting period. He paid $600 instead of $1,200 — the plan paid for itself in one visit.
Accidents don't come with a warning. Accident insurance pays cash benefits for injuries from covered accidents — falls, car accidents, sports injuries, and more. The money goes directly to you, not the hospital.
David, age 55, falls off a ladder and breaks his wrist. His accident plan pays: $250 ER visit + $500 fracture benefit + $100 follow-up visit = $850 cash. He uses it to cover his deductible on his ACA plan and pay for a few days off work.
A critical illness diagnosis can mean months of treatment, missed work, and mounting bills. Critical illness insurance pays a one-time lump sum when you're diagnosed with a covered condition — no questions asked about how you use it.
Patricia, age 62, is diagnosed with early-stage breast cancer. Her critical illness plan pays a $15,000 lump sum. She uses it to cover her out-of-pocket maximum on her health plan, pay for wigs and comfort items during chemo, and take time off work without financial stress.
Stacking ancillary plans is one of the smartest moves you can make. For $50–$100/month total, you can add hospital indemnity + dental + accident coverage and protect yourself from the costs your main health plan doesn't cover.
Now that you know the basics, let us help you put the pieces together. We'll find the right combination of coverage for your situation — and it won't cost you a thing.
Free consultations, always. No obligation, no pressure.