Medicare is one of the most important benefits available to Americans 65 and older — and one of the most confusing. Patients ask us every week: "What is the difference between Part A and Part B?", "Do I need Part D if I already have Part C?", or "What exactly is Medigap and do I need it?"

This guide breaks it down in plain language so you can walk into your next appointment — or your next open enrollment period — knowing exactly what you have and what you may be missing.

Before diving into the parts, it helps to understand the two main ways Medicare is delivered:

• Original Medicare = Parts A + B (run directly by the federal government)
• Medicare Advantage = Part C (run by private insurance companies, replaces Parts A + B)
• Part D = Prescription drug coverage (added separately to Original Medicare, or bundled into many Part C plans)

Most people start with Original Medicare and then decide whether to add a Supplement (Medigap) plan and Part D, or switch to a Medicare Advantage plan instead.

What it covers:

• Inpatient hospital stays
• Skilled nursing facility care (after a qualifying hospital stay)
• Hospice care
• Some home health services

What it does NOT cover:

• Doctor visits
• Outpatient care
• Prescription drugs
• Dental, vision, or hearing

What it costs: Most people pay $0 in premiums for Part A if they or their spouse worked and paid Medicare taxes for at least 10 years. If you do not qualify for premium-free Part A, the 2025 premium is up to $505/month.

There is a deductible per benefit period (not per year) — in 2025, that is $1,632 for the first 60 days of a hospital stay.

The bottom line: Part A is your hospital safety net. It kicks in when you are admitted — not for routine care.

What it covers:

• Doctor visits (primary care and specialists)
• Outpatient care and procedures
• Preventive services (Annual Wellness Visit, screenings, vaccines)
• Lab tests and X-rays
• Durable medical equipment (wheelchairs, walkers, CPAP machines)
• Mental health services
• Telehealth visits

What it does NOT cover:

• Prescription drugs (that is Part D)
• Dental, vision, or hearing
• Long-term custodial care

What it costs: The standard 2025 Part B premium is $185/month, deducted from your Social Security check. Higher-income beneficiaries pay more (IRMAA surcharge). There is also a $257 annual deductible, after which Medicare covers 80% of approved costs and you pay the remaining 20%.

The bottom line: Part B is what covers your visits to Dr. Milian. If you have Original Medicare, you need Part B to receive primary care, specialist visits, and most outpatient services.

What it is: Medicare Advantage is an alternative way to receive your Medicare benefits. Instead of Original Medicare paying providers directly, you enroll in a private insurance plan (like Humana, UnitedHealthcare, or Aetna) that is approved by Medicare to deliver your Part A and Part B benefits — and usually Part D as well.

What it covers: Everything Original Medicare covers, plus many plans add:

• Dental, vision, and hearing benefits
• Fitness memberships (SilverSneakers)
• Transportation to medical appointments
• Over-the-counter allowances

What it costs: Many Medicare Advantage plans have $0 monthly premiums (you still pay your Part B premium). However, you will have copays, coinsurance, and network restrictions. You must use in-network providers, and prior authorizations are common for specialist visits and procedures.

Important: Not all doctors accept all Medicare Advantage plans. Before enrolling in a plan, always verify that your primary care doctor and any specialists you see are in-network.

The bottom line: Part C can offer extra benefits at low cost, but it comes with trade-offs — network restrictions, prior authorizations, and varying coverage rules. Original Medicare gives you more flexibility to see any Medicare-participating provider nationwide.

What it covers: Prescription medications — both generic and brand-name drugs — through a formulary (list of covered drugs) that varies by plan.

What it costs: Premiums vary by plan, typically $20–$100/month. There is also a deductible (up to $590 in 2025), copays or coinsurance for each prescription, and a coverage gap (the "donut hole") — though the Inflation Reduction Act has significantly reduced out-of-pocket costs in recent years.

The out-of-pocket cap: Starting in 2025, Medicare Part D has a $2,000 annual out-of-pocket cap on covered drugs — a major change that protects patients with high medication costs.

Do you need Part D? If you have Original Medicare (Parts A + B), you should enroll in a standalone Part D plan when you first become eligible — even if you take few or no medications. If you skip Part D and enroll later, you may face a late enrollment penalty (1% of the national base premium per month you were without coverage).

If you have Medicare Advantage (Part C), your plan likely already includes drug coverage — check your plan documents.

The bottom line: Part D is your prescription drug coverage. Do not skip it — the late enrollment penalty adds up, and drug costs can be significant if you develop a new condition.

Medigap (also called Medicare Supplement Insurance) is private insurance you can buy to help pay the costs that Original Medicare does not cover — primarily the 20% coinsurance under Part B, hospital deductibles, and copays. It does not replace Medicare; it works alongside Parts A and B to fill in the gaps.

Medigap plans are sold by private insurance companies but are standardized by the federal government. That means a Plan G from one company covers the exact same benefits as a Plan G from another company — the only difference is the premium you pay.

Important: Medigap only works with Original Medicare (Parts A + B). You cannot use a Medigap plan if you are enrolled in Medicare Advantage (Part C).

The most popular Medigap plans in 2025 are Plan G and Plan N. Here is what they cover:

Plan G — Most Comprehensive (for new enrollees after January 1, 2020)

• Part A hospital coinsurance and costs up to 365 days after Medicare benefits are used
• Part A deductible ($1,632 per benefit period in 2025)
• Part A hospice care coinsurance or copayment
• Part B coinsurance or copayment (the 20% you would otherwise owe)
• Part B excess charges (when a doctor charges more than Medicare's approved amount)
• Skilled nursing facility care coinsurance
• Foreign travel emergency care (up to plan limits)

With Plan G, your only out-of-pocket cost is the Part B annual deductible ($257 in 2025). After that, Plan G covers everything else Medicare approves — no surprise bills.

Plan N — Lower Premium, Some Cost-Sharing

• Covers everything Plan G covers, except:
  • You pay up to $20 copay for some office visits
  • You pay up to $50 copay for emergency room visits that do not result in inpatient admission
  • Does NOT cover Part B excess charges

Plan N is a good fit for patients who are generally healthy, rarely see specialists, and want a lower monthly premium in exchange for modest copays.

Plan F — No Longer Available to New Enrollees Plan F was the most comprehensive Medigap plan — it covered the Part B deductible in addition to everything Plan G covers. However, it is no longer available to people who became eligible for Medicare on or after January 1, 2020. If you enrolled before that date and already have Plan F, you can keep it.

Even with a Medigap plan, you will still need separate coverage for:

• Prescription drugs — Medigap does not include drug coverage; you need a standalone Part D plan
• Dental, vision, and hearing
• Long-term custodial care
• Private-duty nursing

Premiums vary by plan type, insurance company, your age, gender, tobacco use, and where you live. In Florida, typical monthly premiums in 2025 range from:

• Plan G: approximately $120–$220/month depending on age and insurer
• Plan N: approximately $90–$160/month depending on age and insurer

Premiums increase as you age, so enrolling earlier generally locks in a lower starting rate.

The best time to enroll is during your Medigap Open Enrollment Period — the 6-month window that starts the month you turn 65 AND are enrolled in Part B. During this window:

• Insurance companies cannot deny you coverage based on pre-existing conditions
• They cannot charge you more because of your health history
• You have guaranteed issue rights to any plan sold in your state

After this window closes, insurers in most states (including Florida) can use medical underwriting — meaning they can deny your application or charge higher premiums based on your health. There are some exceptions (qualifying life events, losing other coverage), but in general, missing your open enrollment window can make Medigap harder or more expensive to obtain.

This is one of the most important decisions a new Medicare enrollee makes. Here is a plain comparison:

There is no universally right answer. Patients with multiple chronic conditions, frequent specialist visits, or who split time between Florida and another state often find that the predictability of Medigap is worth the higher premium. Patients who are generally healthy and want to minimize monthly costs may prefer Medicare Advantage.

Here is a simple way to think about it:

Original Medicare path: Enroll in Part A + Part B → add a Medigap supplement (Plan G or N) to cover the 20% coinsurance and deductibles → add a standalone Part D plan for drugs.

Medicare Advantage path: Enroll in Part A + Part B → choose a Part C plan that replaces A + B, usually includes Part D, and often adds dental/vision/hearing. Note: Medigap cannot be used with Part C.

This surprises many patients:

• Routine dental care — cleanings, fillings, dentures
• Routine vision care — eye exams for glasses or contacts
• Hearing aids
• Long-term custodial care — assisted living, nursing home care not following a hospital stay
• Most care received outside the U.S.

For these gaps, some Medicare Advantage plans offer partial coverage, or you can purchase separate supplemental insurance.

• Initial Enrollment Period: 7-month window starting 3 months before your 65th birthday month
• Annual Open Enrollment: October 15 – December 7 each year (changes take effect January 1)
• Medicare Advantage Open Enrollment: January 1 – March 31 (switch Advantage plans or return to Original Medicare)
• Special Enrollment Periods: Available if you lose employer coverage or have other qualifying life events

Missing your Initial Enrollment Period without qualifying coverage can result in permanent late enrollment penalties for Part B and Part D.

Understanding your Medicare coverage helps you get the most out of every visit. At Manatee Primary Care, we see Medicare patients for Annual Wellness Visits, chronic disease management, preventive screenings, and same-day sick visits.

If you have questions about what is covered at your next appointment, call us at (941) 867-9362 and our staff will help you understand your benefits before you arrive.

Ready to schedule? Book online or call (941) 867-9362.

For official Medicare enrollment information, visit medicare.gov or call 1-800-MEDICARE.