When I first started working with seniors, I had no real understanding of how Medicare worked. And the more I worked with Medicare… the more I realized I really didn’t understand it.
Medicare is a crazy beast. Between Advantage plans, supplements, group plans, and obscure rules, it’s incredibly difficult to know what’s covered and what’s not.
I didn’t truly feel comfortable with Medicare until I spent years working with it from the inside—inside a hospital. And even then, it was so confusing that almost no one fully understood the rules. Not hospital staff, not vendors, and definitely not patients.
I could spend weeks talking about the wisdom (and frustration) of Medicare—but instead, I want to break it down in a way that’s as simple and practical as possible, and highlight why working with an advocate who understands your specific situation really matters.
Medicare Part A: Hospital Insurance
Medicare Part A is your hospital insurance. You generally qualify if you’re over 65, disabled, or have certain chronic conditions.
Part A typically covers:
– Inpatient hospital stays
– Skilled nursing facility stays (short-term rehab)
– Hospice care (wherever you live)
– Limited home health services
Part A is usually premium-free if you or your spouse paid Medicare taxes long enough. However, if you remain on Original Medicare (Part A & B), you’ll still have deductibles for each hospital stay.
Medicare Part B: Medical Insurance
Medicare Part B is what most people think of as traditional medical insurance.
Part B covers:
– Doctor visits and specialists
– Preventive services
– Outpatient care
– Durable medical equipment (walkers, wheelchairs, oxygen, etc.)
Part B comes with a monthly premium, an annual deductible, and coinsurance. The upside is flexibility—most providers accept Original Medicare, which gives you broad access to doctors and specialists.
Medicare Part C: Medicare Advantage Plans
Medicare Advantage (Part C) plans are an alternative to Original Medicare. These plans are offered by private insurance companies and usually bundle:
– Medicare Parts A & B
– Prescription coverage (Part D)
– Dental, vision, and hearing benefits
The trade-off is that you’re limited to a provider network and subject to prior authorizations. That means approvals are often required for hospital stays, skilled nursing, home health, and other services.
While Advantage plans can be more affordable upfront, many are difficult to use, especially for seniors with complex medical needs. Some hospitals are also reducing the number of Advantage plans they accept, which can limit options even further.
Medicare Part D: Prescription Drug Coverage
Medicare Part D provides prescription drug coverage. Original Medicare (Parts A & B) does not include medications.
You can:
– Add a standalone Part D plan to Original Medicare, or
– Receive drug coverage through some Advantage plans
Part D plans include monthly premiums, copays, and coinsurance, but they can significantly reduce out-of-pocket prescription costs.
Medicare Supplements (Medigap)
Medicare Supplement (Medigap) plans help cover the costs that Original Medicare doesn’t—like deductibles, copays, and coinsurance. These plans do not work with Medicare Advantage.
Medigap plans:
– Cost more monthly than Advantage plans
– Are accepted by far more providers
– Offer greater flexibility and predictability
Think of supplements as financial protection. They don’t offer extras like dental or vision, but they dramatically reduce surprise medical bills and expand your choice of doctors, specialists, and skilled nursing facilities.
Choosing the Right Medicare Coverage Isn’t One-Size-Fits-All
Medicare is dense and confusing—and what works for one person may be completely wrong for another.
Ask yourself:
– Do you see multiple specialists across different health systems?
– Are you a low user of healthcare with few prescriptions?
– Do you have mobility limitations that may lead to hospital or skilled nursing stays?
Every situation is different. A one-size-fits-all approach simply doesn’t work.
That’s why talking with a trusted professional and advocate, like Compass Care, can make all the difference. We help families understand their options, avoid costly mistakes, and choose coverage that actually supports their health and independence.
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