The complete guide to your Medicare options
Medicare has four parts, several enrollment windows and dozens of plan choices. This guide explains all of it in plain English — so you can choose coverage with confidence, not guesswork.
- Our guidance is completely free — you never pay for a plan review.
- Every advisor is licensed and trained on current-year plans.
- Compare options from 30+ carriers side by side.
- Open Enrollment ends December 7 — changes take effect January 1.
Who qualifies for Medicare#
Medicare is the federal health insurance program for people age 65 and older, as well as certain younger people with qualifying disabilities or conditions. Most people become eligible during a seven-month window that begins three months before the month they turn 65.
Eligibility is not the same as enrollment. Some people are enrolled automatically, while others must sign up themselves. Missing your window can mean a lifelong premium penalty, so it helps to confirm your status early.
- Age 65+
- You qualify when you turn 65 if you are a U.S. citizen or a lawful permanent resident who has lived in the country for at least five continuous years.
- Disability
- People under 65 generally qualify after receiving Social Security Disability Insurance benefits for 24 months.
- ESRD / ALS
- End-stage renal disease and ALS have special rules that can waive the usual waiting period.
- Work Credits
- Roughly 40 quarters (about 10 years) of Medicare-covered work usually makes Part A premium-free. Fewer credits may mean a monthly Part A premium.
If you are already receiving Social Security benefits when you turn 65, you are usually enrolled in Parts A and B automatically and your card arrives in the mail. Everyone else must enroll on their own.
The four parts of Medicare#
Medicare is built from four lettered parts. Parts A and B form "Original Medicare," which is run by the federal government. Parts C and D are offered by private insurance companies approved by Medicare. Understanding what each part does is the foundation of every good coverage decision.
Hospital insurance#
Part A covers inpatient care — the things that happen when you are admitted.
Most people pay no premium for Part A because they or a spouse paid Medicare taxes while working. You will still have a deductible per benefit period and coinsurance for longer stays.
- Inpatient hospital stays, including semi-private rooms and meals
- Skilled nursing facility care after a qualifying hospital stay
- Hospice care for terminal illness
- Limited home health services ordered by a doctor
Medical insurance#
Part B covers outpatient care — doctors, tests and preventive services.
Part B has a standard monthly premium set each year, plus an annual deductible and typically 20% coinsurance on approved services. Higher-income households may pay an income-related adjustment.
- Doctor visits, specialists and second opinions
- Preventive screenings, annual wellness visits and vaccines
- Lab work, X-rays and diagnostic imaging
- Durable medical equipment such as walkers and oxygen
If you are still working at 65 and covered by a qualifying employer group plan, you may be able to delay Part B without penalty. Confirm that your employer coverage counts as creditable before you skip enrollment.
Medicare Advantage#
Part C bundles Parts A and B — and usually more — into one private plan.
Medicare Advantage plans are offered by private carriers and must cover everything Original Medicare covers. Many add extras and cap your annual out-of-pocket spending, but they use provider networks and may require referrals.
- All Part A and Part B benefits in a single plan
- Prescription drug coverage included in most plans
- Extras like dental, vision, hearing and fitness benefits
- An annual out-of-pocket maximum that Original Medicare lacks
Prescription drug coverage#
Part D helps pay for the medications you pick up at the pharmacy.
Each Part D plan publishes a formulary — the list of drugs it covers — organized into pricing tiers. Two plans with similar premiums can differ dramatically once your specific prescriptions are priced out.
- Generic and brand-name prescription drugs on the formulary
- Tiered copays with preferred pharmacy pricing
- An annual cap on out-of-pocket drug spending
- Many recommended adult vaccines at no cost
If you go 63 days or more without creditable drug coverage after your initial window, a late-enrollment penalty is added to your Part D premium — and in most cases it stays for as long as you have coverage.
| Part | Covers | Typical Cost |
|---|---|---|
| Part A | Inpatient hospital, skilled nursing, hospice | $0 for most; deductible applies |
| Part B | Doctors, outpatient care, preventive services | Standard premium + 20% coinsurance |
| Part C | A + B bundled, usually drugs and extras | Varies by plan and ZIP code |
| Part D | Prescription drugs from a plan formulary | Plan premium + tiered copays |
Comparing your options#
Nearly every Medicare decision comes down to one fork in the road: stay with Original Medicare (often paired with a supplement and a Part D plan), or choose a Medicare Advantage plan. Neither is universally better — the right answer depends on your doctors, your prescriptions and how you like to manage costs.
| Feature | Original Medicare | Medicare Advantage |
|---|---|---|
| Monthly Premium | Part B premium + supplement | Varies many $0-premium plans |
| Provider Choice | Any provider accepting Medicare | Network-based (HMO / PPO) |
| Prescription Coverage | — separate Part D plan | Usually included |
| Dental & Vision | — not covered | Often included |
| Out-of-Pocket Cap | — none without a supplement | Annual maximum required |
| Referrals Required | — no referrals | Varies common with HMOs |
Consider two neighbours. One travels six months a year and sees specialists in three states — the freedom of Original Medicare with a supplement usually suits that life better. The other sees one local primary care doctor, takes two generic medications and wants dental and vision rolled in — a Medicare Advantage plan may fit more naturally. Same town, same age, two different right answers. Actual costs and benefits depend on your plan, ZIP code and the current plan year.
How we help#
UnitedOptionsGuide exists to turn a confusing catalogue of plans into a short list you can actually decide between. There is no cost to you, no obligation, and no pressure at any step.
Share your ZIP code, the doctors you want to keep and the medications you take. That is all we need to begin.
≈ 3 minutesA licensed advisor reviews plans from 30+ carriers available where you live and prices them against your actual prescriptions.
≈ 24 hoursWhen you are ready, we walk through the paperwork together and stay available for questions after your coverage starts.
≈ 20 minutesKey dates and enrollment periods#
Medicare runs on a calendar. Knowing which window you are in determines what you can change — and whether a change is even possible right now.
December 7 is the last day of Open Enrollment. You have — left to review your options for the coming plan year. Start a free review →
What people say#
A few notes from people who used the guide and then spoke with an advisor.
"I had a stack of mail six inches high and no idea what any of it meant. One conversation sorted out which plan actually covered my cardiologist."
"They priced my four prescriptions against three different drug plans and showed me the difference in writing. Nobody rushed me."
"I expected a sales pitch and got an explanation instead. When I said I wanted to keep what I had, that was the end of it — no pressure."
Frequently asked questions#
The questions we are asked most often, answered briefly.
No. Reviewing your options with a licensed advisor is free. Advisors are compensated by the insurance carriers, so your plan premium is the same whether you enroll with help or on your own.
Most people enroll during their Initial Enrollment Period — the seven months surrounding their 65th birthday. After that, Open Enrollment runs October 15 to December 7 each year, and Special Enrollment Periods can open after qualifying life events.
Often, yes. Original Medicare works with any provider who accepts Medicare. Medicare Advantage plans use networks, so we check your specific doctors against each plan's network before you decide.
Medigap (a supplement) works alongside Original Medicare and helps pay costs Medicare leaves behind. Medicare Advantage replaces how you receive Parts A and B through a private plan. You cannot use both at the same time.
Usually it is still wise. Going without creditable drug coverage for 63 days or more triggers a permanent late-enrollment penalty. Many low-premium Part D plans exist for exactly this situation.
Your current coverage generally continues into the new year, but you may have to wait until the next window to change it — unless you qualify for a Special Enrollment Period or the Medicare Advantage OEP from January 1 to March 31.
Formularies change every year. Your plan mails an Annual Notice of Change each fall listing what is different. It is worth re-checking your drug list during Open Enrollment even if you are happy with your plan.
No. UnitedOptionsGuide is a private educational resource and is not affiliated with Medicare or any government agency. For official program information, visit Medicare.gov.
Glossary#
Six terms that appear in almost every plan document.
The fixed amount you pay each month to keep coverage active, whether or not you use care.
What you pay out of pocket before the plan begins paying its share for covered services.
Your percentage of a bill after the deductible — commonly 20% under Part B.
The hospitals, doctors and pharmacies contracted with a plan to provide care at agreed rates.
A drug plan's list of covered medications, grouped into tiers that set your copay.
The annual October 15 – December 7 window to join, switch or drop Advantage and Part D plans.
Resources#
Where to go next, in order of usefulness.
Get your free Medicare review
A licensed advisor will compare the plans available where you live against your doctors and prescriptions — then explain the trade-offs in plain language.