Medicare Plans - The difference in coverage

Reviewed by Russell Noga, a Licensed Medicare Insurance Broker in all 50 states — Updated October 8, 2026

Medicare has four parts: Part A (hospital), Part B (medical), Part C (Medicare Advantage) and Part D (drugs), plus Medicare Supplement (Medigap) plans that fill gaps in Original Medicare. Most people choose either Original Medicare with Part D and often Medigap, or a Medicare Advantage plan.

For 2027, the average Medicare Advantage premium is $12, the Part D deductible can be up to $700, and the Part B premium is projected around $209.50 (official in November).

See Medicare plans 2027.

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Key Highlights

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Part A: hospital. Part B: medical.

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Part C: Medicare Advantage.

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Part D: drugs.

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Medigap fills Original Medicare gaps.

Compare plans and enroll online

The Parts of Medicare

Part Covers Who Sells It
Part A Hospital, skilled nursing, hospice Government
Part B Doctors, outpatient, preventive Government
Part C Medicare Advantage: A + B, usually D Private insurers
Part D Prescription drugs Private insurers
Medigap Original Medicare cost sharing Private insurers

Two Ways to Get Medicare

Medicare Advantage Original Medicare + Medigap
Monthly premium Often low or $0 (2027 average $12, CMS) Higher; varies by plan letter, age and ZIP
Doctors Usually a network Any provider in the U.S. that accepts Medicare
Costs when you get care Copays and coinsurance up to a yearly maximum Predictable and low; on Plan G, little to nothing after the Part B deductible
Drug coverage Usually included Add a separate Part D plan
Dental, vision, hearing Many plans may include some coverage Not included
Changing later Every year during Annual Enrollment In most states, health questions once your Medigap Open Enrollment Period ends

what is Medicare Advantage

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How Medicare Advantage Works

Medicare Advantage, or Part C, lets you receive your Medicare benefits from a Medicare-approved private insurer. These plans cover all that Original Medicare Part A and Part B cover, apart from hospice care, which remains with Original Medicare. Part D drug coverage is included in most plans, and many may also offer extras like routine dental, vision and hearing benefits.

The trade-off is that Medicare Advantage plans generally rely on doctor and hospital networks and may call for referrals or prior authorization for certain services. Unlike Original Medicare, every Medicare Advantage plan caps your yearly out-of-pocket costs for covered medical care. Your Part B premium still applies, along with the plan’s own premium if there is one.

Feature HMO PPO
Out-of-network care Not covered except emergencies and urgent care Covered at a higher cost
Referrals for specialists Usually required Usually not required
Premiums Usually lower Usually higher
Out-of-pocket maximum In-network limit In-network limit plus a higher combined limit
Best for Lower costs, local care Flexibility, travel, keeping specific doctors

Medigap Plans

Plan What You Pay Best For
Plan G The Part B deductible, after which Medicare-approved costs are paid Most complete coverage for new enrollees
Plan N The Part B deductible, Part B excess charges, and copays of up to $20 for certain office visits and up to $50 for certain ER visits Lower premium, accepts small copays
High-Deductible Plan G A yearly deductible, then coverage like Plan G Healthy people who want the lowest premium

Each Medigap plan letter has standardized benefits. Price depends on the insurer, your age, ZIP code and tobacco use.

Plan G

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After the Part B deductible, you pay little or nothing

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Covers Part B excess charges

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Highest premium of the three

Plan N

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You pay the Part B deductible plus small copays

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Does not cover Part B excess charges

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Usually a lower premium than Plan G

High-Deductible G

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In 2027, you pay up to $3,050 before coverage begins

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Then covers like Plan G

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Lowest premium

Part D

Every Part D plan moves through three stages during the year, and the stage you are in decides what you pay at the pharmacy counter.

The Three Payment Stages

1

Deductible. You pay the full negotiated price until you meet your plan’s deductible, which can be up to $700 in 2027. Many plans charge less or waive it on lower tiers.

2

Initial coverage. You pay a copay or coinsurance set by each drug’s tier, and the plan pays the rest.

3

Catastrophic coverage. Once your out-of-pocket spending reaches $2,400, covered Part D drugs cost $0 for the rest of 2027.

$700

Maximum 2027 Part D deductible, up from $615.

$2,400

2027 Part D out-of-pocket cap, up from $2,100.

About $36

Average standalone Part D premium for 2027, rising by under $1 (CMS).

$7

Expected average drug portion of a 2027 Medicare Advantage premium, lower than $11.32.

Comparing Medicare Advantage vs Original Medicare

How to Choose

How to Compare

1

Go through your Annual Notice of Change. It shows each 2027 change to the plan you have now.

2

Review your doctors and hospitals. Make sure every provider is in the 2027 network, not only the 2026 one.

3

Review your prescriptions. Verify each drug, its tier and any step therapy or prior authorization rules.

4

Weigh the full cost for the year. Total the premium, usual copays and drug costs, then check the out-of-pocket maximum.

5

Look at star ratings. Medicare scores plans on quality and service using a 1 to 5 star scale.

6

Sign up by December 7. Coverage under your new plan begins January 1, 2027.

Enrollment Periods

Enrollment Period Dates What You Can Do
Annual Enrollment Period October 15 to December 7, 2026 Enroll in, change or leave a Medicare Advantage or Part D plan effective January 1, 2027
Medicare Advantage Open Enrollment January 1 to March 31, 2027 Medicare Advantage members can make one switch to another plan or back to Original Medicare
Initial Enrollment Period 7 months around your 65th birthday month Sign up for Medicare and choose your first plan
Special Enrollment Periods Varies Switch plans when something happens, such as a move, a loss of other coverage or your plan exiting your area

Annual Enrollment is when most people make their changes. If your current plan suits you, no action is needed, since it renews on its own. Even so, review your Annual Notice of Change, as networks, drug lists, copays and premiums may all change on January 1.

Turning 65

Turning 65 in 2027? Your Initial Enrollment Period runs for seven months: the three months leading up to your birthday month, the birthday month itself and the three months that follow. Enrolling in the first three months starts your coverage on the first day of your birthday month.

Turning 65 Checklist

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Enroll in Part A and Part B, unless you choose to delay Part B because you have qualifying employer coverage

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Choose between Original Medicare with Medigap and Medicare Advantage

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Avoid a Part D late penalty by enrolling in a drug plan or a Medicare Advantage plan with drug coverage

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Going with Medigap? Buy it during your six-month Medigap Open Enrollment Period

Reading Your Annual Notice of Change

Check Every Line

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Your 2027 premium and deductible

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Copays for hospital stays, doctors and specialists

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The out-of-pocket maximum

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Updates to your drug list, tiers and coverage rules

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Whether your pharmacy, hospitals and doctors remain in network

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Updates to dental, vision, hearing and other extra benefits

By September 30, plans have to send the Annual Notice of Change. Because it spells out exactly how your plan changes on January 1, it is the most useful document you receive each fall.

Special Enrollment Periods

Changing plans outside the fall and early-year windows generally requires a Special Enrollment Period. Typical reasons include:

You May Qualify If

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Your plan is leaving your area or ending

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You move outside your plan’s service area

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You lose employer or union coverage

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Your Medicaid status changes, or you become eligible for Extra Help or a Medicare Savings Program

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You want to join a 5-star plan, once a year

Every Special Enrollment Period has its own deadline, so move quickly once the event occurs.

Prior Authorization and Referrals

Prior authorization is required by most Medicare Advantage plans for certain services, including some surgeries, advanced imaging, skilled nursing stays and certain drugs. The request usually comes from your doctor, but check whether a planned service needs approval so you are not caught off guard by a denial.

You or your doctor may appeal a denied request. Plans must decide within deadlines set by Medicare rules, and those deadlines are shorter when a delay could seriously harm your health.

Emergency, Urgent and Out-of-Area Care

Emergency and urgent care are covered by every Medicare Advantage plan anywhere in the U.S., whether in or out of network, and emergencies need no prior approval. Routine care while traveling is another matter: HMOs generally won’t cover it, and PPOs cover out-of-network care but charge more.

Do you spend several months a year away from home? Ask every plan how it covers care at your second location, since this is among the most frequent reasons people change plans mid-year.

Appeals and Complaints

You have the right to appeal when your plan denies a drug, a service or payment for care. Instructions are in the plan’s denial notice. Appeals go through several levels, beginning with the plan and moving on to independent reviewers.

Issues that are not about coverage, like wait times or customer service, can be raised by filing a grievance with the plan. For help, you can also reach 1-800-MEDICARE or your State Health Insurance Assistance Program.

The 2027 Part B Premium