Medicare 101

Understanding Medicare, made simple

Medicare can feel overwhelming. Here's a plain-English walkthrough of what Part A and Part B cover, the options you have for filling the gaps, and how the most common plans stack up — so you can choose with confidence.

The basics

What is Medicare?

Medicare is the federal health insurance program for Americans 65 and older — and for some younger people with certain disabilities. It’s made up of different parts, each covering a different piece of your care.

This is a brief overview. A full presentation can walk you through all the details and help you make the right choice for your situation.

Medicare Part A

$0/month for most people

Free if you or your spouse worked and paid Medicare taxes for at least 10 years

Hospital coverage

$1,736 deductible — days 1–60 per stay
$434/day — days 61–90
$868/day — days 91+ (lifetime reserve)

Skilled nursing facility

$0 co-pay — days 1–20
$217/day — days 21–100
Self-pay — day 101+

Medicare Part B

$202.90/month(2026)

Standard rate for individuals earning under $106k/year. Higher earners pay more.

What's covered

Doctor visits and specialist services
Outpatient care and procedures
Durable medical equipment
Preventive services and screenings

Your costs

$283/year deductible
80/20 co-insurance after deductible is met

Want to see the full picture?

This is just a snapshot. Donal offers a free, personalized Medicare presentation that walks you through all your options — so you can choose the right coverage with confidence.

Schedule a presentation

Original Medicare

Your coverage options

Original Medicare is the foundation. From there, you choose how to cover what it leaves behind.

Original Medicare

Part A Covers hospital stays

Part B Covers doctor and outpatient visits

Your options for more coverage

Part C Medicare Advantage

Part D Covers prescription drugs

Three coverage paths

Put it together in one of three ways. You enroll in a single path — they don’t combine.

Option 1

Available in Plans A through N

Medicare Supplement plus Part D

Medicare Supplement Insurance (Medigap)

Offered by private companies
Covers some of the costs not paid by Original Medicare (Parts A & B)

Medicare Part D

Offered by private companies
Covers prescription drugs

See the Medigap Plan Comparison Chart

Option 2

Medicare Advantage (Part C)

Offered by private companies
Combines Part A (hospital) and Part B (doctor)
Provides additional benefits
Most plans include Part D prescription coverage

Option 3

$0 premium, see any doctor

Medicare Advantage MSA (Part C) plus Part D

Medicare Advantage MSA (Part C)

A high-deductible plan paired with a tax-free medical savings account
Medicare deposits money in your account each year to help pay for care
See any doctor or hospital nationwide that accepts Medicare
$0 monthly premium — you cover costs until you meet the deductible

Medicare Part D

Offered by private companies
Added separately for prescription drug coverage

You choose one path — they don’t combine. Either keep Original Medicare and add a Medicare Supplement plan, or enroll in a Medicare Advantage plan (Part C), which includes the MSA option.

MSA options are available to self-employed individuals and employees of employers who have opted in.

Side by side

What are the differences?

Medicare doesn’t cover everything. A Medicare Supplement or Medicare Advantage plan can help pay for some of the medical expenses not covered by Medicare.

The two types of plans differ in how they cover these expenses.

Medicare Advantage Group MSA

Every advantage, $0 premium

Best for: People who want a $0-premium plan with the freedom to see any Medicare-participating provider, annual funding from Medicare, and tax-advantaged savings — no networks or referrals.
Keep in mind: You cover costs through the account Medicare funds until you meet the deductible, and you add a separate Part D plan for prescriptions.

Company Plan (if offered)

Employer or retiree coverage

Best for: People who already have group health coverage through a current or former employer and want to keep it as their Medicare coverage.
Keep in mind: It doesn’t offer the $0 premium, annual Medicare funding, provider freedom, or tax advantages a Group MSA does.

Other Medicare Advantage

Low premium, network-based

Best for: People who want a low or $0 monthly premium and the convenience of an all-in-one plan that usually bundles prescriptions and extras.
Keep in mind: Care stays within a provider network with prior authorizations and referrals, and there’s no annual Medicare funding.

Medicare Supplement

See any provider, higher premium

Best for: People who want to use any Medicare-participating provider with no networks or referrals and prefer steady, predictable costs.
Keep in mind: A higher monthly premium, no annual Medicare funding, and you add a separate Part D plan for prescriptions.

No matter which option you choose, you’ll still pay your monthly Part B premium — $202.90 in 2026 (the standard rate; higher earners pay more).

Medicare Advantage Group MSA, a company plan, other Medicare Advantage, and Medicare Supplement compared, benefit by benefit
Feature	Medicare Advantage Group MSA Every advantage, $0 premium	Company Plan (if offered) Employer or retiree coverage	Other Medicare Advantage Low premium, network-based	Medicare Supplement See any provider
$0 premium	Yes	No	Yes	No
Annual money from Medicare	Yes	No	No	No
Access to any Medicare-participating provider	Yes	No	No	Yes
No additional prior authorization or referrals	Yes	No	No	Yes
Financial support programs and tax advantages	Yes	No	No	No
Covers Medicare A/B services and items	Yes	No	Yes	Yes

Not sure which path fits your health and budget? Donal can walk you through the trade-offs in plain English.

Talk through your options

New to Medicare?

Let's make Medicare make sense

Donal will help you understand your coverage choices and find the plan that fits — at no cost to you, since Medicare premiums are regulated by law.

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