Three common ways to set up Medicare, compared in plain language. Use it to decide what questions to ask.
| Feature | The baselineOriginal Medicare only | Most predictableOriginal Medicare + Medigap + Part D | Most extrasMedicare Advantage |
|---|---|---|---|
| Monthly premiums | Part B premium only | Part B + Medigap + Part D | Part B + often $0 plan premium |
| Choice of doctors | Any Medicare provider nationwide | Any Medicare provider nationwide | Plan network (HMO or PPO) |
| Referrals to specialists | Not needed | Not needed | Often needed on HMOs |
| Yearly out-of-pocket limit | None | Very low costs after Part B deductible | Yes, set by each plan |
| Prescription drugs | Not included | Separate Part D plan | Included in most plans |
| Dental, vision, hearing | Not covered | Add a stand-alone plan | Often included |
| Coverage while traveling | Nationwide | Nationwide, some foreign travel | Emergencies nationwide, routine care limited |
| Switching later | Flexible | Health questions after Medigap open enrollment | Each fall, and Jan to Mar |
| Often best for | People with other coverage, like TRICARE for Life | Travelers and people wanting predictable bills | Local, budget-minded people who want extras |
| Learn more | Learn more | Learn more | Learn more |
General comparison for education. Benefits, networks and costs vary by plan and county. We do not offer every plan available in your area.
Every insurance company sells the same lettered Medigap benefits, so the letter decides what is covered and the company only decides the price and the service. These are the three letters Southern Arizonans actually choose between.
Premiums shown are sample ranges for a 65-year-old non-smoker in Tucson ZIP 85711 and are for illustration only.
| Benefit | Plan GThe most chosen letter in Pima County | Plan NLower premium, small copays at the desk | High-Deductible GLowest premium, you self-insure first |
|---|---|---|---|
| Part A hospital deductible$1,736 per benefit period in 2026 (sample) | Paid in full | Paid in full | Paid after your $2,980 deductible |
| Part B coinsurance (the 20%)Doctor visits, imaging, outpatient surgery | Paid in full | Paid, minus up to $20 per office visit and $50 per ER visit | Paid after your deductible |
| Part B deductible$283 a year. No letter sold after 2020 may cover it | You pay it | You pay it | You pay it, and it counts toward the $2,980 |
| Part B excess chargesUp to 15% above the Medicare rate from doctors who do not accept assignment | Paid in full | You pay them | Paid after your deductible |
| Skilled nursing coinsuranceDays 21 to 100 of a covered rehab stay | Paid in full | Paid in full | Paid after your deductible |
| Foreign travel emergency80% of billed charges, $50,000 lifetime cap | Included | Included | Included after your deductible |
| Extra 365 hospital daysAfter Original Medicare days run out | Included | Included | Included |
| Yearly deductible you pay first | None | None | $2,980 a year |
| Sample monthly premium | $148 to $182 a month | $112 to $138 a month | $38 to $56 a month |
The most chosen letter in Pima County
Lower premium, small copays at the desk
Lowest premium, you self-insure first
The trade-off in one line: Plan G buys the fewest surprises, Plan N trades small copays for a lower premium, and High-Deductible G is the cheapest premium if you can comfortably absorb the first $2,980 in a bad year.
Medicare scores every Advantage and Part D plan from 1 to 5 stars each autumn, across roughly forty measures. It is not a satisfaction poll and it says nothing about premium. It is closer to a report card on whether the plan keeps its members healthy and answers the phone.
A plan that holds five stars earns a Special Enrollment Period: you may switch into it once between 8 December and 30 November, outside every other deadline.
Whether members get the screenings, vaccines and annual visits the plan is supposed to prompt them toward: colonoscopies, bone density scans, flu shots, eye exams for diabetics.
Blood pressure and blood sugar control, medication adherence for statins and diabetes drugs, follow-up after a hospital stay. These outcome measures carry the heaviest weight in the score.
Survey answers about getting appointments, getting care quickly, and how easy the plan is to deal with. Collected from members, not from the insurance company.
How often members complain to Medicare, how often they leave the plan, and how often the plan is caught denying something it should have paid.
Call centre hold times, TTY availability, how quickly appeals are decided, and whether foreign-language interpreters are actually reachable.
For plans with Part D: whether the price shown on Medicare.gov matches the pharmacy counter, and whether the plan flags risky drug combinations.
Every Medicare Advantage plan must cap what you pay for in-network Part A and Part B services in a calendar year. Once you hit the cap, the plan pays 100% of covered in-network care for the rest of the year. Original Medicare on its own has no such ceiling, which is the single strongest argument for adding Medigap if you stay with it.
Sample figures for illustration. We check the actual MOOP on every plan we show you.
Still weighing it up? These are the three questions that decide it for most people.
About 6 in 10 of our clients choose Medicare Advantage, mostly for low premiums and dental and vision benefits. Clients who travel often or want the widest doctor choice lean toward Medigap.
You can move between Advantage plans or back to Original Medicare each fall. Buying Medigap later may require health questions, so we plan that decision carefully with you.
The structure is national, but premiums, networks and extras depend on your county. We compare the plans we offer for your ZIP code.
We will fill in this table with actual premiums and drug costs for your ZIP code and prescriptions.
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