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The Four Main Parts of Medicare

Medicare is the federal health insurance program for people 65 or older and certain younger people with disabilities. It’s broken down into four main parts, each covering different services. Think of them as building blocks for your healthcare coverage.

Part A is your Hospital Insurance. It helps cover inpatient care in a hospital, short-term stays in a skilled nursing facility after a hospital stay, hospice care, and home health care. Most people don’t pay a monthly premium for Part A because they or their spouse paid Medicare taxes while working for at least 10 years. If you have a qualifying hospital stay, you will have to pay a deductible. For 2026, this deductible applies per 'benefit period' rather than per year. A benefit period starts the day you're admitted and ends when you haven't received any inpatient care for 60 days in a row.

Part B is your Medical Insurance. This is the part that covers your day-to-day medical needs like doctor visits, outpatient hospital care, preventive services (like flu shots and cancer screenings), ambulance services, and durable medical equipment. You will pay a monthly premium for Part B, which is usually deducted from your Social Security check. There is also a small annual deductible you must meet before Part B starts paying its share. For 2026, the exact amounts will be announced by Medicare, but they are adjusted each year.

Part C is also known as Medicare Advantage. These are 'all-in-one' plans offered by private insurance companies that are approved by Medicare. They bundle Part A, Part B, and usually Part D (prescription drug coverage) into a single plan. Many also include extra benefits that Original Medicare doesn’t cover, like routine dental, vision, and hearing care. These plans work with specific networks of doctors and hospitals, such as PPOs or HMOs.

Part D is for Prescription Drug Coverage. You can get a Part D plan in two ways: as a standalone plan that works alongside Original Medicare (Parts A and B), or as part of a Medicare Advantage (Part C) plan. Part D is optional, but if you don't enroll when you're first eligible and decide you need it later, you may have to pay a life-long late enrollment penalty.

Your First Big Choice: Original Medicare vs. Medicare Advantage

Once you're enrolled in Parts A and B, you have a fundamental decision to make. This choice shapes how you'll access your healthcare for at least the next year. There are two main paths.

The first path is Original Medicare. This consists of Part A and Part B, administered directly by the federal government. With Original Medicare, you have the freedom to visit any doctor or hospital in the entire country that accepts Medicare. There are no network restrictions. Most people on this path also add two things: a standalone Part D prescription drug plan and a Medicare Supplement (Medigap) policy. The Medigap plan helps pay for the costs that Original Medicare doesn't, like your deductibles and 20% coinsurance. This combination offers predictable costs and nationwide flexibility.

The second path is Medicare Advantage (Part C). Instead of the government paying your claims, you choose a private insurance company to manage your Medicare benefits. These plans must cover everything that Parts A and B cover, but they do it through a local network of providers. This is a crucial point for Northeast Ohio residents. For example, a person in Parma whose primary care doctor and cardiologist are both part of the University Hospitals network might choose a Medicare Advantage PPO plan that includes UH, offering coordinated care and predictable copays. Most Part C plans also bundle prescription drug coverage and extras like dental, vision, and gym memberships, often for a low or even zero-dollar monthly premium beyond your Part B premium. The trade-off for these lower costs and extra benefits is that you must use doctors and hospitals within the plan's network to get the lowest costs.

Choosing between the nationwide freedom of Original Medicare and the cost-effective, all-in-one structure of a Medicare Advantage plan is a personal decision based on your health needs, budget, and travel habits.

What is a Medigap (Medicare Supplement) Plan?

If you choose to stay with Original Medicare (Parts A and B), you'll quickly notice there are gaps in the coverage. You're responsible for the Part A hospital deductible, the Part B annual deductible, and then 20% of the cost for most doctor services and outpatient care, with no yearly limit on your spending. This is where a Medigap plan, also called a Medicare Supplement, comes in.

Medigap plans are sold by private insurance companies. Their sole purpose is to help pay for some of the out-of-pocket costs that Original Medicare leaves behind. These plans are standardized by the federal government, which makes them easier to compare. This means that a 'Plan G' from one company has the exact same medical benefits as a 'Plan G' from another company; only the price and the company's service can differ. For anyone new to Medicare today, the two most common plans are Plan G and Plan N. Both cover your 20% coinsurance completely. The main difference is that Plan G covers the Part B deductible for you, while Plan N requires you to pay it yourself, along with small copays for some doctor and ER visits. Because of this, Plan N typically has a lower monthly premium.

It's important to know that you cannot have a Medigap plan and a Medicare Advantage plan at the same time. They serve two entirely different purposes. Medigap works with Original Medicare to give you financial predictability and access to any doctor who accepts Medicare nationwide. When you have a Medigap plan, Medicare pays its share first, then sends the rest of the bill to your Medigap company, which pays its share. This process is seamless and usually leaves you with little to no out-of-pocket costs for Medicare-approved services.

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Key Medicare Enrollment Periods You Need to Know

Timing is everything with Medicare. Missing a deadline can sometimes lead to coverage gaps or lifelong penalties, so it's vital to understand the key enrollment periods.

Your first opportunity is your Initial Enrollment Period (IEP). This is a seven-month window that starts three months before the month you turn 65, includes your birthday month, and ends three months after. This is the primary time to enroll in Part A, Part B, and choose your path—either Original Medicare with a Part D and Medigap plan, or a Medicare Advantage plan. Your coverage can start as early as the first day of your birthday month.

What if you plan to keep working past 65? Many people do. If you have group health insurance from a current employer (with 20 or more employees), you can often delay enrolling in Part B without penalty. When you eventually retire or lose that coverage, you'll be eligible for a Special Enrollment Period (SEP). This is an eight-month window to sign up for Part B. For example, a woman in Canton who retires at 68 from her job at Timken has an SEP to enroll in Part B without any late fees.

Once you have your coverage, there are annual opportunities to make changes. The Annual Enrollment Period (AEP) runs from October 15 to December 7 each year. During this time, anyone with Medicare can switch between Original Medicare and Medicare Advantage, change their Part C plan, or change their Part D plan. Changes made during AEP take effect on January 1.

Finally, there's the Medicare Advantage Open Enrollment Period (MA OEP) from January 1 to March 31. This window is only for people who are already enrolled in a Medicare Advantage plan. During this period, you can make one switch: either to a different Medicare Advantage plan or back to Original Medicare (and you can add a Part D plan). You cannot use this period to switch from Original Medicare to a Medicare Advantage plan.

Free, Unbiased Help: OSHIIP and Independent Agents in Ohio

You don't have to figure all this out on your own. There are free resources here in Ohio designed to help you make sense of your options. One of the most important is OSHIIP, the Ohio Senior Health Insurance Information Program. This is a state-funded service that provides free, objective information about Medicare. Their trained counselors can explain how Medicare works, review your options, and help you understand the differences between plans. However, it's important to know that as a government entity, OSHIIP counselors are not allowed to recommend one specific insurance plan or company over another. They provide education, not recommendations.

This is where a licensed, independent Medicare agent or broker can be a valuable partner. At BenefitsCompass Ohio, our role is different from OSHIIP's. We represent multiple insurance carriers that offer plans in Northeast Ohio. This allows us to actively help you compare the specific plans available in your ZIP code. We can check if your doctors are in a plan's network, help you estimate your prescription drug costs under different Part D plans, and compare the total out-of-pocket costs you might face with various options. A captive agent, by contrast, only works for one insurance company and can only show you their products. As an independent agency, our goal is to help you find the right fit for your situation, regardless of the company. Best of all, our services are provided at no cost to you; if you decide to enroll in a plan through us, we are compensated by the insurance carrier. Our focus is to simplify the process and provide the specific, plan-level guidance you need to make a confident choice. For this personalized help, we encourage you to use the callback form on our site to schedule a conversation.