Do You Know What Plan You Want to Go With Your Medicare Parts A and B — and Why?

If you're turning 65 or finally enrolling in Medicare Parts A and B, you're entering one of the most important health care decisions of your retirement years: choosing the right plan to go with your Original Medicare. The big question is whether to add a Medigap (Supplemental) plan and a standalone Part D prescription plan, or to choose an all-in-one Medicare Advantage (Part C) plan. Your choice will shape your access to doctors, out-of-pocket costs, and even the types of care you receive.

So ask yourself: Do you know exactly what plan you want to enroll in — and why?

Let’s walk through the key concerns you should consider before you commit.

1. Access to Doctors: Do You Want Flexibility or a Network?

Original Medicare + Medigap offers the broadest access to doctors. You can see any provider nationwide who accepts Medicare, without referrals. This is especially important if you travel frequently or have specific specialists you want to continue seeing.

Medicare Advantage plans, on the other hand, often operate through networks. HMOs typically require you to stay in-network and get referrals. PPOs offer more flexibility but may charge more for out-of-network care. If you have trusted doctors, make sure they participate in the plan’s network before enrolling.

2. Prescription Drug Coverage: Don’t Overlook Part D

If you're choosing Original Medicare + Medigap, you'll need to enroll separately in a Part D prescription drug plan. Medigap policies do not include drug coverage, and going without Part D could mean late enrollment penalties and paying full price for medications.

Most Medicare Advantage plans include drug coverage (MA-PDs), which makes them a convenient all-in-one option. However, check the plan’s formulary to ensure your medications are covered at a reasonable cost.

3. Budget: What Can You Afford Monthly — and in a Crisis?

Medicare Advantage plans often come with low or even $0 premiums, which can be appealing. However, they do include cost sharing (copays, coinsurance), and there's an annual out-of-pocket maximum. If you face a major health issue, you could pay thousands in a single year.

Medigap plans have higher monthly premiums, but very low out-of-pocket costs for covered services. You pay more upfront, but less when you actually use care. For people with known health issues or who want predictable costs, this can offer peace of mind.

4. Your Health History and Expectations

Are you someone who only sees the doctor once a year? Or do you have a chronic condition that requires frequent visits, tests, and prescriptions?

If your health is excellent and you don't expect many medical needs, a Medicare Advantage plan might offer great value. But if your history suggests more frequent or complex care, or if you want maximum financial protection, a Medigap plan could be a better fit.

Remember: You may not be guaranteed Medigap coverage later. If you delay enrolling and want it in the future, you could face medical underwriting and be denied or charged more based on your health.

5. Extras Like Dental, Vision, and Hearing

Original Medicare + Medigap typically does not cover dental, vision, or hearing. You’d need to buy standalone coverage if these are important to you.

Medicare Advantage plans often include these benefits at no additional premium. But the coverage can be limited in scope, provider choice, or annual maximums. Still, if routine dental cleanings, eye exams, or hearing aids are a priority, Advantage plans often win on this front.

The Bottom Line

There is no one-size-fits-all answer. Choosing between Medicare Advantage and Original Medicare with Medigap is a personal decision that depends on your:

• Doctor preferences

• Medication needs

• Monthly budget vs. risk tolerance

• Health status and expectations

• Desire for extra benefits

The most important thing is to understand why you’re choosing one route over the other. Take the time to compare plans in your area, think about how you've used health care in the past, and picture the kind of care you want going forward.

Still unsure? A licensed Medicare agent or SHIP counselor can help walk you through your options, free of charge.

Whatever you choose, make sure it aligns with your needs today and sets you up for stability tomorrow.