Fair Square Medicare Wordmark

Medicare 101

By Daniel Petkevich
May 20, 2020

How Medicare is a lot like putting on layers on a cold day.

In the same way that you put on layers before going outside on a cold day, you put on layers of health insurance when it comes to Medicare. And just like you wouldn’t put your coat on before your undershirt, there’s an order to these layers of health insurance.

Stay Up to Date on Medicare!

Join the Fair Square Medicare Newsletter to stay informed on cost savings, changes to Medicare, and other valuable healthcare information.

Your First Layer: Part A

Your Second Layer: Part B

  • Covers - Out-Patient care and doctor’s charges in a hospital. Examples of Out-Patient care are a check-up, X-Ray, blood test, or a simple elective procedure. After meeting an annual deductible ($226 in 2023), Part B covers 80% of expenses, and you pay the remaining 20%.
  • Premium - If your individual tax return shows income of $97,000 (or $194,000 for a joint tax return), or less, your Part B premium is $164.90 a month in 2023. If your income is higher, your premium will be as well. You can find a chart of Part B premiums as they vary with income at


  • Provided by - The federal government
  • When To Enroll - Three months before your 65th birthday up to three months after
  • How to Enroll - You’re automatically enrolled if you’re collecting Social Security. Otherwise go to www.medicare.gov or follow

    this link.

  • Employer Coverage & Delaying Enrollment - Because everyone pays Part B premium, more people consider delaying enrollment in it if they have sufficient coverage from their or their spouse’s employer. The employer’s HR staff will let you know if you can delay enrollment in Part B. If you delay enrolling in Part B and don’t have sufficient employer coverage, you will face financial penalties in the future. 

A Quick Pause Before Adding More Layers

Parts A and B together are referred to as “Original Medicare”, and while they satisfy the minimum medical coverage the government requires you to have, many folks find they have gaps in the following areas:
  • Part A Deductible - The Part A deductible resets once you’ve been out of the hospital for 60 days. So if you go to the hospital several times, each time 60 days since the last one, you’ll pay a $1,600 deductible each time. This could add up.
  • Part B Coinsurance - After you meet the Part B deductible, you pay 20% of Part B covered care. 20% of a large number can be a large number.
  • Excess Charges - Healthcare providers will occasionally charge more than Medicare will reimburse them. The difference is called an “excess charge”, and you pay for all of it.
  • Foreign Travel - Original Medicare doesn’t cover healthcare received abroad except for a few limited cases in Canada and Mexico.
Further, the government requires you to have Prescription Drug Coverage, also referred to as “Part D”. Time to put on some more layers.

More Layers: Medigap, Medicare Advantage, and Prescription Drug Coverage

If you’re fine with the coverage provided by Original Medicare (Parts A and B), you can purchase an additional Prescription Drug Plan from a private insurance carrier (Part D), and you will have met the minimum amount of health insurance the government requires you to carry.
If you want additional coverage to “fill the gaps” in Original Medicare, you have two options:

Medigap Plan (Medicare Supplement)

If you’ve ever heard of “Plan G” or “Plan F”, you’ve heard of Medigap plans. They pick up the bill after Original Medicare pays. So if you got a blood test that costs $100, Part B will cover $80, and if your Medigap plan covers Part B coinsurance, it’ll cover all or part of the remaining $20.
Medigap plans are defined by the government but offered by private carriers. This means that the benefits of Plan G offered by Humana and Cigna are the same. The premium, however, will likely be different. Medigap premium is paid in addition to Medicare Part B premium.
The different Medigap benefits are listed on


. Though there are ten options, four or five can usually be ruled out because, surprisingly, they cost more than other Medigap options with more coverage. The Medigap plan with the most comprehensive coverage that’s currently available to new Medicare enrollees is Plan G.
Should you choose a Medigap plan, you also need to purchase a Prescription Drug Plan. I am happy to discuss which Medigap plan might be a good fit for you.

Medicare Advantage Plans

Unlike Medigap Plans, Medicare Advantage plans are entirely defined and run by private carriers. They typically have you pay a copayment (a flat fee) or coinsurance (a percent of the total costs) for In-Patient and Out-Patient care until your medical payments for the calendar year reach an “out-of-pocket maximum”, at which point the plan covers all your expenses. Out-of-pocket maximums depend on the plan and typically cost about as much as a used car.
Medicare Advantage plans are typically offered as HMOs or PPOs. In the HMO model, you can only see doctors in the HMO, and you must get a referral from your primary care physician to see a specialist. This is in contrast to Original Medicare or Medigap, which allow you to see any doctor who accepts Medicare.
In the PPO model, Medicare Advantage plans let you see out of network doctors, but provide less coverage when you do so. If you choose the Medicare Advantage route, be sure it covers your preferred healthcare providers.
Unlike Medigap plans, Medicare Advantage plans come bundled with prescription drug coverage, so there’s no need to purchase a separate Prescription Drug Plan. Be sure a Medicare Advantage plan covers your prescriptions before enrolling in it.

Choosing Between Medigap and Medicare Advantage

To compare any plans, you must consider their total cost for the year: their premium plus your share of the year’s expected healthcare bills.
Depending on the plans available in your zip code, a Medicare Advantage plan might make more sense than a Medigap plan, or vice versa. I can help you compare different plans in your area.
Fortunately, there is an “escape hatch” for folks who enroll in a Medicare Advantage plan and are unhappy. If you enroll in a Medicare Advantage plan when you turn 65, you may switch to a Medigap plan for any reason during the first year.

Next Steps

I hope I have been able to somewhat demystify the world of Medicare for you, and if you have any further questions about Medicare in general or about which specific Medigap or Medicare Advantage plans are the best fit for you, please call at 1 (888) 376-2028 or click "Get Started" below.

Stay Up to Date on Medicare!

Join the Fair Square Medicare Newsletter to stay informed on cost savings, changes to Medicare, and other valuable healthcare information.

Recommended Articles

How to Choose a Medigap Plan
Jan 10, 2023
Senior woman smiling after vaccination stock photo
Does Medicare Cover Flu Shots?
Dec 9, 2022
cartoon hospital and male doctor stock image
Can I Have Two Primary Care Physicians?
Oct 3, 2022
Cover image
Welcome to Fair Square's First Newsletter
Feb 28, 2023
Psoriasis on elbow stock photo
Does Medicare Cover Ilumya?
Dec 7, 2022
Pre-Existing condition stock image
Can Medicare Advantage Plans Deny Coverage for Pre-Existing Conditions?
Mar 28, 2023
Rattlesnake biting on a hiker's boot stock image
Does Medicare Pay for Antivenom?
Dec 6, 2022
Indianapolis skyline at night stock image
13 Best Ways for Seniors to Stay Active in Indianapolis
Mar 9, 2023
Medicare Part A & Part B stock photo
How Much Does Medicare Part A Cost in 2023?
Nov 18, 2022
Abortion stock image
Does Medicare Cover Abortion Services?
Dec 13, 2022
Person receiving a vaccine stock photo
Is the Shingles Vaccine Covered by Medicare?
Nov 17, 2022
Illustrated representation of medical marijuana, using a prescription bottle with a marijuana leaf on the front.
Does Medicare Cover Medical Marijuana?
Jan 6, 2023
plastic surgeons standing over a patient stock image
Does Medicare Cover Cosmetic Surgery?
Nov 28, 2022
Doctor talking to patients are explaining the treatment of a patient's illness stock photo
How Much Does Rexulti Cost with Medicare?
Jan 24, 2023
older man suffering from stomach pain due to IBS stock photo
Does Medicare Cover Xiafaxan?
Jan 19, 2023
Doctor showing patient bone anatomy of skeleton of nose and nasal cavity on skull. Preparing for rhinoplasty surgery, correcting deviated nasal septum, localization of rhinitis, sinusitis in nose stock photo
Does Medicare cover Deviated Septum Surgery?
Nov 18, 2022
Medigap plan letters on outstretched fingers stock image
How Do Medigap Premiums Vary?
Apr 12, 2023
Senior person holding tissue roll near a toilet bowl, using walker to walk to the bathroom stock photo
Does Medicare Cover Urodynamic Testing?
Dec 2, 2022

More of our articles

14 Best Ways for Seniors to Stay Active in Seattle

14 Best Ways for Seniors to Stay Active in Washington, D.C.

2024 Medicare Price Changes

Can I switch From Medicare Advantage to Medigap?

Can I Use Medicare Part D at Any Pharmacy?

Can Medicare Advantage Plans be Used Out of State?

Costco Pharmacy Partners with Fair Square

Do I Need Medicare If My Spouse Has Insurance?

Do I Need to Renew My Medicare?

Do Medicare Supplement Plans Cover Dental and Vision?

Does Medicare Cover Air Purifiers?

Does Medicare Cover Cold Laser Therapy (CLT)?

Does Medicare Cover Compounded Medications?

Does Medicare Cover Diabetic Eye Exams?

Does Medicare Cover ESRD Treatments?

Does Medicare Cover Hearing Aids?

Does Medicare Cover Hepatitis C Treatment?

Does Medicare Cover Hoarding Cleanup?

Does Medicare Cover Incontinence Supplies?

Does Medicare Cover Jakafi?

Does Medicare Cover Kidney Stone Removal?

Does Medicare Cover Orthodontic Care?

Does Medicare Cover Piqray?

Does Medicare Cover PTNS?

Does Medicare Cover Qutenza?

Does Medicare Cover RSV Vaccines?

Does Medicare Cover SI Joint Fusion?

Does Medicare Cover SIBO Testing?

Does Medicare Cover Stair Lifts?

Does Medicare Cover TENS Units?

Does Medicare Cover Tymlos?

Does Medicare Cover Zilretta?

Does Medicare Pay for Bunion Surgery?

Does Medicare Pay for Funeral Expenses?

Does Medicare pay for Opdivo?

Does Your Plan Include A Free Gym Membership?

Estimating Prescription Drug Costs

Explaining IRMAA on Medicare

Fair Square Client Newsletter: AEP Edition

Finding the Best Dental Plans for Seniors

How Can I Get a Replacement Medicare Card?

How is Medicare Changing in 2023?

How Medicare Costs Can Pile Up

How Much Does a Medicare Coach Cost?

How Much Does Xeljanz Cost with Medicare?

How Often Can I Change Medicare Plans?

How to Apply for Medicare?

How to Deduct Medicare Expenses from Your Taxes

How to Enroll in Social Security

How Your Employer Insurance and Medicare Work Together

Is Balloon Sinuplasty Covered by Medicare?

Is Botox Covered by Medicare?

Is Emsella Covered by Medicare?

Medicare Advantage Plans for Disabled People Under 65

Medicare Explained

Medicare Guaranteed Issue Rights by State

Medicare Savings Programs in Kansas

Medicare Supplement Plans for Low-Income Seniors

Medigap vs. Medicare Advantage

Plan G vs. Plan N

The Fair Square Bulletin: June 2023

The Fair Square Bulletin: November 2023

The Fair Square Bulletin: October 2023

The Fair Square Bulletin: September 2023

What Does Medicare Cover for Stroke Patients?

What Happens to Unused Medicare Set-Aside Funds?

What Is a Medicare Advantage POS Plan?

What is the 8-Minute Rule on Medicare?

What is the Medicare ICEP?

What to Do When Your Doctor Doesn't Take Medicare

What's the Difference Between HMO and PPO Plans?

Why Is Medicare So Confusing?

Your Medicare One-Stop-Shop

Your guide to Medicare Parts A & B, Medicare Advantage, and Medigap. 100% free.
Get the Fair Square Bulletin

Medicare savings tips, helpful guides, and more.


Medicare 101

Current Clients

Medicare Supplement Plans

Medicare Advantage Plans

Fair Square 2023

Terms of Use
Notice of Privacy Practices

Virgil Insurance Agency, LLC (DBA Fair Square Medicare) and www.fairsquaremedicare.com are privately owned and operated by Help Button Inc. Medicare supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. This is a solicitation of insurance. A licensed agent/producer may contact you. Medicare Supplement insurance is available to those age 65 and older enrolled in Medicare Parts A and B and, in some states, to those under age 65 eligible for Medicare due to disability or End-Stage Renal disease. Virgil Insurance Agency is a licensed and certified representative of Medicare Advantage HMO, HMO SNP, PPO, PPO SNP and PFFS organizations and stand-alone PDP prescription drug plans. Each of the organizations we represent has a Medicare contract. Enrollment in any plan depends on contract renewal. The plans we represent do not discriminate on the basis of race, color, national origin, age, disability, or sex. Plan availability varies by region and state. For a complete list of available plans please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov. © 2022 Help Button Inc

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.