Making Sense of Medicare

Medicare can be confusing. We are here to help you make sense of it.

If you are approaching age 65 or age 65+, you may be exploring Medicare coverage options. There are a few different ways to set up your Medicare coverage. Each works a little differently-and understanding those differences can help you avoid surprises later.

Your Medicare Options

Three common ways coverage is set up.

Original Medicare (Fee for Service Medicare)

Basic coverage through Parts A & B
Covers hospital stays and doctor visits
Limited network restrictions; you can see any provider nationwide who accepts Medicare.
You pay a share of costs when you receive care
Does not include prescriptions or extra benefits

Supplemental or MediGap Coverage

An insurance helping cover out-of-pocket costs Original Medicare will not
Can include prescription drug coverage (Part D)
Works alongside Original Medicare, but is purchased separately through a private health plan
Limited network restrictions; keeps nationwide access to providers
Often used to make costs more predictable

Medicare Advantage (Part C)

Combines hospital, medical, and often drug coverage
May include extra benefits Original Medicare doesn’t, like dental or vision
Has provider networks, meaning lowest cost care option is typically from seeing an in-network provider.
Costs and coverage vary by plan
May require primary care referrals and/or insurance authorization before certain care can be delivered

Comparing the Options

Medicare chart

Medicare FAQs

Can I keep my current doctor?

It depends on the type of coverage you choose.

With Original Medicare (with or without a supplement), you can see any provider nationwide who accepts Medicare
With Medicare Advantage, you typically need to use doctors within the plan’s network, and going outside the network may cost more

How will my costs work?

Costs are structured differently depending on your coverage.

With Original Medicare, you pay deductibles and a share of the cost for services
With Original Medicare + a supplement, many of those out-of-pocket costs may be covered, which can make expenses more predictable
With Medicare Advantage, you may have lower upfront costs, but you typically pay copays or other costs as you receive care

Will I need referrals to see a specialist?

This depends on how your plan is set up.

With Original Medicare (with or without a supplement), you can usually see specialists without a referral
With Medicare Advantage, some plans require a referral from a primary care doctor before seeing a specialist

Do services ever need approval before they're covered?

In some cases, yes.

With Original Medicare, most services are covered without prior approval
With Medicare Advantage, certain services or procedures may require approval before they’re covered by insurance

What happens if I have high medical costs?

Protection from higher costs works differently depending on coverage.

With Original Medicare alone, there is no yearly limit on what you pay
With Original Medicare + a supplement, many out-of-pocket costs may be covered, depending on the plan
With Medicare Advantage, plans include a yearly limit on what you spend for covered services

How do prescription drugs work?

Prescription coverage is handled differently depending on your setup.

With Original Medicare, you can enroll in a separate Part D prescription drug plan
With Medicare Advantage, prescription coverage is often included in the plan

What's the difference between bundling coverage and adding coverage?

There are two general approaches:

Original Medicare + supplement + Part D → You build your coverage piece by piece
Medicare Advantage → You get hospital, medical, and often drug coverage bundled into one plan

Each approach works differently depending on how you prefer to manage your care and costs.

Enrollment & Timing

When to Enroll

Initial Enrollment Period

Eligibility for Medicare begins three months before you turn 65
Individuals can enroll three months prior to their 65^th birthday month through three months after their birthday month.

Annual Enrollment Period (AEP) October 15 – December 7

This is an annual process where those 65+ review and make changes to plans for the upcoming year.
Changes take effect January 1 – December 31

GET HELP FROM SOMEONE YOU TRUST

You don’t have to figure this out on your own.

Free, local help is available:

AR SHIP (Senior Health Insurance Information Program) - (800) 224-6330 website - ARSHIP
White River Area Agency on Aging (WRAAA) (870) 612-3000
Click for details on our free education event

Medicare Seminar