Start with what you already have
Before you search for new coverage, find out what you're already enrolled in. Most people over 65 are covered by Medicare — either Original Medicare (Part A and Part B) or a Medicare Advantage plan. If you're still working or have coverage through a spouse's employer, you may have group health insurance instead. The insurance you have now shapes what your next step should be.
Pull out your insurance card or log into your account online. Write down the plan name, your coverage type, and your out-of-pocket costs for the things you use most — doctor visits, prescriptions, hospital stays. This is your baseline. You're not looking for perfect coverage; you're looking for coverage that costs less or covers more of what you actually need.
Key Takeaways
- Your current plan's costs and coverage gaps matter more than plan names — compare what you pay now against what you would pay under other plans.
- Medicare.gov's Plan Finder tool shows you side-by-side costs for Original Medicare, Medigap, Medicare Advantage, and Part D plans in your area.
- Open Enrollment runs from October 15 to December 7 each year, and you can change plans only during this window unless you have a may have access to life event.
- A local State Health Insurance information Program (SHIP) counselor will review your options for free and can answer questions about your specific situation.
- Prescription drug coverage, dental, vision, and hearing vary widely between plans — check whether the drugs and providers you use are covered before you enroll.
Use Medicare.gov's Plan Finder to compare costs side by side
Go to Medicare.gov and click "Find Care Providers & Compare Plans." You'll enter your ZIP code, the medications you take, and the doctors and hospitals you use. The tool then shows you every plan available in your area with the actual out-of-pocket costs you would pay under each one.
The Plan Finder shows Original Medicare with a Medigap plan, Medicare Advantage plans, and Part D prescription drug plans all in one place. For each plan, you see your monthly premium, your deductible, what you pay per doctor visit, and what your drugs would cost. This is the most honest way to compare — not plan names or marketing, but your actual dollars.
Write down the top three plans by total cost. Include the monthly premium, the annual deductible, and the out-of-pocket maximum (the most you'd pay in a year before insurance covers everything). These three numbers tell you whether a plan is cheap month-to-month or cheap overall.
Understand the three main paths: Original Medicare, Medicare Advantage, and staying on employer coverage
Original Medicare (Part A and Part B) is run by the federal government. You pay a monthly premium for Part B, and you have a deductible and coinsurance for hospital and doctor visits. Most people add a Medigap policy (also called Supplemental Insurance) to cover the gaps — the deductible, coinsurance, and copays that Original Medicare doesn't pay. Original Medicare lets you see any doctor or hospital in the country that accepts Medicare.
Medicare Advantage is a private insurance plan that covers everything Original Medicare covers, usually with lower premiums and sometimes with dental, vision, or hearing included. The trade-off is that you have a network — you must use doctors and hospitals in the plan's network, or pay more. Some plans require referrals to see specialists. If you travel or move, your coverage may not follow you.
If you're still working or covered by a spouse's employer plan, you may not need to enroll in Medicare yet. However, you must enroll in Part A and Part B when you leave that job or lose the coverage, or you'll face a penalty. Ask your employer's benefits office when your coverage ends and what happens to your coverage when you turn 65.
Know when you can change plans and what counts as a may have access to event
Open Enrollment for Medicare runs from October 15 to December 7 each year. During this window, you can switch from one plan to another, drop coverage, or enroll for the first time. Any change you make takes effect on January 1. If you miss Open Enrollment, you're locked into your current plan until next October.
A may have access to life event lets you change plans outside Open Enrollment. These include losing employer coverage, moving to a new state, getting married or divorced, or a significant drop in income. You have 60 days from the event to make a change. Call Medicare at 1-800-MEDICARE to report the event and confirm you're may be able to access to change plans.
If you're new to Medicare — turning 65 or losing employer coverage — you have a 7-day window to enroll in Part B without a penalty. After that window closes, you pay a 10% penalty on your Part B premium for life. Enroll as soon as you're may be able to access, even if you're still working.
Check whether your doctors, hospitals, and drugs are covered
The cheapest plan is worthless if your doctor isn't in the network or your medication isn't covered. Before you choose a plan, verify three things: whether your primary care doctor is in-network, whether your preferred hospital is in-network, and whether each of your regular medications is on the plan's formulary (the list of covered drugs).
Call your doctor's office and ask which Medicare plans they accept. Log into the plan's website and search for your hospital by name. For medications, use the plan's drug search tool or call the plan's pharmacy line. If a drug isn't on the formulary, ask whether a similar drug is covered or whether the plan will make an exception. Some plans cover drugs only after you've paid a certain amount out of pocket.
Pay special attention to specialty drugs — cancer medications, biologics, injectables — because they often have higher copays or require prior approval from the plan before you fill the prescription. If you take multiple medications, add up the total annual cost under each plan, not just the monthly premium.
Contact your State Health Insurance information Program for free, one-on-one help
Every state runs a State Health Insurance information Program (SHIP) that offers free counseling about Medicare and health insurance. A SHIP counselor will review your current coverage, compare it against plans available in your area, and explain the trade-offs in plain language. They work for the state, not for any insurance company, so they have no incentive to steer you toward one plan.
Find your state's SHIP by going to shiptalk.org or calling 1-877-839-2675. You can meet with a counselor in person, by phone, or online. Bring your insurance card, a list of your medications, and a list of your doctors. The counselor will walk you through the Plan Finder tool and answer questions about your specific situation — whether you should switch plans, what to do if you can't afford your premiums, or how to appeal a coverage denial.
SHIP counselors also help with problems after you enroll — if a claim is denied, if your pharmacy says a drug isn't covered, or if you're being billed for something you thought was covered. This service is free and confidential.
Factor in costs beyond the premium: deductibles, copays, and out-of-pocket maximums
The monthly premium is only part of what you pay. A plan with a low premium might have a high deductible or high copays, which means you pay more when you actually use care. A plan with a higher premium might have no deductible and low copays, which means you pay less overall if you see doctors frequently.
Use this table to compare the total cost of three plans you're considering:
| Cost Type | Plan A | Plan B | Plan C |
|---|---|---|---|
| Monthly premium | |||
| Annual deductible | |||
| Copay per doctor visit | |||
| Copay per specialist visit | |||
| Annual prescription drug cost | |||
| Out-of-pocket maximum |
Multiply your monthly premium by 12, then add your expected out-of-pocket costs for the year. If you see your doctor four times a year and take three regular medications, estimate that cost under each plan. The plan with the lowest total is usually the best choice, unless it doesn't cover a doctor or drug you need.
Frequently Asked Questions
Can I change plans if I'm unhappy with my current coverage?
Yes, but only during Open Enrollment (October 15 to December 7) or if you have a may have access to life event like moving, losing coverage, or a major income change. Outside these windows, you're locked in until next October. If you're in the first three months of a new plan, you can disenroll without penalty.
What's the difference between a Medigap plan and a Medicare Advantage plan?
Medigap is supplemental insurance that works with Original Medicare — it covers the deductibles and copays that Medicare doesn't. You can see any doctor nationwide. Medicare Advantage is an all-in-one plan run by a private insurer; it has lower premiums but a limited network of doctors. Choose Medigap if you want freedom to see any doctor; choose Medicare Advantage if you want lower monthly costs and don't mind a network.
Do I have to take Part D prescription drug coverage?
If you have Original Medicare, you should enroll in Part D when you first become may be able to access. If you wait and enroll later, you pay a penalty on your premium for life. If you have Medicare Advantage, prescription coverage is usually included. If you have no prescription coverage and no income, some programs help pay for drugs.
What if I can't afford my insurance premiums?
You may be may be able to access for Extra Help (for Part D) or Medicare Savings Programs (for Part A and Part B premiums). These are based on income and assets. Contact your SHIP counselor or call 1-800-MEDICARE to find out whether you may have access to. Some plans also offer premium information programs for low-income enrollees.
How do I know if my doctor is in a plan's network?
Call your doctor's office and ask which Medicare plans they accept, or log into the plan's website and search for your doctor by name. If your doctor isn't listed, call the plan directly to confirm — sometimes the online directory is out of date. Ask whether your doctor is accepting new Medicare patients.