Quick select:
Original Medicare
Parts A + B
Monthly cost
$174–$594
Part B premium (income-based) + no Part A premium if worked 10+ years
Any doctor nationwide who accepts Medicare — no networks
Specialist access — see any Medicare specialist without referral
No out-of-pocket maximum — costs can be unlimited without a supplement
No prescription drug coverage — need separate Part D plan
Does not cover dental, vision, hearing, or long-term care
SNF coverage up to 100 days after qualifying hospital stay
Medicare Advantage
Part C — private insurance
Monthly cost
$0–$100+
Premium varies by plan; often $0 above Part B. Has annual out-of-pocket maximum.
Network-based — must use plan's doctors and hospitals (except emergencies)
Out-of-pocket maximum — protects against catastrophic costs (up to $8,850/year in-network 2024)
Often includes Part D — prescription drug coverage bundled in most plans
Extra benefits — many plans add dental, vision, hearing, fitness
Prior authorization required for many services — can delay care
SNF coverage included but varies by plan; check network requirements
Medigap / Supplement
Standardized supplement plans A–N
Monthly cost
$100–$400+
Added to Original Medicare. Pays the gaps Original Medicare leaves. Requires separate Part D.
Any Medicare doctor nationwide — full freedom of choice, same as Original Medicare
Predictable costs — pays Medicare's coinsurance, copays, and deductibles
Plan G (most popular) covers nearly everything except the Part B deductible ($240/yr)
Higher monthly premium than most Advantage plans
No extra benefits — dental, vision, hearing not included
Best for frequent specialist use, travel, or serious chronic illness
Medicare Part D
Prescription drug coverage
Monthly cost
$10–$120+
Standalone plan added to Original Medicare + Medigap. Included in most Advantage plans.
Covers prescription drugs — formulary varies by plan; check your medications
$2,000 out-of-pocket cap on drugs starting 2025 (Inflation Reduction Act)
Required if on Original Medicare — late enrollment penalty if delayed without other coverage
Extra Help / LIS — subsidy available for low-income beneficiaries; significantly reduces costs
Review annually — formularies change; compare plans every October during Open Enrollment
Parkinson's & MS drugs — verify specific medications are on the formulary before enrolling
Side-by-side comparison
What each plan covers — and what it doesn't.
| Coverage area | Original Medicare | Medicare Advantage | Medigap + Original | Part D (standalone) |
|---|---|---|---|---|
| Monthly premium | $174–$594 (Part B) | Often $0 extra above Part B | Part B + $100–400 supplement | $10–120 added on top |
| Out-of-pocket maximum | None | Yes — up to $8,850 | Effectively very low | $2,000 cap (2025) |
| Doctor network freedom | Any Medicare doctor | Network only | Any Medicare doctor | Pharmacy network |
| Specialist referrals | No referral needed | Varies by plan | No referral needed | N/A |
| Prescription drugs | Not included | Usually included | Not included | Primary purpose |
| Skilled nursing facility | Up to 100 days/benefit period | Varies — check plan | Same as Original | Not applicable |
| Home health care | Skilled care when homebound | Same + possible extras | Same as Original | Not applicable |
| Memory care / assisted living | Not covered | Not covered | Not covered | Not applicable |
| Hospice care | Covered (Part A) | Covered (via Original) | Covered | Some hospice drugs |
| Dental / Vision / Hearing | Not covered | Often included | Not covered | Not applicable |
| Travel / out-of-area care | Full nationwide | Emergency only (HMO) | Full nationwide | Pharmacy-dependent |
| Prior authorization requirements | Minimal | Common — can delay care | Minimal | Some drugs require it |
| Best for caregivers when… | Using multiple specialists, traveling | Stable condition, local network sufficient | High specialist use, serious illness | Multiple or expensive prescriptions |
Not sure which plan is right
for your specific situation?
Danny can walk you through the Medicare decision specific to your loved one's condition, care stage, and financial situation — in plain English, without the sales pitch.
Medicare questions caregivers ask most
Does Medicare cover memory care or assisted living? ▾
No. Neither Original Medicare nor Medicare Advantage covers residential memory care or assisted living. These are considered custodial care, which Medicare explicitly excludes. Medicare covers skilled nursing facility care only after a qualifying 3-day inpatient hospital stay, and only for skilled care services — not ongoing custodial care. Medicaid, long-term care insurance, veterans benefits, and private pay are the primary funding sources for residential care.
Is Medicare Advantage or Original Medicare better for someone with Parkinson's or ALS? ▾
For serious progressive conditions like Parkinson's or ALS, many specialists recommend Original Medicare plus a Medigap supplement (particularly Plan G). The reason: Original Medicare allows access to any Medicare-accepting doctor nationwide — which matters when you need multiple specialists, academic medical centers, or specific movement disorder clinics. Medicare Advantage's network restrictions can limit access to specialized ALS and Parkinson's programs. However, the right answer depends on specific plan availability in your area, your current providers, and financial considerations. Danny can help you think through this for your specific situation.
What does Medicare cover for ALS specifically? ▾
ALS has special Medicare rules: Medicare begins immediately upon SSDI approval for ALS — there is no 24-month waiting period that applies to other disabilities. This makes applying for SSDI immediately after an ALS diagnosis critically important. Medicare covers ALS clinic visits, physical and occupational therapy, speech therapy, respiratory equipment, durable medical equipment (wheelchairs, hospital beds), home health services when homebound, and hospice when appropriate. It does not cover long-term custodial care.
Can you have both Medicare and Medicaid? ▾
Yes — people who qualify for both are called "dual eligibles." Medicare pays first; Medicaid covers costs Medicare doesn't, including premiums, cost-sharing, and long-term custodial care. Dual eligibility can dramatically reduce out-of-pocket costs and is particularly relevant for families where a loved one has both a serious illness (qualifying for Medicare) and limited financial resources (qualifying for Medicaid). An elder law attorney can help determine if dual eligibility applies to your situation.
What is the Medicare Part D out-of-pocket cap for 2025? ▾
Starting January 1, 2025, the Inflation Reduction Act caps Medicare Part D out-of-pocket prescription drug costs at $2,000 per year. This is a significant change from previous years and particularly benefits people with Parkinson's, MS, ALS, and other conditions that require expensive medications. After reaching the $2,000 cap, you pay $0 for covered prescription drugs for the remainder of the year.
When can you switch Medicare plans? ▾
The main opportunity to switch is Medicare Open Enrollment (October 15 – December 7 each year), with changes taking effect January 1. There is also a Medicare Advantage Open Enrollment period (January 1 – March 31) allowing one switch. Special Enrollment Periods exist for qualifying life events. Medigap enrollment is most flexible in the first 6 months after turning 65 and enrolling in Part B — after that, insurers can use medical underwriting in most states.
Important: This tool is for educational purposes only and does not constitute insurance or financial advice. Medicare plans, premiums, and coverage change annually. Always verify current plan details at medicare.gov or through a licensed Medicare counselor (SHIP/HICAP programs provide free counseling). This tool does not collect or sell your information.