Medicare Plans Tailored to You
Medicare is not one product but several, and the right combination depends on your doctors, your prescriptions and your budget. We will explain the parts plainly, compare what is actually available in your county, and never push you towards a plan that does not fit.
What Original Medicare covers
Original Medicare is made up of Part A, which covers inpatient hospital care, skilled nursing, hospice and some home health, and Part B, which covers doctor visits, outpatient care, diagnostic tests and preventive services.
You pay for services as you receive them, through deductibles and coinsurance, and there is no annual cap on what you might spend. That last point surprises people, and it is the main reason most enrollees add either a Medicare Advantage plan or a Medicare Supplement alongside it.
To receive Part A and Part B covered services you must be lawfully present in the United States. Full details of what Original Medicare does and does not cover are published at Medicare.gov.
Medicare coverage rests on three things
Understanding these explains most of the confusion people run into when a service is covered for a friend in another state but not for them.
Federal and state law
The statutory framework that sets what Medicare must and must not pay for nationally.
National coverage decisions
Determinations made by Medicare itself about whether a particular item or service is covered across the country.
Local coverage decisions
Made by the claims processing companies in each state, deciding whether something is medically necessary in that area. This is why coverage can differ from one state to another.
You have Medicare options, and understanding them matters
Whether you are new to Medicare or reviewing what you already have, these are the building blocks. Most people combine two or three of them.
Hospital insurance
Inpatient hospital stays, skilled nursing facility care, hospice and some home health services. Most people pay no premium for Part A.
Medical insurance
Doctor visits, outpatient care, diagnostic tests, durable medical equipment and preventive services. Part B carries a monthly premium.
Prescription drug cover
Optional cover offered by Medicare-approved private plans to reduce what you pay for prescriptions. Each plan has its own formulary.
Medicare Advantage
An all-in-one alternative to Original Medicare from a private insurer. Bundles Part A and Part B, usually includes Part D, and often adds extras.
Medicare Supplement
Private cover that pays your share of costs under Original Medicare — copayments, coinsurance and deductibles. Cannot be combined with Advantage.
Special Needs Plans
Advantage plans built for people with both Medicare and Medicaid, an institutional need, or a qualifying chronic condition.
The main Medicare routes compared
No single column is best for everyone. The honest answer depends on your income, your doctors, how much you travel, and how much uncertainty you can absorb.
| Original Medicare (A & B) | Medicare Advantage (Part C) | Dual Eligible SNP | Medicare Supplement | |
|---|---|---|---|---|
| Often suits | People wanting the widest provider choice who will add a Supplement | People wanting lower monthly costs and bundled extras | People who qualify for both Medicare and Medicaid | People who want predictable costs and travel often |
| Who you pay | Part B premium, deductibles and 20% coinsurance | Part B premium plus any plan premium, with plan copays | Depends on the level of Medicaid or savings programme you qualify for | Medigap premium plus Part B premium, usually no copay |
| Any doctor? | Yes, if they accept Medicare | HMO: network only. PPO: yes, at higher cost out of network | HMO: network only. PPO: yes, at higher cost | Yes, if they accept Medicare |
| Routine care area | Anywhere in the country | Usually restricted to your service area | Usually restricted to your service area | Anywhere in the country |
| Emergency care | Anywhere in the country | Anywhere in the country | Anywhere in the country | Anywhere in the country |
| Specialist referral | No | HMO: usually. PPO: no | HMO: usually. PPO: no | No, unless you hold a Medicare SELECT plan |
| Out-of-pocket cap | No annual limit | Yes, an annual maximum set by the plan | Yes, and it may be very low depending on your Medicaid level | Yes, in practice — the plan pays most cost sharing |
| Extras such as dental, vision, hearing | Not included | Often included, varies by plan | Often included, varies by plan | Not included, bought separately |
Scroll sideways to compare all four →
Help paying for Medicare
If your income is limited, there are two federal programmes worth checking before you choose a plan. They can change which option makes sense for you entirely.
Medicare Savings Programs
Federally funded and administered by each state, these programmes help pay some or all of your Medicare premiums, deductibles, copayments and coinsurance. Eligibility is based on income and resources, and the thresholds change annually.
Learn more →Extra Help with drug costs (LIS)
The Low Income Subsidy helps people with Medicare pay for prescription drugs, substantially lowering premiums, deductibles and copays under Part D. Many who qualify never apply, simply because nobody told them.
Learn more →The official Medicare & You handbook
Medicare mails an updated handbook to every Medicare household each autumn. It is the official guide, and it is genuinely worth keeping — it covers benefits, costs, your rights and protections, health and drug plans, and answers to the questions people most often ask.
It is published in large print, braille and a range of languages, and an electronic version is available if you would rather not wait for the post.
Download the current handbook directly from Medicare.gov, or ask us and we will walk you through the parts that apply to your situation during a free plan review.
Carriers we work with
Which carriers offer plans where you live is decided county by county. A licensed agent can confirm your local options in a single call.
Speak to a licensed agent, not a call centre
Give us your ZIP code, your doctors and your prescription list. We will compare what is available in your county and explain the trade-offs plainly — at no cost, with no obligation, and no pressure to switch if what you have already works.
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 (1–800–633–4227), 24 hours a day / 7 days a week, or your local State Health Insurance Program (SHIP), to get information on all of your options. All Solution Plus is a licensed insurance agency and is not connected with or endorsed by the United States government or the federal Medicare program. Enrolment in a plan depends on the plan’s contract renewal. Plan availability, benefits, premiums, provider networks and formularies vary by county and change annually.