What are the basic Medicare eligibility requirements?

To be eligible for Medicare, you must be at least 65 years old and a U.S. citizen or a permanent legal resident who has lived in the United States for at least five continuous years.

How does my work history affect my Medicare eligibility?

If you have paid Medicare taxes for about 10 years, you typically qualify for premium-free Part A hospital insurance. Those with shorter work histories may still qualify by paying monthly premiums.

Can individuals under 65 qualify for Medicare?

Yes. Individuals under 65 can qualify if they have received Social Security Disability Insurance (SSDI) benefits for 24 months or have specific medical conditions such as End-Stage Renal Disease (ESRD) or ALS.

What is the Initial Enrollment Period for Medicare?

The Initial Enrollment Period begins three months before your 65th birthday and ends three months after it—a seven-month window that allows you to enroll without late-enrollment penalties.

What is the main difference between Original Medicare and Medicare Advantage?

Original Medicare is administered by the federal government and includes Part A and Part B. Medicare Advantage (Part C) is offered by private insurers and combines hospital, medical, and often drug coverage with different cost structures and networks.

How does hospitalization coverage differ under each program?

Original Medicare uses benefit periods with deductibles and coinsurance after 60 days, while Medicare Advantage typically charges daily copays for a limited number of days and caps annual out-of-pocket costs.

What is the 90-day hospitalization rule under Original Medicare?

After 90 days in one benefit period, you begin using 60 lifetime reserve days at a higher daily cost. Once those are used, you pay all remaining hospital costs yourself.

Does Medicare Advantage have an annual spending limit?

Yes. Every Medicare Advantage plan includes a maximum out-of-pocket (MOOP) limit. In 2025 it can be up to $8,850 for in-network care, after which the plan pays 100% of covered services.

What is the main difference between Original Medicare and Medicare Advantage?

Original Medicare is administered by the federal government and includes Part A and Part B. Medicare Advantage (Part C) is offered by private insurers and combines hospital, medical, and often drug coverage with different cost structures and networks.

How does hospitalization coverage differ under each program?

Original Medicare uses benefit periods with deductibles and coinsurance after 60 days, while Medicare Advantage typically charges daily copays for a limited number of days and caps annual out-of-pocket costs.

What is the 90-day hospitalization rule under Original Medicare?

After 90 days in one benefit period, you begin using 60 lifetime reserve days at a higher daily cost. Once those are used, you pay all remaining hospital costs yourself.

Does Medicare Advantage have an annual spending limit?

Yes. Every Medicare Advantage plan includes a maximum out-of-pocket limit. In 2025 it can be up to 8850 dollars for in-network care, after which the plan pays 100 percent of covered services.

What are the key parts of family health insurance?

Premiums, deductibles, copays, and out-of-pocket maximums determine how much a family spends on health insurance each year.

How do I find affordable ACA coverage?

Visit GenerationHealth.me/aca-marketplace-quotes to compare ACA plans and see if you qualify for subsidies that lower your monthly premium.

Do family health plans include dental and vision?

Most standard health plans do not include dental and vision. Families should add standalone coverage to complete their protection.

What is the main difference between Medicare Plan G and Medicare Advantage?

Medicare Plan G works with Original Medicare to cover most out-of-pocket costs after the Part B deductible. Medicare Advantage replaces Original Medicare with a private plan that includes copays, networks, and often drug and extra benefits.

Is Medicare Plan G better than Medicare Advantage?

Plan G is better if you want predictable costs and doctor freedom. Medicare Advantage can be better if you want lower premiums and built-in extras like dental and vision.

What are the four main parts of Medicare?

Medicare consists of four primary parts: Part A (Hospital Insurance), Part B (Medical Insurance), Part C (Medicare Advantage), and Part D (Prescription Drug Coverage). Each part covers different aspects of healthcare needs.

How do I enroll in Medicare, and what are the important enrollment periods?

You can enroll in Medicare during your Initial Enrollment Period, which begins three months before your 65th birthday and lasts for seven months. There are also General Enrollment Periods from January 1 to March 31 each year and Special Enrollment Periods for unique circumstances like continued employment or qualifying life events.

What are the costs associated with each Medicare part?

Part A is often premium-free for most beneficiaries but includes a $1,676 deductible per benefit period. Part B has a standard $185 monthly premium and a $257 annual deductible in 2025. Costs for Part C (Medicare Advantage) and Part D (drug coverage) vary by plan and include potential copays and premiums.

What are the penalties for missing Medicare enrollment deadlines?

Missing Medicare enrollment deadlines can result in permanent financial penalties. For Part D, the penalty adds 1% of the national base beneficiary premium for each month without coverage, applied permanently. Late enrollment in Part B also triggers ongoing higher monthly premiums.

Medicare Plan G vs Medicare Advantage Plan -

Plan G (Medigap) vs Plan C (Medicare Advantage)

Choosing between Medicare Plan G and Medicare Advantage can feel confusing, especially when comparing premiums, coverage, and out-of-pocket costs. This guide breaks down both options side-by-side so you can make an informed choice that fits your health and budget needs.

Topic	Medigap Plan G	$0-Premium Medicare Advantage (Part C)
What it is	A Medicare Supplement that works with Original Medicare (Parts A & B) to pay most leftover costs.	A private plan that replaces Original Medicare for billing; it must cover all A & B services, often bundles Part D and extras. Medicare
Typical monthly plan premium	National data show ~$164/mo on average (varies by age, zip, tobacco, rating method; roughly ~$140–$236 for many 65-yr nonsmokers). KFF	Many plans are $0 plan premium (you still pay your Part B premium). Average MA premium in 2025 ≈ $17/mo, but $0 is common. National Council on Aging+1
Part B premium	You still pay Part B.	You still pay Part B (some MA plans partially offset it, but plan premium can be $0). Medicare
How A & B costs are covered	Plan G pays: Part A coinsurance & hospital costs; Part A deductible; Part B coinsurance/copays; first 3 pints of blood; SNF coinsurance; hospice coinsurance; foreign travel emergency (80% up to limits). It does NOT pay the Part B deductible. After you meet the Part B deductible, most A/B costs are covered close to 100%. Medicare+1	MA plan sets its own copays/coinsurance for A & B services (e.g., fixed copay for PCP/specialist, copays per test or hospital day). You pay these until you hit the plan’s in-network maximum out-of-pocket (MOOP). Medicare
Out-of-pocket protection	No MOOP in Original Medicare, but Plan G sharply limits your exposure (after the small Part B deductible, covered A/B costs are typically paid). There’s also a High-Deductible G option (lower premium, higher annual deductible). Centers for Medicare & Medicaid Services	MA plans must have a MOOP. In 2025 the cap can’t exceed $9,350 (in-network) or $14,000 (combined in/out) for Part A/B services. Part D drug costs have a separate cap structure. KFF
Doctors & hospitals	Any provider nationwide who takes Medicare (no network). Great for travelers/snowbirds or those with multiple specialists.	Network-based (HMO/PPO); out-of-network may cost more or be disallowed (HMO). Plans can require prior authorization for many services. Medicare+1
Drugs (Part D)	Not included. Add a separate Part D plan.	Often includes Part D. (Formulary, tiers, and pharmacies vary.) Medicare
Dental/vision/hearing & extras	Generally not included (you can buy stand-alone).	Often included as supplemental benefits (vary by plan and area). Medicare
Referrals / prior auth	No referrals, no prior auth (you follow Medicare rules).	Often required for high-cost services/procedures; varies by plan. Commonwealth Fund
When it shines	You want the broadest access and predictable medical costs; you see specialists frequently; you travel; you prefer to avoid utilization hurdles.	You value lower premiums and bundled extras (dental/vision/hearing/fitness) and are comfortable staying in-network and managing copays & authorizations.

In short:

Medicare Plan G offers predictable costs and nationwide provider access, ideal if you want fewer restrictions and don’t mind paying a monthly premium.

Medicare Advantage ($0-premium plans) trades flexibility for convenience — combining medical, drug, and extra benefits under one plan but with network and prior-authorization rules.

The right choice depends on your health needs, travel habits, and how much you value doctor choice versus bundled extras.

Example:

A 65-year-old non-smoker in North Carolina pays around $165/month for a Plan G policy.

A local Medicare Advantage HMO costs $0/month, but doctor visits are $10–$40 and hospital stays can reach $300 per day up to the plan’s out-of-pocket maximum.

🧾 Frequently Asked Questions (FAQ)

1. What’s the main difference between Medicare Plan G and a $0-premium Medicare Advantage plan?

Medicare Plan G works with Original Medicare to cover most out-of-pocket costs after you meet the Part B deductible. A $0-premium Medicare Advantage plan replaces Original Medicare with a private insurer that sets its own copays, networks, and often includes drug, dental, or vision coverage.

2. Does Plan G cover the Medicare Part B deductible?

No. Plan G does not pay the Part B deductible. Once you pay that small annual amount yourself, Plan G typically covers nearly all remaining Part A and B approved costs.

3. Do I still pay the Part B premium with either option?

Yes. No matter which plan you choose, you continue paying your monthly Part B premium to Medicare. Some Advantage plans offer a small “give-back,” but that depends on the plan and your zip code.

4. Which has lower monthly costs: Plan G or a $0-premium Advantage plan?

Many Medicare Advantage plans cost $0 per month (not counting your Part B premium). Plan G usually costs around $150 – $200 per month, but it greatly reduces out-of-pocket expenses when you need care. Advantage plans can cost more later in copays and hospital bills if you use a lot of services.

5. Can I see any doctor with Plan G or Medicare Advantage?

Plan G lets you see any doctor or hospital nationwide that accepts Medicare. Medicare Advantage plans use networks — usually HMOs or PPOs — which may limit your choices or charge more if you go out of network.

6. Do these options include prescription drug coverage?

Plan G doesn’t include drug coverage, so you’d need to buy a separate Part D plan. Most Medicare Advantage plans include Part D, but drug lists, copays, and pharmacy networks vary by plan.

7. Do Medicare Advantage plans require prior authorization?

Yes, many do. Advantage plans can require pre-approval for certain tests, surgeries, or specialist visits. Plan G follows Original Medicare rules and doesn’t require prior authorization for covered services.

8. What is a MOOP and how does it compare to Plan G?

MOOP means “Maximum Out-of-Pocket.” Medicare Advantage plans must set a yearly cap — up to $9,350 in 2025 for in-network care. After that, the plan pays 100%. Original Medicare has no MOOP, but Plan G limits your costs to the small Part B deductible plus your premium.

9. Can I switch between Plan G and Medicare Advantage?

Yes, but timing matters. You can switch during certain enrollment periods. Moving from Advantage to Plan G may require health underwriting unless you qualify for guaranteed issue rights in your state.

10. Which option is better for frequent travelers or snowbirds?

Plan G is generally better for travelers because you can see any Medicare provider nationwide and even get limited foreign-travel emergency coverage. Medicare Advantage plans are region-based and may not cover routine care outside your service area.

Written by Robert Simm
Licensed Health Insurance Broker — Generation Health
Robert Simm specializes in Medicare, Marketplace, Medicaid and supplemental insurance solutions. For help comparing your options, visit GenerationHealth.me.