Vykare Seniorhood Advisors

Pillar 02

Medicare & Senior Insurance

This part of our site is meant to be helpful, not an exhaustive replacement for the great resources already out there. If you'd rather just ask, that's perfectly fine.

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Medicare disclaimer. We do not offer every plan available in your area. Currently we represent [NUMBER] organizations which offer [NUMBER] products in your area. Please contact Medicare.gov, 1-800-MEDICARE (TTY users call 1-877-486-2048), or your local State Health Insurance Program (SHIP) to get information on all of your options.

Our Medicare roots

VyKare's roots are in helping people with Medicare. In the summer of 2017, our founder Garry attended a seminar on becoming a certified Medicare Advantage agent, passed the certification exam before summer was out, and started advising during that October's Annual Enrollment Period.

Medicare, in brief

Medicare sits within the U.S. Department of Health and Human Services, under the Centers for Medicare & Medicaid Services (CMS), and leans heavily on the Social Security Administration to process enrollments and the financial side. It began in 1965 as a simple hospital-and-medical program for seniors, and over six decades it has grown into a complex, multi-part system:

  • Part A, hospital care
  • Part B, outpatient care
  • Part D, prescription drug plan (PDP)
  • Part C, private-plan alternatives (Medicare Advantage)

The parts, and what they cost (2026)

Parts A, B, and D are the core enrollments. Part A is premium-free for most people (paid in through about 40 quarters of payroll withholding), with an inpatient hospital deductible of $1,736 per benefit period. Part B carries a monthly premium of $202.90 (higher for upper incomes, via IRMAA) and an annual deductible of $283. All of these adjust every year. Miss your enrollment windows for Part B or Part D without documented comparable coverage and you can face lasting penalties, call us and we'll make sure you avoid them.

Coverage map

Medicare coverage options

A two-step picture: enroll in Original Medicare first, then pick the additional coverage that fits your life.

Step one

First, enroll in Original Medicare

Provided by the federal government

Part A

Helps pay for hospital stays and inpatient care.

Part B

Helps pay for doctor visits and outpatient care.

Step two

Then choose your additional coverage

Offered by private insurance companies

Option 1

Original Medicare + Part D (+ Medigap)

Medicare Part D plan

Helps pay for prescription drugs.

And, you can also add

Medicare Supplement (Medigap)

Helps pay some out-of-pocket costs that come with Original Medicare.

Option 2

Medicare Advantage (Part C)

Medicare Advantage Plan

Combines Original Medicare Part A & Part B coverage in one plan.

Usually includes Part D

Prescription drug coverage built into the plan.

Extra benefits

May offer additional benefits like vision and dental coverage.

Option 3

Medicare Savings Account (MSA)

Medicare Savings Account

Requires a plan-approved financial institution account opened separately.

Plus

Medicare Part D plan

Standalone prescription drug coverage paired with the MSA.

Two paths

Two ways to cover what Original Medicare leaves behind

Option A

Medigap (Medicare Supplement)

Medigap extends Parts A and B by covering the gaps they leave, things that can cost you real money, like the Part A deductible and the 20% Part B leaves on your shoulders. There's a guaranteed-issue window within six months of enrolling in Part B. Premiums are typically based on your attained age and vary quite a bit between insurers.

Option B, separate & distinct

Medicare Advantage (Part C)

By law, an Advantage plan's benefits must be equal to or better than Original Medicare Parts A and B. Premiums are low, sometimes $0, but you pay copays or coinsurance when you actually use care, up to an annual Maximum Out-of-Pocket (MOOP). Many preventive exams are $0.

There are five Advantage plan types, HMO, PPO, PFFS, SNP, MSA. HMOs typically pay $0 outside their network; PPOs generally cover about 40% of an out-of-network claim. MSA plans use the broad CMS provider network, carry a $0 monthly premium and an annual deductible that doubles as the MOOP.

At a glance

Medicare Supplement (Medigap) plan comparison

A quick side-by-side of what each standardized Medigap plan covers. Use it as a starting point, then call us to talk through what actually fits.

Medicare Supplement BenefitsABC*DF¹*G¹K²L³MN⁴
Part A coinsurance and hospital coverage✓✓✓✓✓✓✓✓✓✓
Part B coinsurance or copayment✓✓✓✓✓✓50%75%✓✓
Part A hospice care coinsurance or copayment✓✓✓✓✓✓50%75%✓✓
First 3 pints of blood✓✓✓✓✓✓50%75%✓✓
Skilled nursing facility coinsurance✓✓✓✓50%75%✓✓
Part A deductible✓✓✓✓✓50%75%50%✓
Part B deductible✓✓
Part B excess charges✓✓
Foreign travel emergency80%80%80%80%80%80%
Out-of-pocket limit (2026)——————$8,000$4,000——

* Plans F and C are not available to Medicare beneficiaries who became eligible for Medicare on or after January 1, 2020. If you became eligible before 2020, you may still be able to enroll in Plan F or Plan C where available.

1 Plans F and G offer high-deductible versions with an annual deductible (set yearly by CMS). Once met, the plan pays 100% of covered services for the rest of the year. The high-deductible Plan F is not available to new beneficiaries eligible on or after January 1, 2020.

2 Plan K has an annual out-of-pocket limit. After you reach it and pay the Part B deductible, the plan pays 100% of covered services for the rest of the calendar year.

3 Plan L has an annual out-of-pocket limit. After you reach it and pay the Part B deductible, the plan pays 100% of covered services for the rest of the calendar year.

4 Plan N pays 100% of the Part B coinsurance, except for a copay of up to $20 for some office visits and up to $50 for emergency room visits that don't result in an inpatient admission.

Benefits are standardized by CMS; premiums vary by insurer and area. Current-year limits change annually — call us for the latest figures.

Part D, prescription drugs

Part D is the optional federal prescription-drug program, in effect since 2006. "Optional" comes with a catch: if you're enrolled in Part B and go more than 63 days without a Part D plan (or comparable coverage), a penalty kicks in and grows until you're covered, and that's true whether you take zero prescriptions or forty. The good news is that most areas have low-premium plans, and even $0/month isn't unusual.

Beyond Medicare, ancillary coverage

Folks who choose an Advantage plan often add a hospital indemnity policy alongside it, those inpatient and outpatient copays can stack up toward $2,000 in a single benefit period, and indemnity coverage helps offset that. Also available are policies for major accidents and serious health events, heart attack, stroke, cancer, and other critical illnesses. And because Original Medicare (and therefore Medigap) doesn't cover Dental, Vision, or Hearing, standalone DVH plans are common.

Choosing your path: three strategies

  • The one-and-done. Original Medicare (Parts A, B, and D) paired with a Medigap plan. The simplest and most predictable path, usually a higher fixed monthly cost in exchange for very few out-of-pocket surprises.
  • The actively managed. Start on a Medicare Advantage plan (low or $0 premium), review it every year, and switch to Medigap when the math says to. Can be the least expensive route overall, but timing matters.
  • The MSA route, for the healthy. A one-and-done built on a group MSA plan, designed for healthier clients. Annual deposits, invested for growth, steadily lower your effective out-of-pocket over time.

Not sure which fits you? That's the whole point of a conversation with us.

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