Hospital Insurance
Helps cover inpatient hospital care, limited skilled nursing facility care, hospice and certain home health services when requirements are met.
Medicare & Senior Benefits
Navigating Medicare
With Confidence
Understand the parts, the timing and the choices before selecting coverage. PJRC helps you slow the process down, understand what matters and approach the decision with a clear plan.
Calm guidance. Thoughtful comparisons. Personal service.Insurance, Made Personal.
Begin where you are
Where are you starting?
You do not need to understand all of Medicare before taking the first step. Choose the situation that sounds most like yours.
Turning 65
Your first Medicare enrollment window generally begins three months before the month you turn 65 and continues for three months afterward. Start by learning when coverage can begin and whether you will be enrolled automatically.
The foundation
Medicare, without the alphabet soup.
Four letters describe different parts of coverage. Here is the map before the details.
Medical Insurance
Helps cover physician services, outpatient care, preventive services, durable medical equipment and other medically necessary services.
Medicare Advantage
Another way to receive Part A and Part B benefits through a private Medicare-approved plan. Rules, networks, costs and benefits vary.
Drug Coverage
Helps cover outpatient prescription drugs through a standalone plan or, commonly, a Medicare Advantage plan with drug coverage.
Original Medicare route
Begin with Parts A and B
Original Medicare provides hospital and medical coverage. From there, most people evaluate two separate decisions based on their needs.
Add Part D?Standalone prescription drug coverage.
Add Medigap?Optional help with certain Original Medicare cost sharing.
Medicare Advantage route
Choose one private Medicare plan
The plan provides your Part A and Part B benefits. Many plans include Part D, and some offer additional benefits. Networks, authorization rules and costs vary.
Neither path is universally better. Location, providers, prescriptions, travel, budget and personal preferences all matter.
Before the plan names
What matters most to you?
Select the concerns you want to remember when comparing coverage. Your choices create a printable conversation list—not a recommendation.
Your Medicare Conversation List
- Select priorities above to build your list.
Five educational chapters
Understand the choices before comparing the plans.
01 — Original Medicare Guidance
Original Medicare is the federal program’s traditional structure: Part A and Part B. It provides broad access to participating providers, but it does not cover every service or place the same annual ceiling on out-of-pocket spending that Medicare Advantage plans must provide.
Look deeper: enrollment timing, provider participation, Part D, Medigap, deductibles, coinsurance, travel and services Medicare generally does not cover.
02 — Medicare Advantage Plans
Medicare Advantage is another way to receive Medicare-covered benefits through a private plan. Many plans combine medical and drug coverage, but details vary by plan and service area.
Look deeper: networks, referrals, prior authorization, cost sharing, annual maximums, drug coverage and annual plan changes.
03 — Medicare Supplement (Medigap)
Medigap works with Original Medicare and can help pay certain deductibles, copayments and coinsurance. It does not replace Medicare and cannot be paired with Medicare Advantage.
Look deeper: standardized plan letters, carrier pricing, open enrollment, underwriting, guaranteed-issue rights and separate Part D coverage.
04 — Prescription Drug Plans (Part D)
A useful drug review asks more than whether a medication appears on a list. Tier, pharmacy, restrictions and alternatives may also affect access and cost.
Look deeper: formularies, tiers, preferred pharmacies, prior authorization, step therapy, quantity limits, creditable coverage and Extra Help.
05 — Indemnity, Dental, Vision & Hearing
Standalone or supplemental products can sometimes address expenses Medicare does not, but they are not the same as Medicare coverage.
Look deeper: benefit schedules, waiting periods, networks, exclusions, underwriting, maximums and state availability.
Compare the structure
Two paths. Different tradeoffs.
| Consideration | Original Medicare + optional Part D/Medigap | Medicare Advantage |
|---|---|---|
| Benefits | Federal Original Medicare; optional private drug and supplement policies | Private Medicare-approved plan provides Part A and Part B benefits |
| Providers | Generally any provider accepting Medicare; participation and assignment still matter | Network and service-area rules may apply |
| Drug coverage | Usually requires a separate Part D decision | Commonly included, but not always |
| Out-of-pocket structure | No Original Medicare annual out-of-pocket maximum; Medigap may address some costs | Plan cost sharing plus annual maximum for Part A and Part B services |
| Additional benefits | Separate products may be considered | Some plans offer additional benefits; availability and limits vary |
| Travel | Broad domestic access; foreign coverage is limited | Emergency, urgent and travel provisions vary by plan |
The better question: How does each structure fit the way you receive care and manage costs?
Timing matters · Verified September 2026
The right coverage at the wrong time can still create a problem.
Initial Enrollment
Generally seven months: three before your birthday month, that month and three afterward.
General Enrollment
January 1–March 31 for certain people who missed Part A or B enrollment.
Open Enrollment
October 15–December 7 for permitted health and drug coverage changes.
MA Open Enrollment
January 1–March 31 for people already enrolled in Medicare Advantage.
Special Enrollment
Certain events create limited opportunities; exact circumstances control.
Important: Active employer coverage, retiree coverage, COBRA and Marketplace coverage are not interchangeable. Confirm the rules before delaying Medicare.
See the full picture
The premium is only one number.
Costs to carry coverage
- Monthly plan premium
- Part B premium
- Income-related adjustments
- Possible late penalties
Costs when you use care
- Deductibles
- Copayments
- Coinsurance
- Prescription costs
Your total-year exposure
- Maximum out-of-pocket, where applicable
- Expected healthcare use
- Medication spending
- Expenses coverage does not pay
A low or zero additional premium may still involve deductibles, cost sharing, network rules and prescription costs. Low premium and low total cost are not the same thing.
One list can change the comparison
Your medications deserve their own review.
Gather exact names and dosages, frequency, preferred pharmacies, mail-order preferences, current plan notices and formulary changes.
- Formulary status and tier
- Preferred pharmacy network
- Prior authorization or step therapy
- Quantity limits and estimated annual cost
Privacy: Do not submit prescription information through this page. Use only an approved secure comparison or PJRC intake process.
The deeper comparison
The plan is not the whole decision.
A thoughtful review may also include providers, prescription access, expected healthcare use, travel, prior authorization, annual changes, retiree coverage, future flexibility and caregiver involvement.
The most attractive advertised benefit may not be the benefit that matters most when care is actually needed.
When you are ready to look
Explore Medicare plan options available in your area.
Use our secure plan-shopping experience to review available options. Have your ZIP code, providers, prescriptions and preferred pharmacies nearby.
This plan-shopping experience is provided through a private third-party platform. It is not Medicare.gov and is not affiliated with or endorsed by the U.S. government or the federal Medicare program.
Help without taking over
Supporting someone you love through Medicare.
A spouse, adult child or caregiver can help organize the decision while keeping the beneficiary’s voice at the center.
- Write down questions
- Gather cards and official notices
- Organize provider and medication information
- Compare official documents
- Obtain permission before discussing private information
Good support creates clarity—not pressure.
Reliable answers
Official resources, gathered in one place.
Official U.S. Government Medicare Handbook
Medicare
& You
2027
Medicare
& You
2027
Keep the official handbook nearby.
Review coverage pathways, benefits, costs, enrollment, Medigap, Part D, financial-help programs, rights, protections and key definitions.
The wider picture
Medicare is important. It is not your entire retirement.
Questions people ask us
Clear answers begin with the right questions.
Do I automatically receive Medicare at 65?
Some people are enrolled automatically based on Social Security or Railroad Retirement benefits; others must take action. Confirm your status rather than assuming.
Do I need Medicare if I am still working?
It depends on the type of coverage, employment status and employer circumstances. Active employer coverage, retiree coverage, COBRA and Marketplace coverage follow different rules.
What is the difference between Medicare Advantage and Medigap?
Medicare Advantage is another way to receive Part A and Part B benefits through a private plan. Medigap works with Original Medicare to help cover certain out-of-pocket costs. They are not used together.
Can I keep my doctor?
That depends on the coverage structure, whether the provider accepts Medicare and, for private plans, the applicable network and rules. Verify every important provider directly.
Can I change coverage later?
Changes are allowed only at certain times or after qualifying events. Switching Medigap coverage may involve underwriting unless a protected right applies.
Does Medicare cover long-term care?
Medicare generally does not pay for most long-term custodial care. Limited skilled care may be covered when Medicare’s requirements are met.
How often should I review my coverage?
At least annually and whenever prescriptions, providers, residence, finances or health needs change.
White-glove guidance
Bring the questions. We’ll help organize the decision.
A PJRC Medicare review helps identify what matters, compare choices carefully and understand the next step before making a decision.
What to bring
- ZIP code and county
- Current coverage
- Provider names
- Prescription and pharmacy information through the approved secure process
- Employer or retiree coverage details
- Your questions and priorities
Insurance, Made Personal.
You do not have to decode Medicare alone.
Start with what you know. Ask what you do not. PJRC will help you approach the decision with clarity, patience and personal attention.