Medicare explained. No jargon, no fine print.

Tom covers what Medicare includes, what it costs, and the mistakes that are hard to undo.

Medicare 101 with Tom Vaughn

Medicare isn't one thing, it's several.

Medicare is not one thing. It comes in parts. Each covers something different, costs something different, and has its own sign-up rules.

A

Hospital Insurance

$0a month, for most people

Hospital stays, nursing care, hospice, and some care at home.

A deductible every benefit period, plus coinsurance on long stays. No premium is not the same as no cost.

B

Medical Insurance

Premiumvaries by income.

Doctor visits, check-ups, lab tests, day surgery, and equipment.

Pays 80% after the deductible — your 20% has no cap. Enrol late and the premium rises 10% for every year you waited, permanently.

C

Medicare Advantage

Often $0on top of your Part B premium

Everything Original Medicare covers, usually plus dental, vision, hearing, and drugs. Caps what you spend in a year.

You use the plan's doctors and may need a referral. Plans change by carrier, county, and year.

D

Prescription Drugs

Variesby plan, and by the drugs you take

Prescription drugs. Bought on its own, or bundled inside a Medicare Advantage plan.

Delay it without other drug cover and the penalty is permanent. Drug lists change every year.

Medigap plans explained.

Medigap fills the gaps Original Medicare leaves. Deductibles, coinsurance and copays. Most of Tom's clients choose between Plan G and Plan N.

G
Plan G
The most complete Medigap plan open to new members. It covers nearly everything Medicare leaves. Your only bill is the yearly Part B deductible.
  • Part A coinsurance and hospital costs
  • Part B coinsurance: you pay nothing after the deductible
  • Part A deductible covered
  • Skilled nursing facility coinsurance
  • Foreign travel emergency (80%)
  • Your only bill: the yearly Part B deductible, about $240
N
Plan N
Like Plan G, but you pay small copays at office and emergency visits. The monthly premium is lower. It suits people in good health.
  • Part A coinsurance and hospital costs
  • Part B coinsurance, with copays up to $20 a visit
  • Part A deductible covered
  • Skilled nursing facility coinsurance
  • Foreign travel emergency (80%)
  • Lower monthly premium than Plan G
A
Medicare Advantage
Not a Medigap plan. It replaces Original Medicare instead. Shown here for comparison. The premium is lower or nothing, but you use a network and the benefits can change each year.
  • Replaces Original Medicare (not a supplement)
  • Often $0 premium beyond Part B
  • Includes dental, vision, hearing, drug coverage
  • You must use the plan's doctors
  • Has out-of-pocket maximum (Original Medicare doesn't)
  • Plans and benefits change every year
Compare Medigap plans with Tom

The Medicare mistakes Tom sees most often.

Some Medicare mistakes cannot be undone. They raise your premium for life, or lock you into cover you cannot change. A short conversation before you turn 65 avoids nearly all of them.

Talk to Tom before you enroll
1
Missing the Part B enrollment windowSign up late without a reason that qualifies and your premium rises 10% for each year you waited. It never comes back down.
2
Assuming employer coverage protects youIf your employer has fewer than 20 staff, Medicare becomes primary at 65. Sign up then, even if you are still working.
3
Skipping Part D because you're healthySkip a Part D drug plan now and you pay a penalty when you need one later.
4
Waiting until you're sick to add MedigapOutside your first window, Medigap insurers can look at your health history. They may charge more, or turn you down.
5
Picking a plan based on premium aloneA Medicare Advantage plan with no premium can still cost a lot when you need care.
6
Not reviewing your Part D plan annuallyDrug plans change their lists every year. A plan that covered your medicines this year may not next year.

Questions Tom hears every day.

Question not here? Tom will answer it on a free call.

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The window is seven months. It opens three months before the month you turn 65. If you still work and your employer has 20 or more staff, you may be able to wait. Tom works out the timing for you.

Medigap works with Original Medicare. Medicare stays primary. Medigap fills most of the gaps. Any doctor in the country who takes Medicare will see you, with no referrals. Medicare Advantage replaces Original Medicare with a private plan. The premium is often lower and it may add dental and vision. You must use the plan's network.

Original Medicare does not cover routine dental, vision or hearing. Medicare Advantage plans often do. On Original Medicare with Medigap, you buy separate dental and vision plans. Tom can help you find them.

Part A is free for most people. Part B has a monthly premium, which varies by income. Medigap adds $100 to $250 or more. That depends on your age, your health and the plan. Medicare Advantage often adds nothing beyond Part B. Tom shows you the full cost of each option.

You can change Medicare Advantage and Part D plans once a year, between October 15 and December 7. Medigap is harder. Outside your first window, insurers can look at your health history. They may charge more, or turn you down. That is why the first Medigap choice matters.

Original Medicare does not usually cover care outside the US. Some Medigap plans, including G and N, pay 80% of emergency costs abroad up to a lifetime limit. If you travel, this matters when you choose between Medigap and Advantage.

The donut hole was a gap in Part D. It started once you and your plan had spent a set amount on drugs. From 2025 there is a $2,000 yearly cap on what you pay for Part D drugs, so the gap matters much less now.

Have questions? Tom has plain English answers.

Talk to Tom for free. By phone, on Zoom, or in person. You have done the reading. He will tell you what it means for you.

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