Medicare plans, explained by a local broker
Original Medicare leaves gaps. There are three ways to fill them, and they work very differently. I'll walk you through what each one is, what it costs in your county, and which fits the doctors and prescriptions you already have.
Original Medicare (Parts A and B) covers about 80% of medical costs with no yearly cap and no drug coverage. You fill the gaps one of three ways: a Medicare Advantage plan, or Original Medicare plus a Medigap policy plus a Part D plan. Which is right depends on your doctors, your prescriptions and total yearly cost, and in New York you can switch Medigap plans any time. I compare all of it at no fee.
How Medicare is put together
Original Medicare is run by the federal government and has two parts. Part A covers hospital stays, skilled nursing after a hospital stay, hospice and some home health; most people pay no premium for it. Part B covers doctors, outpatient care, tests and equipment; everyone pays a monthly premium for Part B — $202.90 in 2026 — deducted from Social Security if you're receiving it, plus a yearly Part B deductible ($283 in 2026).
Original Medicare pays roughly 80% of Part B costs and has no cap on what you can pay out of pocket in a year. It also does not cover most prescription drugs, routine dental, vision or hearing. That's why almost everyone adds something to it — and the choice you make there is the real decision.
Your three ways to fill the gaps
Medicare Advantage (Part C)
A private plan approved by Medicare that replaces how you receive Part A and B. Networks, prior authorization, usually drug coverage and extras built in, a yearly out-of-pocket maximum. Often low or $0 premium on top of Part B.
Read more →Medicare Supplement (Medigap)
A policy that pays what Original Medicare leaves to you. Any doctor who accepts Medicare, no networks, no referrals. Monthly premium. New York has unusually strong consumer rules here — you can switch plans any month with no health questions.
Read more →Part D prescription coverage
Standalone drug coverage to go with Original Medicare and a Supplement, or built into most Advantage plans. Every plan has its own drug list and pharmacy network, so the right plan is the one that covers your prescriptions cheapest.
Read more →What a real comparison weighs
Advertising sells Medicare plans on premium and perks. The comparison I run starts somewhere else:
- Your doctors — every one of them, including the specialist you see once a year, checked against each plan's network.
- Your prescriptions — priced through each plan's formulary and tiers, at the pharmacy you actually use, for the whole year.
- Total yearly cost — premium plus what you'd realistically pay in copays, coinsurance and deductibles, not premium alone.
- How you like to get care — whether you're fine with referrals and prior authorization in exchange for lower premiums, or you'd rather pay monthly and never think about it.
- Where you live — plan availability, networks and premiums are set county by county, so a plan that's excellent in Albany County may not exist in Saratoga County.
- Whether you qualify for help — Medicare Savings Programs, Extra Help and EPIC change the math completely, and a surprising number of people qualify.
There is no "best" Medicare plan
There is only the plan that fits your doctors, your medications and your budget this year. That's why I re-check every client's plan each fall — plans change their networks and drug lists every January.
Medicare where you live
Plan availability, networks and Medigap premiums are set county by county, and the hospital systems people use differ town by town. I've written a page for each: Saratoga County, Albany County, Schenectady County and Rensselaer County, plus Clifton Park, Saratoga Springs, Albany, Schenectady and Troy.
Carriers I represent for Medicare
I'm appointed with the national carriers and the regional plans that matter in upstate New York, including UnitedHealthcare, Aetna, Humana, CDPHP, MVP Health Care, Anthem, EmblemHealth, VNS Health, Trinity Health Plan New York, Devoted Health, Wellcare. Not every carrier offers every product in every county; I check what's actually available at your ZIP code.
How the process works
- A short call. You tell me your ZIP code, your doctors and your prescriptions. I'll ask about employer coverage, VA or union benefits, and your budget.
- A written comparison. The two or three plans I'd genuinely consider for you, side by side, with the trade-offs spelled out — including when the plan you already have is the right answer.
- You decide, I file. If you enroll through me, I submit the application, confirm the effective date, and stay your point of contact for questions, claims problems and next year's review.
Federal rules require a Scope of Appointment before we discuss specific Medicare Advantage or Part D plans — it's a short form that records what you asked to talk about. I'll send it before our call.
I do not offer every plan available in your area. Any information I provide is limited to the plans I do offer in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your State Health Insurance Assistance Program for information on all of your options. Not connected with or endorsed by the U.S. government, the Social Security Administration or the federal Medicare program.
Common questions
Short answers to what people ask before they call.
When can I enroll in or change a Medicare plan?
Three main windows. Your Initial Enrollment Period is the seven months around your 65th birthday. The Annual Enrollment Period runs October 15 – December 7 every year, when anyone can switch Medicare Advantage or Part D plans for January 1. The Medicare Advantage Open Enrollment Period, January 1 – March 31, lets people already on a Medicare Advantage plan make one change. Outside those, you need a Special Enrollment Period — moving, losing employer coverage, or qualifying for Extra Help are common ones.
Is there a fee for using a Medicare broker?
No. Medicare plan comparison, help choosing and enrollment cost you nothing — the carrier pays a commission when you enroll, and your premium is identical whether you enroll through me, through the carrier, or on medicare.gov.
Can I keep my doctor?
It depends on the plan type. With Original Medicare plus a Medigap policy, you can see any provider in the country who accepts Medicare. With Medicare Advantage, you're usually limited to a network — so we check your specific doctors, including specialists, before we look at anything else.
What's the difference between Medicare Advantage and a Medicare Supplement?
Medicare Advantage replaces how you receive your benefits — a private plan with a network, usually bundling drug coverage and extras, often with a low or $0 premium but more cost-sharing when you use care. A Supplement sits alongside Original Medicare, keeps provider freedom, and has a monthly premium but far fewer bills. Read about Medicare Advantage or Medigap in New York.
Do I need a Part D plan if I don't take any medications?
Usually yes, or you should have other creditable drug coverage. Going 63 consecutive days or more without it after your Initial Enrollment Period triggers a permanent late-enrollment penalty added to your premium for as long as you have Part D. A low-premium plan is typically the sensible hedge. More on Part D.
Let's talk it through
A phone call or a message is all it takes. The first conversation is just a conversation.
Where I work
I'm based in Clifton Park and work across four Capital Region counties, in person or by phone.