Beyond Original Medicare Parts A and B, you have several options to get additional coverage. Over 34 million Americans (54% of Medicare beneficiaries) are now enrolled in Medicare Advantage plans, while millions more use Medigap or standalone Part D plans. Understanding your options can help you find the right coverage for your health needs and budget.
Medicare offers several plan types beyond Original Medicare, Parts A (hospital insurance) and B (medical insurance). Each option offers different benefits and can provide additional coverage tailored to your needs. If you're based in North Carolina, our experienced Medicare agents in Charlotte and across the state can walk you through all your options, which include:
Medicare Prescription Drug Plans (Medicare Part D)
Medicare Supplement Insurance Plans (Medigap)
Medicare Advantage Plans (Part C)
Special Needs Plans (SNPs)
Medicare Part D plans are standalone prescription drug plans that help pay for the cost of medications. About 80% of Medicare beneficiaries have some form of Part D coverage, either through a standalone plan or as part of a Medicare Advantage plan.
You can use a Part D plan with Original Medicare alone, or pair it with a Medicare Supplement (Medigap) plan for comprehensive coverage.
Major Part D Changes for 2025-2026 (Inflation Reduction Act)
The Inflation Reduction Act brought significant improvements to Medicare Part D coverage:
$2,000 Out-of-Pocket Cap (2025): Starting in 2025, your out-of-pocket costs for covered Part D drugs are capped at $2,000 per year. This cap increases to $2,100 in 2026. Once you reach this limit, you pay $0 for covered prescriptions the rest of the year.
Donut Hole Eliminated: The coverage gap ("donut hole") was eliminated as of 2025. Part D coverage now has just three phases: deductible, initial coverage, and catastrophic coverage.
Medicare Prescription Payment Plan: You can now spread your out-of-pocket drug costs into equal monthly payments throughout the year instead of paying large amounts upfront. This is voluntary—contact your plan to opt in.
$35 Insulin Cap: Insulin costs are capped at $35 per month with no deductible.
Free Vaccines: Recommended adult vaccines are covered with no cost-sharing.
Drug Price Negotiations: Medicare negotiated lower prices on 10 drugs, taking effect in 2026, with 15 more drugs negotiated for 2027. These include common medications like Eliquis, Jardiance, Xarelto, and Januvia.
2026 Part D Deductible: $615 (up from $590 in 2025)
What Drugs Are Covered?
Each Part D plan has a formulary (list of covered drugs) that includes commonly prescribed medications as determined by federal standards. Brand-name and generic drugs on the formulary are covered, and drugs are organized into cost tiers. Vaccines not covered under Part B may also be covered under Part D.
What's NOT Covered Under Part D?
Drugs not listed on the plan's formulary
Prescription vitamins and minerals (except prenatal vitamins or fluoride)
Fertility or erectile dysfunction drugs
Drugs for cosmetic purposes or hair growth
Over-the-counter medications
Weight loss or weight gain drugs
Drugs already covered under Part A or Part B
Medicare Supplement Insurance (Medigap) plans help pay for out-of-pocket costs not covered by Original Medicare, such as deductibles, coinsurance, and copays. More than 14 million people have Medigap coverage, which provides predictable costs and comprehensive protection.
Standardized Plans: Medigap plans are standardized by the federal government and identified by letters: A, B, C, D, F, G, K, L, M, and N. Plans with the same letter offer the same benefits regardless of which insurance company sells them—only the price and customer service differ.
Important: Plans C and F are only available to people who became eligible for Medicare before January 1, 2020, because these plans cover the Part B deductible.
Most Popular Plans:
Plan G: The most popular Medigap plan for new enrollees. Covers everything Plan F covers except the Part B deductible ($283 in 2026). Nearly one in three Medigap beneficiaries now have Plan G.
Plan N: Lower premiums than Plan G, but requires copays for some office visits (up to $20) and ER visits that don't result in admission (up to $50). Doesn't cover Part B excess charges.
High-Deductible Plan G: Same coverage as Plan G, but with a higher deductible ($2,950 in 2026) in exchange for lower monthly premiums. Good for healthy people who want catastrophic protection.
Key Benefits of Medigap Plans:
No network restrictions: See any doctor or hospital that accepts Medicare, anywhere in the U.S.
Portability: Keep your plan if you move to another state
Predictable costs: Know what you'll pay out-of-pocket with no surprise bills
Guaranteed renewable: Your plan can't be canceled as long as you pay your premiums
Foreign travel emergency coverage: Most plans cover 80% of emergency care abroad
2026 Medigap Cost-Sharing Amounts:
Part A deductible: $1,736 per benefit period
Part B deductible: $283 per year
High-Deductible Plan G/F deductible: $2,950
Remember: Medigap plans don't include prescription drug coverage. If you choose Medigap, you'll need to add a standalone Part D plan for drug coverage.
Medicare Advantage plans are an alternative to Original Medicare, offered by private insurance companies approved by Medicare. In 2025, more than 34 million Medicare beneficiaries (54%) are enrolled in Medicare Advantage—up from just 19% in 2007.
These plans combine Part A (hospital) and Part B (medical) coverage into a single plan, often with Part D prescription drug coverage included. They also frequently offer extra benefits not available with Original Medicare.
What's Included in ALL Medicare Advantage Plans:
Everything covered by Medicare Part A (hospital insurance)
Everything covered by Medicare Part B (medical insurance)
Annual out-of-pocket maximum (Original Medicare has no cap)
Note: Hospice care is still paid by Original Medicare Part A
Included in MOST Medicare Advantage Plans:
Part D prescription drug coverage
Extra Benefits in Many Medicare Advantage Plans:
Dental coverage (cleanings, exams, X-rays, and sometimes more)
Vision coverage (eye exams, glasses, contacts)
Hearing coverage (hearing tests and hearing aids)
Fitness memberships and wellness programs
Transportation to medical appointments
Over-the-counter (OTC) allowances
Telehealth/virtual visit options
Plan Types: Medicare Advantage plans come in several types, including HMO (must use in-network providers), PPO (can go out of network at a higher cost), and HMO-POS (limited out-of-network options). Most plans have provider networks, so make sure your doctors are in-network before enrolling.
2026 Update: The average Medicare beneficiary will have access to 32 Medicare Advantage plans. Virtually all plans offer dental, vision, and hearing benefits. About 13% of enrollees (2.6 million people) are in plans that have been terminated for 2026, so check your plan's status during Open Enrollment.
Special Needs Plans are a type of Medicare Advantage plan designed for people with specific conditions or circumstances. Nearly 7.3 million Medicare beneficiaries are enrolled in SNPs, which now make up 21% of all Medicare Advantage enrollment.
All SNPs include Part A, Part B, and prescription drug coverage (Part D), plus they offer care coordination and benefits tailored to the specific needs of their members.
Types of Special Needs Plans:
Dual Special Needs Plans (D-SNPs): For people who have both Medicare and Medicaid ("dual eligible"). D-SNPs coordinate benefits across both programs and often include additional benefits such as dental, vision, hearing, transportation, OTC allowances, and food/utility benefits. About 6 million people are enrolled in D-SNPs.
Chronic Condition Special Needs Plans (C-SNPs): For people with specific severe or chronic conditions such as diabetes, heart failure, cardiovascular disease, or ESRD. C-SNP enrollment has grown significantly, with over 1 million enrollees in 2025.
Institutional Special Needs Plans (I-SNPs): For people who live in a skilled nursing facility or require an institutional level of care.
Institution-Equivalent Special Needs Plans (IE-SNPs): For people living in a contracted assisted living facility who need a nursing-home level of care but can live in an assisted living setting.
D-SNP Eligibility:
To qualify for a D-SNP, you need Medicare Parts A and B plus Medicaid benefits. You may be "full dual eligible" (full Medicaid benefits) or "partial dual eligible" (Medicaid helps pay certain Medicare costs). Not all D-SNPs accept partially dual-eligible individuals—some are only available to those with full benefits.
D-SNP Benefits May Include:
$0 premiums and low or no cost-sharing
Dental, vision, and hearing coverage
Monthly OTC allowances
Food and utility allowances (often for members with chronic conditions)
Transportation to medical appointments
Personal care coordinator to help manage your care
Personal Emergency Response System (PERS)
Important: Your Medicaid benefits remain unchanged if you enroll in a D-SNP. D-SNP benefits and availability vary by region and plan, so check what's offered in North Carolina.
Choosing between Part D, Medigap, Medicare Advantage, and Special Needs Plans depends on your health needs, budget, and preferences. Our team of knowledgeable and experienced Medicare agents can help you:
Compare plans available in your area
Check which doctors and medications are covered
Determine if you qualify for Special Needs Plans or Extra Help
Understand the enrollment periods and deadlines
Enroll in the plan that's right for you