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Medicare Insurance: What You Need to Know
Your Foundation for Reliable Healthcare Coverage
Medicare is a federal health insurance program primarily for individuals ages 65 and older, as well as certain younger individuals with disabilities or specific health conditions. It provides essential coverage that helps reduce the financial burden of medical care and supports your long-term wellness.
Understanding your Medicare options can help you make informed decisions and get the most out of your benefits.
Medicare is made up of different parts, each offering distinct benefits:
Part A : Hospital Insurance
Covers inpatient hospital stays, skilled nursing facility care, hospice, and some home health care.
Part B : Medical Insurance
Helps pay for doctor visits, outpatient care, preventive services, and some home health care.
Part C : Medicare Advantage
All-in-one private health insurance plan alternative to original Medicare
Part D : Drug Coverage
Helps cover the cost of prescription drugs, including many recommended vaccines.
What Is Medicare Part A?
Medicare Part A is your hospital insurance, which helps cover:
- Inpatient hospital stays
- Skilled nursing facility care (not long-term custodial care)
- Hospice care
- Limited home health care services
Most people don’t pay a premium for Part A if they or their spouse paid Medicare taxes while
working. However, there may be deductibles and coinsurance depending on the length of your
hospital stay.
What Is Medicare Part B?
Medicare Part B is your medical insurance, which covers medically necessary services such as:
- Doctor visits yearly checkups
- Preventive services (flu shots, etc.)
- Emergency room & urgent care
- Durable medical equipment (DME)
- Along with many other outpatient Services
There is a standard monthly premium for Part B, which may vary based on income. You may also be
responsible for an annual deductible and 20% coinsurance after Medicare pays its portion.
Enrollment & Eligibility
Automatically enrolled in Original Medicare if
- You receive Social Security or Railroad Retirement Board benefits at least 4 months before you turn 65
- Youre under 65 and have received disability benefits for 24 months
- You have End-Stage Renal Disease (ESRD) or ALS (Lou Gehrig’s disease), qualifying you for Medicare regardless of age
If not, you can sign up during:
- Initial Enrollment Period (IEP): Begins 3 months before the month you turn 65 and ends 3 months after
- General Enrollment Period (GEP): January 1 March 31 (if you missed IEP)
- Special Enrollment Period (SEP): If you qualify due to specific life events
What Medicare Does NOT Cover
Original Medicare does not typically cover
- Routine dental, vision, or hearing services
- Long-term care (nursing home stays)
- Prescription drugs (Part D or Medicare Advantage)
- Overseas medical expenses
To bridge these gaps, many beneficiaries choose to add
- A Medicare Supplement (Medigap) policy
- A Medicare Advantage Plan (Part C)
- A Part D Prescription Drug Plan
FAQs
General Medicare
What is Medicare, and who qualifies for it?
Medicare is a federal health insurance program for people aged 65 and older. You may also qualify if you're under 65 and have a qualifying disability or End-Stage Renal Disease (ESRD). Eligibility typically starts three months before your 65th birthday and continues for a total of seven months.
What are the different parts of Medicare, and what do they cover?
- Part A: Hospital insurance (inpatient care, skilled nursing, hospice)
- Part B: Medical insurance (doctor visits, outpatient care, preventive services)
- Part C (Medicare Advantage): All-in-one alternative to Original Medicare, often includes dental, vision, and wellness programs
- Part D: Prescription drug coverage
What’s the difference between Medicare Advantage and Original Medicare?
Original Medicare includes Part A and Part B and allows you to see any provider that accepts Medicare. Medicare Advantage plans are offered by private insurance companies and may offer additional benefits like dental, vision, hearing, and gym memberships. They often have network restrictions.
Does Medicare cover prescription drugs?
Prescription drug coverage is not included in Original Medicare. You can get coverage through a standalone Part D plan or through a Medicare Advantage plan that includes drug coverage.
How much does Medicare cost?
Part A is usually premium-free if you or your spouse paid Medicare taxes while working. Part B requires a monthly premium. Part C and Part D costs vary depending on the plan. You may also have deductibles, copays, or coinsurance.
Speak With a Licensed Medicare Specialist
Choosing the right Medicare coverage can be confusing. Were here to make it easy.