Medicare Explained
What Is Medicare?
Medicare is a federal health insurance program that helps eligible people pay for health care services.
Who Is Eligible for Medicare?
Medicare is available to:
- People age 65 or older;
- People under age 65 with certain disabilities (typically after qualifying for Social Security disability benefits);
- People of any age with End-Stage Renal Disease (ESRD) — permanent kidney failure requiring dialysis or a kidney transplant;
- People diagnosed with amyotrophic lateral sclerosis (ALS) (no waiting period after disability entitlement).
The Four Parts of Medicare
Medicare Part A – Hospital Insurance
Part A helps cover:
- Inpatient care in a hospital
- Skilled nursing facility care (after a qualifying hospital stay)
- Hospice care
- Some home health care services
Most people do not pay a monthly Part A premium if they (or a spouse) worked and paid Medicare taxes long enough. Deductibles, coinsurance, and copayments may apply.
Medicare Part B – Medical Insurance
Part B helps cover:
- Doctor visits and outpatient care
- Preventive services
- Durable medical equipment (like wheelchairs or oxygen)
- Some home health services
Part B has a monthly premium and cost-sharing (deductibles, coinsurance, or copayments). Part A and Part B together are known as “Original Medicare.”
Medicare Part C – Medicare Advantage Plans
Medicare Advantage Plans are:
- Offered by Medicare-approved private insurance companies
- Required to include all Part A and Part B benefits
- Often include prescription drug coverage (Part D) and may offer added benefits such as vision, hearing, and dental coverage
You must keep your Part B coverage and pay the Part B premium. Some Medicare Advantage Plans also charge a separate monthly plan premium; others may have $0 plan premium.
Medicare Part D – Prescription Drug Coverage
Part D provides coverage for prescription drugs through Medicare-approved private plans.
- Helps lower prescription drug costs
- Available to everyone with Medicare
- You pay a separate plan premium (which varies by plan)
Notes About Costs
Medicare helps with costs, but most people will still have deductibles, copayments, or coinsurance depending on the services and plan they choose.
How to Enroll
People becoming eligible for Medicare usually enroll during their Initial Enrollment Period around age 65. Others who qualify because of disability or ESRD have enrollment windows tied to their benefit start dates. You can also join or change coverage during Open Enrollment periods.