What Is Medicare?
Medicare is a federal health insurance program primarily for people aged 65 and older. It also covers certain younger individuals with qualifying disabilities, End-Stage Renal Disease (ESRD), or ALS (Lou Gehrig's disease).
Medicare is administered by the Centers for Medicare & Medicaid Services (CMS) and is not the same as Medicaid, which is a state-run program for low-income individuals.
The 4 Parts of Medicare
Part A — Hospital Insurance
Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care. Most people get Part A premium-free if they (or their spouse) paid Medicare taxes for 10+ years.
Part B — Medical Insurance
Covers doctor visits, outpatient care, preventive services, durable medical equipment, and medically necessary services. Part B has a monthly premium (standard: $185/month in 2025).
Part C — Medicare Advantage
An all-in-one alternative to Original Medicare offered by private insurers. Includes Part A & B benefits, often adds dental, vision, hearing, and prescription drug coverage. Network-based (HMO or PPO).
Part D — Prescription Drugs
Standalone prescription drug coverage for people on Original Medicare. Covers brand-name and generic medications. Plans vary by formulary, pharmacy network, and cost structure.
Who Is Eligible?
- Age 65+ — U.S. citizens or permanent residents who have lived in the U.S. for at least 5 continuous years
- Under 65 with a disability — After receiving Social Security Disability Insurance (SSDI) for 24 months
- End-Stage Renal Disease (ESRD) — Kidney failure requiring dialysis or a transplant
- ALS (Lou Gehrig's Disease) — Eligible immediately upon SSDI approval
Original Medicare vs. Medicare Advantage
| Feature | Original Medicare (A+B) | Medicare Advantage (C) |
|---|---|---|
| Provider Choice | Any doctor that accepts Medicare | Network-based (HMO/PPO) |
| Drug Coverage | Requires separate Part D plan | Usually included |
| Extra Benefits | None (add Medigap for gap coverage) | Dental, vision, hearing, fitness |
| Monthly Cost | Part B premium + Medigap premium | Part B premium + $0–$50/mo plan premium |
| Out-of-Pocket Max | No cap (unless Medigap) | Annual cap required by law |
What Does Medicare NOT Cover?
Original Medicare does not cover:
- Most dental, vision, and hearing care
- Long-term care (custodial nursing home care)
- Cosmetic surgery
- Most care outside the U.S.
- Routine foot care and acupuncture (with some exceptions)
Medicare Advantage plans often add dental, vision, and hearing — ask us which plans include the benefits you need.
Frequently Asked Questions
Medicare is a federal program based on age or disability. Medicaid is a state program based on income. Some people qualify for both (called "dual eligible") and can receive extra benefits through special plans.
If you're receiving Social Security, you'll be automatically enrolled in Parts A & B. If not, you need to actively enroll during your Initial Enrollment Period. Delaying Part B without qualifying coverage can result in permanent late penalties.
Part A is premium-free for most people. Part B has a standard monthly premium. You may also pay deductibles, copays, and coinsurance depending on your plan and services.
Yes. If you're still working at 65 with employer coverage, your employer plan may be primary. When you retire, you'll need to enroll in Medicare during a Special Enrollment Period to avoid penalties.