What Is Medicare?
Medicare is the national health insurance program for people 65 and older. It’s run by the Centers for Medicare and Medicaid Services (CMS), and you sign up through the Social Security Administration (SSA). Some people under 65 can also qualify if they have certain disabilities.
Who Can Get Medicare?
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Anyone 65 or older who is a U.S. citizen
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Legal residents who have lived in the U.S. continuously for at least 5 years
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People under 65 who qualify for Social Security disability benefits
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The Four Parts of Medicare
Part A
Hospital Insurance
Part B
Medical Insurance
Part C
Medicare Advantage
(offered by private insurance companies)
Part D
Prescription Drug Coverage
Understanding Medicare Part A & Part B
When you first hear about Medicare, the focus is usually on Part A and Part B. Together, these two parts create the foundation of your coverage.
Medicare Part A – Hospital Insurance
Think of Part A as your safety net for major medical needs.
Covers hospital stays, skilled nursing care, hospice, and some home health services.
Most people don’t pay a monthly premium.
If you or your spouse worked and paid Medicare taxes for at least 10 years, you qualify for premium‑free Part A.
Medicare Part B – Medical Insurance
Part B is your everyday coverage for doctors and outpatient care.
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Covers doctor visits, outpatient care, lab work, preventive services (like vaccines and screenings), and medical equipment.
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Requires a monthly premium, usually taken right out of your Social Security check.
Together, Part A & Part B, are known as Original Medicare.
What Is Original Medicare?
Original Medicare is the traditional program offered directly by the federal government. With Original Medicare:
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You can go to any doctor or hospital in the U.S. that accepts Medicare.
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You pay deductibles and coinsurance, but you aren’t limited to a provider network.
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Prescription drugs aren’t included—you’ll need a separate Part D plan if you want drug coverage.
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Many people add a Medigap (Medicare Supplement Insurance) plan to help pay costs like deductibles and coinsurance.
What Medicare Covers
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Hospital care
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Medical visits and services
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Preventive care like vaccines and screenings
What Medicare Does Not Cover
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Long‑term care
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Dental, vision, and hearing
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Care outside the U.S.
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Cosmetic surgery, acupuncture, or other alternative care
Enrollment Basics
Most people sign up at age 65, even if they’re still working.
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If you are retiring – you should sign up for Medicare Parts A & B.
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If you’re covered by a large employer plan (20+ employees), you may be able to delay signing up.
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If you are continuing to work, and are self-employed / work for a small company with less than 20 employees – you should sign up for Medicare Parts A & B.
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You have a 7-month window to enroll in Parts A and B for the first time when you turn 65. You have 3 months before you turn 65, the month of, and 3 months after to enroll in Medicare.
What Happens If You Don’t Enroll on Time?
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You could pay late‑enrollment penalties
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Your health care bills may not be covered
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Your private insurance choices may be limited
Enrollment Scenarios
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Already receiving Social Security at 65: You’ll be automatically enrolled in Parts A and B (you can opt out of Part B if you want). You must choose and enroll separately in Parts C or D if you want them.
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Not receiving Social Security: You’ll need to sign up during one of Medicare’s enrollment periods.
Enrollment Periods
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Initial Enrollment Period: Around your 65th birthday.
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Special Enrollment Period: Anytime a beneficiary has a qualifying event such as the loss of employer coverage.
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General Enrollment Period: Jan 1 – Mar 31 if you missed your first chance.
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Annual Enrollment Period: The Annual Election Period (AEP) begins October 15th and ends December 7th of each year. Medicare beneficiaries that already have Part A and Part B can use this election period to enroll in, change, or disenroll from a Part D or Medicare Advantage plan.
Medicare Coverage starts usually the first day of the month you turn 65, unless you delay because of employer coverage.
Who Signs Up for What?
Part A
People not covered by a large employer plan (retirees, self‑employed, COBRA, small company employees)
Part B
Same as Part A, plus anyone with less comprehensive employer coverage
Part D
Anyone needing prescription drug coverage (can be a standalone plan or built into a Medicare Advantage plan)
Medicare Costs
Premiums:
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Part A: Free for most, otherwise $278–$505/month
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Part B: $174.70/month in 2024, plus possible income adjustments
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Part D: Varies by plan
Deductibles:
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Part A: $1,632 per hospital stay period
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Part B: $240 per year
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Part D: $545 per year
Coinsurance:
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Hospital: $408–$816/day after certain limits
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Part B: 20% of Medicare‑approved charges
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Part D: 25% of drug costs after deductible until your yearly limit is met
Private Insurance Options
Medigap (Medicare Supplement Insurance):
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Helps pay for deductibles, coinsurance, and other gaps in Original Medicare
Medicare Advantage (Part C):
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Combines Parts A, B, and usually D, often with extra benefits like dental or vision
Planning Ahead
Health care costs rise as we age. Planning now can help you:
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Handle higher insurance premiums and out‑of‑pocket costs
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Prepare for services not covered by Medicare
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Think about long‑term care needs
Why Plan for Long‑Term Care?
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Reduce the burden on family
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Protect your savings from being spent down to qualify for Medicaid
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Ensure you get the kind of care you want
Key Reminders
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Sign up for Medicare on time
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Compare and shop for the coverage that fits your needs
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Plan for future health care costs, including long‑term care