Medicare Basics
What is Medicare?
Medicare is a federally administered health insurance program overseen by the Centers for Medicare and Medicaid Services (CMS). Established in 1966, Medicare was originally managed by the Social Security Administration and has evolved significantly over the decades. Today, it offers a range of options designed to meet the diverse healthcare needs of modern beneficiaries. The program primarily covers those aged 65 and older, as well as certain younger individuals with disabilities or end-stage renal disease. Eligibility is often tied to having paid Medicare taxes during employment, and there are specific enrollment windows that must be followed to avoid late penalties or coverage gaps.
Understanding Medicare Parts A, B, C, and D
Medicare is divided into four key components — Parts A, B, C, and D — each offering different types of coverage. Parts A and B together form Original Medicare.
Part A generally covers hospital-related expenses, such as inpatient stays, care in skilled nursing facilities, hospice services, and some forms of home healthcare. For most people who have paid Medicare taxes for at least 10 years, Part A is premium-free. Others may purchase it by paying a monthly premium.
Part B covers medical services that fall outside of hospitalization — such as doctor visits, outpatient care, preventive screenings, durable medical equipment, and certain vaccinations. Part B always requires a monthly premium and includes cost-sharing through deductibles and coinsurance. There is no out-of-pocket maximum under Original Medicare.
Part C (also called Medicare Advantage) offers an alternative to Original Medicare and is provided by private insurance companies. These plans typically include coverage from both Parts A and B, and often add benefits such as prescription drug coverage, dental, vision, and wellness services. Costs and coverage rules vary depending on the plan.
Part D focuses on prescription drug coverage, helping beneficiaries pay for medications not covered under Original Medicare. Like Part C, these plans are provided by private insurers, and individuals with Original Medicare often choose to enroll in a Part D plan to ensure prescription coverage.
What Does Original Medicare Not Cover?
While Parts A and B provide a broad foundation, they do not cover everything. Routine dental, vision, and hearing services — including dentures, eyeglasses, and hearing aids — are typically not covered. Original Medicare also does not cover custodial long-term care, cosmetic procedures, or care received outside of the U.S. (except in limited situations). These gaps can lead to significant out-of-pocket expenses.
Medicare Supplement (Medigap) Plans
To help cover these gaps, many individuals choose to purchase Medicare Supplement Insurance, commonly known as Medigap. These optional policies work alongside Original Medicare to help pay for deductibles, coinsurance, and copayments. Some Medigap plans also provide limited coverage for medical care received while traveling internationally. However, Medigap plans do not include prescription drug coverage (you’ll need a separate Part D plan for that) and typically do not cover services like dental, vision, or long-term care.
We're Here to Help
Choosing the right combination of Medicare coverage can feel complicated, but it doesn’t have to be. Contact us today to review your options and find a plan that fits your healthcare needs and your budget.