Your Guide to Understanding Medicare

Hospital, consultation and doctor at patient bed for check up. Diagnosis, medicare and medical aid

Medicare is a vital government-funded health insurance program that many Americans rely on for coverage for the cost of medical services and hospitalization.The program is administered by the Centers for Medicare and Medicaid Services, part of the U.S. Department of Health and Human Services. Medicare was created in 1965 as part of the Social Security Act.

Medicare currently provides coverage to nearly 60 million people in the United States. With the aging of the Baby Boomer generation, and with rising healthcare costs, the program is growing rapidly, and it’s vital that Americans understand their options concerning the program. This article is your guide to understanding the basics of Medicare.

What is Medicare?

Medicare is a federal government-run health insurance program for people aged 65 and over, people with certain disabilities, and people with end-stage kidney disease, regardless of age. Medicare was created in 1965 when the Social Security Act was passed.

The program is divided into four parts: Part A, Part B, Part C and Part D. Each part offers different types of coverage. Part A, also known as hospital insurance, covers inpatient hospital stays, skilled nursing and hospice care. Part B, also known as medical insurance, covers services such as doctor visits, preventive care, laboratory tests and medical equipment.

Medicare Part C, or Medicare Advantage Plans, is a private health plan offered through a Medicare-approved private insurer. These plans replace the coverage received under Parts A and B, and usually include additional benefits and lower out-of-pocket costs. Plans vary from state to state, but can include coverage for vision and dental care, prescription drugs and more.

Medicare Part D, or prescription drug coverage, helps cover the cost of prescription medications. While there is a variety of private plans available, most people enroll in a plan administered by Medicare.

Who Qualifies for Medicare?

In order to qualify for Medicare, a person must be a U.S. citizen or permanent legal resident who is 65 years or older, has certain disabilities, or has end-stage kidney disease. People who are 65 and older, but who have not paid into the Social Security system long enough, may have to pay a premium, depending on their income.

In addition, most people who qualify for Social Security disability benefits will qualify for Medicare after 24 months, or someone who is receiving Social Security benefits before age 65.

What Does Medicare Cover?

Medicare Part A covers inpatient hospital care, skilled nursing facility care, hospice care, home health care and other services. Part B covers physician and outpatient services, preventive services, durable medical equipment, and home health care. Medicare Part C covers all services included in Parts A and B, as well as additional benefits such as vision and dental care, prescription drugs and more. Part D covers prescription drugs.

How Does Medicare Work?

When a person enrolls in Medicare, they will be issued a red, white and blue Medicare card. The card has their name, Social Security number, and a unique Medicare number.

Once enrolled in Medicare, the individual has to choose from the different types of plans available, depending on their needs and budget. This includes traditional Medicare fee-for-service (Parts A and B) or a Medicare Advantage plan (Part C).

Once a plan is chosen, the participant will then have to choose a provider. Depending on the plan, this could include hospitals, doctors, nursing homes, pharmacies, and other providers. The participant will need to make sure that the provider accepts their particular plan.

How Much Does Medicare Cost?

Medicare is offered at a low cost, or free, depending on the type of plan chosen and the participant’s income. Those with low-incomes maybe eligible for extra help from Medicaid to cover the cost of Medicare premiums and other out-of-pocket costs.

For traditional Medicare plans, Part A is usually offered at no cost, though there is a deductible for hospital stays. Part B usually has a monthly premium, along with a deductible and coinsurance for services. For Medicare Advantage plans, premiums vary depending on the plan chosen, but can sometimes be lower than traditional Medicare.

Those enrolled in Medicare Part D pay monthly premiums, along with an annual deductible and a copayment for each prescription filled.

What Are The Different Types of Medicare Plans?

In addition to the four parts of Medicare, there are other types of plans available. Medicare Supplement Insurance, also known as Medigap, helps cover costs associated with Medicare Part A and Part B, including copayments, coinsurance and deductibles.

Medicare Advantage plans, also known as Part C, offer coverage beyond what’s offered in traditional Medicare. These plans are offered through private insurers and typically have lower premiums and out-of-pocket costs than traditional Medicare.

Medicare Special Needs Plans are Medicare Advantage plans specifically designed for people with certain medical conditions, including diabetes, kidney failure, and heart failure.

There are also Medicare Savings Programs available for those with limited incomes. These programs lower Medicare costs for those who qualify.


Medicare is a vital health insurance program for those aged 65 and over, people with disabilities and those with end-stage kidney disease. It is important for individuals to understand their options, including the types of plans available, the cost of coverage, and the coverages included in each plan in order to make the best decision for their situation.

Final Thought

Medicare is an important health insurance program for many Americans, and it is important that individuals thoroughly research the different options available so they can make the best choice for their circumstances. With the ever-changing health care landscape, understanding Medicare is key to securing the coverage you need.