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🟩 What Is Medicare?

Medicare is a federally funded health insurance program primarily for people age 65 and older. It also covers certain younger individuals with qualifying disabilities or End-Stage Renal Disease (ESRD). The program is divided into four main parts, each covering specific types of healthcare services.

✅ Who Qualifies for Medicare?

  • Adults 65 years or older

    • Automatically enrolled in Part A and Part B if receiving Social Security.

  • People under 65 with certain disabilities

    • Eligible after receiving Social Security Disability benefits for 24 months.

  • Individuals with End-Stage Renal Disease (ESRD)

    • Eligible at any age with permanent kidney failure requiring dialysis or transplant.

📘 The 4 Parts of Medicare

Part A – Hospital Insurance

What it covers:

  • Inpatient hospital care

  • Skilled nursing facility care (short-term)

  • Hospice care

  • Limited home health care

Cost:

  • Usually free if you or your spouse paid Medicare taxes for at least 10 years.

  • If not, premiums can apply.

Part B – Medical Insurance

What it covers:

  • Doctor visits and outpatient care

  • Preventive services (like screenings and vaccines)

  • Lab tests, durable medical equipment

  • Mental health services

Cost:

  • Monthly premium required (standard amount in 2025 is ~$174.70, varies by income)

  • Typically 80/20 cost-sharing: Medicare pays 80%, you pay 20% (after deductible)

Part C – Medicare Advantage

What it is:

  • Private insurance plans approved by Medicare that bundle Part A, Part B, and usually Part D (drugs)

  • Often includes extra benefits like vision, dental, hearing, fitness, and over-the-counter allowances

Important Notes:

  • Must continue to pay your Part B premium

  • Plans may have low or $0 monthly premiums, but copays, coinsurance, and out-of-pocket limits apply

  • Network restrictions: You often need to see doctors within the plan’s network

Part D – Prescription Drug Coverage

What it covers:

  • Helps cover the cost of prescription medications

  • Offered by private insurers approved by Medicare

  • Coverage tiers vary, affecting copays for generics vs. brand-name drugs

Penalty alert:

  • If you delay enrollment and don’t have creditable drug coverage, a lifetime penalty may be added to your premium

💡 Bonus: Medicare Supplement Insurance (Medigap)

Medigap policies help pay for some of the costs that Original Medicare (Part A and B) doesn’t cover, such as:

  • Deductibles

  • Copayments

  • Coinsurance

These are stand-alone policies sold by private insurance companies.
You must be enrolled in Original Medicare (Parts A & B) to purchase Medigap — not compatible with Medicare Advantage.

🟪 Plan Comparison Table

📝 Pro Tip for Clients:

“If you want maximum freedom to choose your doctors, a Medicare Supplement may be ideal. If you prefer a bundled, all-in-one option with low premiums, a Medicare Advantage Plan may suit your needs — especially if you’re healthy and don’t travel often.”

Comparison table of Medicare and Medigap plans, showing features and costs for original Medicare Part A and Part B, and Plan G Medigap, including deductibles, insurance, and coverage details.
Comparison chart titled "Medigap vs. Medicare Advantage" with features listed in two columns. Medigap is described as supplemental insurance working with Medicare Parts A and B, usable with any provider, monthly premium, and only original Medicare. Medicare Advantage is an all-in-one alternative combining parts A, B, and often D, with network restrictions, low or no premium, and may offer extra benefits.