What Is Medicare?
Established in 1965, Medicare is the federal health insurance program primarily for people age 65 and older, as well as certain younger people with disabilities or specific health conditions. It is administered by the Centers for Medicare & Medicaid Services (CMS).
Medicare is not a single plan — it is made up of different parts that cover different types of care. Understanding how each part works helps you make smarter enrollment decisions and avoid costly penalties.
The Four Parts of Medicare
Medicare is divided into four parts, each covering a different category of healthcare costs.
Hospital Insurance
Covers inpatient hospital stays, skilled nursing facility care, hospice, and some home health care. Most people don't pay a premium for Part A if they worked and paid Medicare taxes for at least 10 years.
Medical Insurance
Covers doctor visits, outpatient care, preventive services, durable medical equipment, and some home health services. Part B requires a monthly premium (standard is $174.70 in 2024).
Medicare Advantage
An alternative to Original Medicare offered by private insurers. Bundles Part A and Part B — and usually Part D — into one plan, often with added benefits like dental, vision, and hearing coverage.
Prescription Drug Coverage
Adds prescription drug coverage through private insurers approved by Medicare. Enrolling when first eligible protects you from a permanent late enrollment penalty, even if you take few medications.
Medicare Enrollment Periods
Enrolling at the right time is critical. Missing a window can result in permanent premium penalties or gaps in coverage.
| Enrollment Period | When It Occurs | What You Can Do |
|---|---|---|
| Initial Enrollment Period (IEP) | 7-month window around your 65th birthday (3 months before, birthday month, 3 months after) | Enroll in Parts A, B, C, and D for the first time |
| Annual Enrollment Period (AEP) | October 15 – December 7 each year | Switch Medicare Advantage plans, change Part D plans, or switch between Original Medicare and Medicare Advantage |
| General Enrollment Period (GEP) | January 1 – March 31 each year | Enroll in Part A or B if you missed your IEP (may result in late enrollment penalties) |
| Special Enrollment Period (SEP) | Triggered by qualifying life events | Enroll or change plans due to losing employer coverage, moving, or other qualifying events |
What Original Medicare Doesn't Cover
Original Medicare (Parts A and B) leaves significant gaps — including deductibles, copays, and coinsurance that can add up quickly. It also doesn't cover routine dental, vision, hearing, or most long-term care.
There are two main ways to fill those gaps:
Medicare Supplement (Medigap)
Works alongside Original Medicare to cover out-of-pocket costs. Standardized plans (A, B, D, G, K, L, M, N) are available from private insurers. Plan G is the most comprehensive option available to new enrollees today.
Medicare Advantage (Part C)
Replaces Original Medicare with a private plan that bundles Parts A, B, and usually D. Often includes dental, vision, and hearing. Plans vary significantly by county — we compare available options in your specific area.
How to Choose the Right Medicare Plan
The right plan depends on your health needs, preferred doctors, medications, and budget. Here are the key questions to ask:
- Do my current doctors accept this plan?
- Are my prescriptions covered under the plan's formulary?
- What are my expected out-of-pocket costs for the year?
- Do I travel frequently or spend time in multiple states?
- Do I want predictable costs (Medigap) or potentially lower premiums (Advantage)?
Our licensed agents compare plans side by side and help you work through these questions — at no cost to you.