How does Medicare work?

Intro to Medicare

How does Medicare work?

Your Medicare information guide

Skip the intro and START LEARNING!

“What is Medicare?”
“How does Medicare work when you turn 65?

These are common questions people have when they’re getting ready to turn 65. They may have other questions like:

"When can I enroll in Medicare?"

"What exactly does Medicare cover?"

"What does Medicare not cover?"

"Do you have to pay for Medicare?"

-OR-

Maybe you’re seasoned and have had Medicare for a few years, but you’re looking to brush up on the latest information. Perhaps you want a quote to switch your Medicare Supplement Plan or Medicare Advantage Plan and you’re looking for some guidance. Your questions may be a little different like:

"Can I switch to a different Medigap policy?"

"When can I switch my Medicare Advantage Plan?"

"Can you switch back to Original Medicare?"

"What qualifies as a Special Enrollment Period (SEP)?"

This will be your introduction to Medicare and it’s counterparts. I will keep explanations brief and link you to areas of my website that offer more detailed information on popular Medicare topics as well. Keep in mind, I am an Insurance Agent, not a writer! I’ll do my best to explain everything in a friendly and easy to read manner, but NO PROMISES. If you find a topic that seems difficult to understand, or doesn’t fully answer your question, send me an email. I will address it both on the website and with you, personally. My guess is that if you are confused so are others and I want this guide to be as helpful as possible. I didn’t spend days writing all about Medicare because I love writing. I did it to try and make things easy to understand, which is a term most people don’t associate with Medicare!

With all of that out of the way let’s begin.

Jump straight to:

What is Medicare?

In a nut shell, Medicare is just Health Insurance provided by the Federal Government. The governing body that overlooks the medicare program is CMS (Centers for Medicare & Medicaid Services). That was easy, right? Let’s dive into some of the details of what we’ll call “Original Medicare” – the parts that you get through the federal government. We’ll talk about who is eligible and what is covered. We’ll also review coverage plans that compliment Original Medicare to ensure that all of your health associated needs are well taken care of.

Medicare Eligibility

Who is eligible for Medicare?

  • People who are age 65 and older
  • Certain people on Social Security Disability
  • People with End-Stage Renal Disease (ESRD)
 For more on enrollment and eligibility check out article I wrote: “The Ultimate Guide to Medicare Enrollment” I cover topics such as when and how to enroll, avoiding late enrollment fees, the Annual Election Period (AEP), qualifying for a Special Enrollment Period (SEP), and so much more. It’s an extremely detailed article on everything enrollment related.

Medicare Part A

Medicare Part A is the part of Original Medicare that covers hospitalization.

Medicare Part A coverage examples:

  • Inpatient hospital related expenses
  • Care for skilled nursing facility (SNF) stays
  • Long-term Care Hospital (LCTH) care

Learn more about Original Medicare Part A here: What is Medicare Part A? I cover topics such as your cost sharing (deductibles & co-payments), more detailed examples about what is covered, what’s NOT covered, how much you will pay for Original Medicare Part A, and much more!

Medicare Part B

Medicare Part B is the part of Original Medicare that covers outpatient services.

Medicare Part B coverage examples:

  • Doctor’s services
  • Outpatient care
  • Preventative Services
  • Other medical related expenses
Learn more about Original Medicare Part B here: What is Medicare Part B? I cover topics such as your cost sharing (deductibles & co-payments), more detailed examples about what is covered, what’s NOT covered, how much you will pay for Original Medicare Part B, and much more!

Medicare Part C Medicare Advantage

Medicare Part C is commonly referred to as Medicare Advantage. Even though it is called Medicare Part C, Medicare Advantage plans are not actually a part of Original Medicare.

So what is a Medicare Advantage plan?

A Medicare Advantage plan is very similar to Original Medicare and provides the same benefits as Medicare’s Part A and Part B. However, when you purchase a Medicare Advantage plan your Medicare services are no longer provided for by Original Medicare.

Here’s what makes it different:

  • Medicare Advantage plans are administered by a private health insurance company, which is who will pay for your Medicare services
  • It often times provides coverage not included in Original Medicare

Some of the additional benefits that may be provided by a Medicare Advantage Plan include:

  • Prescription Drug Plan Coverage
  • Gym Membership
  • Hearing
  • Vision
  • Dental

Not only that, but often times these plans are offered to you at a very low cost or even a $0 monthly premium.

“Learn more about Medicare Part C Medicare Advantage Plans here: What is Medicare Part C? I cover topics such as the advantage and disadvantage of enrolling in a Medicare Advantage plan, plan restrictions, how to enroll in a Medicare Part C Medicare Advantage plan, and much more!

Medicare Part D Prescription Drug Plan

Medicare Part D plans are also known as Prescription Drugs plans (PDP).

  • They are provided to you by private health insurance companies
  • They cover your prescription drug needs

Learn more about Medicare Part D Prescription Drug plans here: What is Medicare Part D? I cover topics such as your cost sharing (deductibles & co-payments), drug formulary, pharmacy networks, Part D late enrollment fees, and much more!


Medicare Supplement (Medigap) Plan

Medicare Supplement insurance is commonly referred to as a Medigap plan. Both terms refer to the exact same type of policy.

Much like Medicare Advantage and Prescription Drug plans, Medicare Supplement plans are provided by a private health insurance company who is approved by Medicare. Like Part D Prescription Drug plans, Medigap plans compliment Original Medicare by, you guessed it, covering the “gaps” in Original Medicare.

Medicare Supplement coverage examples:

  • Original Medicare Part A and Part B co-payments
  • Original Medicare Part A and Part B deductibles
  • Other Original Medicare Part A and Part B cost sharing expenses

Learn more about Medicare Supplement Plans here: What is a Medicare Supplement? I cover topics such as how to enroll in a Medigap plan, What Medicare Supplemental insurance covers, is Plan G better than Plan F?, what’s NOT covered, and much more!

Share on Facebook
Share on Twitter
Share on Linkdin
Share on Pinterest

Like this article?

Sean Senseman

Sean Senseman

Leave a comment

Close Menu