Understanding Medicare – The Basics and What It Covers
Medicare is the federal health insurance program in the United States, primarily serving adults aged 65 and older, as well as younger individuals with certain disabilities or illnesses. The program is divided into four parts, each offering specific types of coverage to meet different healthcare needs.
Part A covers hospital care and related services. This includes inpatient hospital stays, skilled nursing facility care, hospice, and some home health services. Most people do not pay a premium for Part A if they or their spouse paid Medicare taxes for at least 10 years.
Part B covers doctor visits, outpatient care, preventive services, and some home health care. Unlike Part A, Part B requires a monthly premium, which is determined annually. For 2025, the standard monthly premium for Part B is $185, with an annual deductible of $257.
Part C, also known as Medicare Advantage, is offered by private insurers and combines Parts A and B, often including additional benefits such as dental, vision, and hearing coverage. These plans may have different cost structures and provider networks compared to Original Medicare.
Part D provides prescription drug coverage and is also offered through private insurers. Individuals must enroll in a Part D plan separately if they want prescription drug coverage.
Eligibility for Medicare is straightforward: you qualify if you are 65 or older and a U.S. citizen or permanent resident, or if you have a qualifying disability or condition such as end-stage renal disease or ALS. Most people are automatically enrolled in Medicare when they turn 65, but some may need to sign up manually.
Medicare does not cover all healthcare costs. There are out-of-pocket expenses such as premiums, deductibles, copays, and coinsurance. Many beneficiaries choose to purchase supplemental insurance, known as Medigap, to help cover these additional costs.
Understanding the basics of Medicare helps individuals make informed decisions about their healthcare coverage as they age or if they develop qualifying conditions.