Understanding Medicare: A Simple Guide for Seniors

  • Medicare is federal health insurance for people 65+ and some under 65 with certain disabilities.
  • You can get coverage through Original Medicare (Parts A & B) and add Part D and/or a Medigap plan, or choose a Medicare Advantage plan (Part C) that bundles coverage.
  • Costs and benefits change each year. We help you compare options and enroll.

What is Medicare?

Medicare is federal health insurance with several parts:
  • Part A (Hospital Insurance): Inpatient hospital care, skilled nursing facility (limited), hospice, and some home health care.
  • Part B (Medical Insurance): Doctor visits, outpatient care, preventive services, lab work, durable medical equipment (e.g., walkers, wheelchairs).
  • Part C (Medicare Advantage): Private plans that include Part A and Part B, often Part D, and may add dental, vision, and hearing.
  • Part D (Prescription Drug Coverage): Helps pay for prescription medications.
  • Medigap (Medicare Supplement Insurance): Private plans that help pay some out‑of‑pocket costs not covered by Original Medicare.

Original Medicare vs. Medicare Advantage vs. Medigap at a glance

Original Medicare (Parts A & B)

  • Choose any doctor/hospital that accepts Medicare nationwide.
  • No built‑in prescription drug coverage (add Part D if needed).
  • No annual out‑of‑pocket maximum; you pay your share for each service.
  • You can add a Medigap plan to reduce out‑of‑pocket costs.

Medicare Advantage (Part C)

  • All‑in‑one private plan that includes Part A and Part B; most plans include Part D.
  • Usually HMO or PPO networks; some require referrals and in‑network providers for lowest costs.
  • Annual maximum out‑of‑pocket limit for medical costs (varies by plan).
  • Often includes extras like dental, vision, hearing, fitness, and over‑the‑counter benefits.

Medigap (Medicare Supplement)

  • Works with Original Medicare (not with Medicare Advantage).
  • Helps pay Part A and B deductibles, coinsurance, and copays, depending on plan letter (A, B, C, D, F, G, K, L, M, N).
  • No provider network—use any Medicare‑accepting provider.
  • You’ll still need a separate Part D plan for prescriptions.
Elderly couple reviewing Medicare cost details with a healthcare advisor in a bright office setting.

What does Medicare cost?

Your costs include premiums, deductibles, and coinsurance. Amounts change yearly. We confirm current rates during your review.

Examples (2022 figures; for illustration only—today’s amounts may differ):

  • Part A
    • Inpatient hospital deductible per benefit period: $1,556
    • Coinsurance per day: 389(days61–90),778 (days 91–150, lifetime reserve)
    • Skilled nursing facility coinsurance per day: $194.50 (days 21–100)
  • Part B
    • Standard monthly premium: $170.10 (higher for higher incomes)
    • Annual deductible: $233
    • Most services: 20% coinsurance after deductible
  • Durable Medical Equipment (Part B): 20% coinsurance after deductible
  • Home health (with qualifying medical need): Typically $0 for skilled services under Part A/B rules
Note: Costs and coverage limits update every year. Request your free current‑year benefits review to avoid surprises.

Enrollment windows you should know

  • Initial Enrollment Period (IEP): 7 months around your 65th birthday (3 months before, your birthday month, and 3 months after).
  • Special Enrollment Period (SEP): If you had qualifying employer coverage and delayed Part B; also for certain life events (moving, plan changes, Medicaid changes).
  • General Enrollment Period (GEP): Jan 1–Mar 31 annually if you missed IEP/SEP; coverage starts the following month after enrollment.
  • Part D and Medicare Advantage Annual Enrollment: Oct 15–Dec 7 each year for plan changes effective Jan 1.
  • Medicare Advantage Open Enrollment: Jan 1–Mar 31; switch MA plans or return to Original Medicare (and join a Part D plan).
  • Medigap Open Enrollment: 6 months starting the month you’re 65+ and enrolled in Part B (no health underwriting during this window).
Senior man marking Medicare enrollment dates on a calendar at home, planning his coverage timeline.

Late enrollment penalties

  • Part B: Penalty may apply if you delay without qualifying coverage.
  • Part D: Penalty may apply if you delay without creditable drug coverage.
    We’ll help you avoid penalties by enrolling at the right time.

How to choose your Medicare path (simple 5‑step guide)

  1. List your doctors, clinics, and hospitals.
  2. Gather your medications (names, dosages, pharmacies).
  3. Decide your flexibility needs (any doctor vs. network savings).
  4. Set a monthly budget and comfort with copays; consider whether you prefer a cap on out‑of‑pocket costs.
  5. Consider extras: dental, vision, hearing, transportation, fitness, and travel coverage.
Then:
  • Prefer freedom to see any provider and predictable cost‑sharing? Consider Original Medicare + Medigap + a Part D plan.
  • Prefer an all‑in‑one plan with added benefits and an annual out‑of‑pocket maximum? Consider Medicare Advantage (most include Part D)

Frequently Asked Questions

What’s the difference between Medicare Advantage and Medigap?
Medicare Advantage replaces Original Medicare with a private plan and often includes drugs and extras. Medigap works with Original Medicare to help pay your share of costs; you add a separate Part D plan for prescriptions.
Can I keep my doctor?
Original Medicare lets you see any provider that accepts Medicare. Medicare Advantage plans have networks; check if your doctor is in‑network.
Does Medicare cover dental, vision, and hearing?
Original Medicare has limited coverage. Many Medicare Advantage plans include these benefits.
What if I travel?
Original Medicare covers you nationwide with Medicare‑accepting providers. Medicare Advantage may have limited out‑of‑area coverage except for emergencies. Some Medigap plans include limited foreign travel emergency benefits.
Can I change my plan later?
Yes, typically during the annual enrollment periods. Special situations may allow changes mid‑year.
Will I pay more if my income is higher?
Possibly. Part B and Part D may have income‑related monthly adjustments.