Medicare 101
Start With the Basics
Medicare has its own vocabulary, timelines, and rules. This page explains the fundamentals in straightforward language so you can ask better questions about your own situation.
What Medicare Is
Medicare is the federal health insurance program primarily for people age 65 and older, and for some younger people with certain disabilities or conditions. It is made up of different parts, and each part covers different types of care.
Understanding how the parts fit together is the first step in deciding what coverage makes sense for you.
Hospital Insurance
Part A generally helps cover inpatient hospital stays, skilled nursing facility care, hospice, and some home health care. Many people qualify for premium-free Part A based on their work history.
Medical Insurance
Part B generally helps cover doctor visits, outpatient care, preventive services, lab work, and durable medical equipment. Part B has a monthly premium set by Medicare.
Medicare Advantage
Part C plans are offered by private insurance companies approved by Medicare. These plans provide your Part A and Part B coverage, and may include additional benefits.
Prescription Drug Coverage
Part D helps cover prescription medications. Plans differ in premiums, deductibles, covered drug lists, pharmacy networks, and copayments.
Medicare Supplement
Medicare Supplement insurance is designed to help cover certain costs that Original Medicare doesn't fully pay, such as coinsurance and deductibles. It works alongside Original Medicare.
Turning 65 or Leaving Employer Coverage
If you're approaching 65, your Initial Enrollment Period is the natural starting point. It's worth reviewing your situation a few months in advance so nothing is rushed.
If you're still working past 65 and covered by an employer group health plan, the timing may work differently. Whether you should enroll right away or delay depends on the size of the employer and how your coverage is structured.
We'll walk through your specific situation, explain what applies to you, and help you map out the dates that matter.
Common Terminology
Premium
The amount you pay for coverage, usually monthly.
Copayment
A set amount you pay for a covered service or prescription.
Deductible
The amount you pay before your coverage begins to pay.
Formulary
The list of prescription drugs a plan covers.
Coinsurance
A percentage of a covered service's cost that you pay.
Network
The doctors, hospitals, and pharmacies a plan works with.
Important Questions to Ask
01
When does my Medicare eligibility begin, and what do I need to do first?
02
Do I need to enroll in Part B if I'm still working and have employer coverage?
03
Are my current doctors and hospitals part of the plan I'm considering?
04
Are my prescriptions covered, and at which pharmacies?
05
How would this coverage work with any other coverage I already have?
How would this coverage work with any other coverage I already have?