Understanding Medicare
Is Medicare Right for You?
As we age, our healthcare needs often increase—and so can the costs. That's why Medicare, a government-run health insurance program, exists. Medicare helps millions of Americans aged 65 and older (and some younger people with disabilities) pay for doctor visits, hospital stays, prescriptions, and more.
Overview
What is Medicare?
Medicare is a federal health insurance program primarily for:
Medicare helps cover a wide range of healthcare services, from hospital care to preventive checkups, depending on the plan you choose. It's not completely free—you may still pay premiums, deductibles, copayments, and coinsurance:
Premium
The amount you pay each month to keep your insurance active.
Deductible
The amount you pay out of pocket each year before your insurance starts paying.
Copayments (Copays)
A fixed amount that you pay for certain services (like $20 for a doctor visit).
Coinsurance
The percentage of costs you pay after meeting your deductible. For example, you might pay 20% while Medicare covers 80%.
Although you may be responsible for some costs, Medicare significantly reduces out-of-pocket medical expenses.
How It Works
How Does Medicare Work?
Medicare is divided into parts, each of which covers specific types of healthcare. You can choose Original Medicare, which is run by the government, or Medicare Advantage, which is offered by private insurance companies.
You'll usually sign up around age 65 during your Initial Enrollment Period, which begins three months before your 65th birthday and ends three months after.
Once enrolled, you can see doctors and hospitals that accept Medicare and receive coverage according to your plan's rules.
Plan Parts
What Are the Different Parts of Medicare?
Medicare is made up of four main parts—A, B, C, and D.
Part A – Hospital Insurance
Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.
Most people don't pay a premium for Part A if they (or their spouse) paid Medicare taxes while working.
Part B – Medical Insurance
Covers doctor visits, outpatient care, preventive services such as vaccines and screenings, and medical equipment.
You pay a monthly premium and a deductible before Medicare begins paying its share.
Part C – Medicare Advantage
Offered by private insurance companies. Includes everything in Parts A and B, often with extra benefits like vision, hearing, dental, and prescription drugs.
Works like traditional health insurance with provider networks.
Part D – Prescription Drug Coverage
Covers prescription medications. Available as a standalone plan with Original Medicare or included in many Medicare Advantage plans.
You'll pay a monthly premium for Part D.
Together, Part A and Part B make up Original Medicare, which is provided by the government.
What Medicare Doesn't Cover
It's important to know that Original Medicare doesn't cover everything. You'll typically need to pay for:
You may want to consider adding supplemental coverage or a Medicare Advantage plan that includes some of these services.
What is Medigap?
Original Medicare doesn't pay for everything. You're still responsible for deductibles, copays, and coinsurance. To help with these out-of-pocket payments, you can buy a Medigap policy (supplemental insurance for Medicare) from a private insurer.
Medigap plans work only with Original Medicare. They do not include prescription coverage; you'll need a separate Medicare Part D plan.
Benefits
What Are the Benefits of Medicare?
Medicare offers several important benefits:
Comprehensive Coverage
Helps pay for hospital stays, doctor visits, preventive care, and prescriptions.
Affordability
Reduces major healthcare expenses for seniors.
Choice of Plans
Choose Original Medicare or a Medicare Advantage plan that fits your needs.
Nationwide Access
With Original Medicare, you can see any provider that accepts Medicare anywhere in the U.S.
Who It's For
Who Is Medicare Beneficial For?
Medicare is especially helpful for:
Even if you're still working at age 65 or older, you can enroll in Medicare and coordinate it with your employer's plan.
Getting Started
What to Know Before Enrolling
Here are some key things to keep in mind:
Talk to a Medicare Specialist
Schedule a call to get clear guidance on Medicare Parts A, B, C, and D, plus plan options and enrollment timing for your situation.
Is Medicare Right for You?
Medicare is a vital program that provides affordable, reliable health coverage for millions of older Americans and those with disabilities. It's designed to give you access to quality care and protect you from overwhelming medical costs, especially in retirement.
Understanding how Medicare works—what it covers, what it doesn't, and which parts you need—can help you make confident, informed decisions about your health and financial future.
If you'd like additional guidance choosing a Medicare plan, one of CoveredWell's trusted insurance professionals would be happy to discuss your options with you.