Understanding Medicare Basics
What Is Medicare?
Section titled “What Is Medicare?”Medicare is a federal health insurance program for:
- People age 65 and older
- Certain younger people with disabilities
- People with End-Stage Renal Disease (ESRD)
The Centers for Medicare & Medicaid Services (CMS) manages Medicare. The program has multiple parts that cover different types of care.
Part A – Hospital Insurance
Section titled “Part A – Hospital Insurance”Part A covers inpatient hospital stays, skilled nursing facility care, hospice, and limited home health services.
Most people get Part A without paying a premium if they worked and paid Medicare taxes for at least 10 years.
Part B – Medical Insurance
Section titled “Part B – Medical Insurance”Part B covers doctor visits, outpatient care, preventive services, and durable medical equipment.
You pay a monthly premium for Part B. It also includes deductibles and coinsurance.
Part C – Medicare Advantage
Section titled “Part C – Medicare Advantage”Medicare Advantage plans are offered by private insurers approved by Medicare. These plans bundle Part A and Part B coverage, and usually include Part D (prescription drugs) plus extra benefits like dental, vision, and fitness programs.
Medicare Advantage plans may have provider networks and different cost structures than Original Medicare.
Part D – Prescription Drug Coverage
Section titled “Part D – Prescription Drug Coverage”Part D helps you pay for prescription medications. You can get Part D as a standalone plan or as part of a Medicare Advantage plan.
Part D includes premiums, deductibles, and copays. Each plan has coverage tiers and a list of covered drugs called a formulary.
Medicare vs. Medicaid
Section titled “Medicare vs. Medicaid”| Feature | Medicare | Medicaid |
|---|---|---|
| Who Qualifies | People age 65 and older, certain people with disabilities | Low-income individuals and families |
| Managed By | Federal government (CMS) | State and federal governments |
| Income-Based? | No | Yes |
| Coverage | Hospital, medical, drug, and Advantage plans | Broad medical coverage, including long-term care |
| Can You Have Both? | Yes — called dual eligibility | Yes — Medicaid may cover Medicare costs |
Consumer Takeaway
Section titled “Consumer Takeaway”Medicare is your federal health insurance starting at age 65. It has different parts for hospital care, medical services, prescription drugs, and bundled coverage. Medicaid is a state-run program for people with low income. Some people qualify for both programs, which unlocks extra help and specialized plans.