1What is Medicare?

Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant).

The program was established in 1965 and is managed by the Centers for Medicare & Medicaid Services (CMS). Today, Medicare covers over 65 million Americans and provides essential healthcare coverage for hospital stays, doctor visits, prescription drugs, and more.

2The Four Parts of Medicare

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, durable medical equipment, and some home health care.

Part B has a monthly premium (standard is $202.90 in 2026).

Medicare Supplement (Medigap) vs. Medicare Advantage

After enrolling in Parts A & B, you have two paths: add a Medicare Supplement (Medigap) policy for comprehensive gap coverage, or switch to Medicare Advantage which replaces Original Medicare.

Medicare Supplement: Pairs with Original Medicare to cover out-of-pocket costs. See any Medicare-accepting doctor nationwide with no referrals needed.

Medicare Advantage: Replaces Original Medicare with a private plan. Often includes some extra benefits, but typically requires using network doctors and may need referrals for specialists.

Part D: Prescription Drug Coverage

Helps cover the cost of prescription drugs. Available as a standalone plan or included in Medicare Advantage.

Important: If you don't enroll when first eligible, you may face late enrollment penalties.

3Medicare Eligibility

You're eligible for Medicare if you:

Are 65 or older and a U.S. citizen or permanent legal resident for at least 5 continuous years
Are under 65 with certain disabilities and have received Social Security disability benefits for 24 months
Have End-Stage Renal Disease (ESRD) or ALS (Lou Gehrig's disease)

4Enrollment Periods

Initial Enrollment Period (IEP)

A 7-month window that begins 3 months before your 65th birthday, includes your birthday month, and ends 3 months after. This is your primary opportunity to enroll without penalties.

Annual Enrollment Period (AEP)

October 15 – December 7 each year. You can switch Medicare Advantage plans, go back to Original Medicare, or change Part D plans during this time.

Medicare Advantage Open Enrollment Period

January 1 – March 31 each year. If you're in a Medicare Advantage plan, you can switch to another MA plan or go back to Original Medicare.

Special Enrollment Periods (SEP)

Triggered by specific life events like moving, losing employer coverage, or qualifying for Medicaid. These allow you to make changes outside the normal enrollment periods.

5Original Medicare + Supplement vs. Medicare Advantage

Feature	Original Medicare + Supplement	Medicare Advantage
Coverage	Part A + Part B + Medigap (comprehensive gap coverage)	Part A + B bundled together, sometimes includes Part D
Doctor Choice	Any doctor nationwide that accepts Medicare—no referrals needed	Limited to plan's network; may require referrals for specialists
Travel Coverage	Full coverage anywhere in the U.S. with Medicare-accepting providers	Coverage may be limited or unavailable outside service area
Cost Predictability	Consistent, predictable costs with Medigap covering most out-of-pocket expenses	Costs vary based on services used; copays at each visit
Extra Benefits	Separate dental/vision/hearing plans available (often more comprehensive options)	Some plans include basic dental, vision, hearing, or gym memberships
Prior Authorization	Generally not required—you and your doctor decide on care	May require approval before certain procedures or treatments
Switching Plans	Keep your Medigap plan as long as you pay premiums	Plans can change yearly; benefits and networks may shift

6Medicare Supplement (Medigap)

Medigap policies are sold by private insurance companies to fill "gaps" in Original Medicare coverage—like copayments, coinsurance, and deductibles. When paired with Original Medicare, a Medigap policy gives you the freedom to see any Medicare-accepting doctor in the country with predictable, low out-of-pocket costs.

Key Points:

Only works with Original Medicare (not Medicare Advantage)
Plans are standardized—Plan G from one company covers the same as Plan G from another, so you can shop for the best price
Your coverage is guaranteed renewable as long as you pay your premium
The best time to enroll is 6 months prior to turning 65—this is when you have guaranteed issue rights with no health questions

7Understanding Medicare Costs

Premium

Monthly amount you pay for coverage (like a subscription fee)

Deductible

Amount you pay before your coverage kicks in

Copayment

Fixed amount you pay for a service (e.g., $20 for a doctor visit)

Coinsurance

Percentage of costs you pay (e.g., 20% of a procedure)

8Your Next Steps

Ready to Find Your Perfect Medicare Plan?

Understanding Medicare is just the first step. Let me help you navigate your options and find a plan that fits your health needs and budget—at no cost to you.

Medicare 101 Guide

In This Guide