Medicare Education
Medicare Basics — Explained Simply
Medicare can seem overwhelming at first. Here's a plain-English guide to the different parts and what they cover — no insurance jargon required.
Hospital Insurance
Medicare Part A is your hospital insurance. It helps pay for inpatient hospital stays, care in a skilled nursing facility after a hospital stay, hospice care, and some home health services.
What it covers:
- Inpatient hospital care (after a deductible)
- Skilled nursing facility care (up to 100 days)
- Hospice care for terminal illness
- Some home health services
Cost overview:
Most people don't pay a premium for Part A if they (or their spouse) worked and paid Medicare taxes for at least 10 years.
Medical Insurance
Medicare Part B covers your outpatient medical care — the services you receive when you're not admitted to a hospital. It's where most of your doctor visits and routine care fall.
What it covers:
- Doctor visits and consultations
- Outpatient hospital care and surgery
- Preventive services (flu shots, screenings, annual wellness visits)
- Medical equipment (wheelchairs, walkers)
- Mental health care
Cost overview:
Part B has a monthly premium (set by Medicare each year), plus an annual deductible. After meeting your deductible, Medicare typically pays 80% and you pay 20%.
Medicare Advantage
Medicare Advantage (also called Part C) is an all-in-one alternative to Original Medicare. These plans are offered by private insurers approved by Medicare and bundle your Part A, Part B, and usually Part D coverage together.
What it covers:
- Everything Original Medicare covers
- Often includes prescription drug coverage
- Many plans include dental, vision, and hearing
- Some include gym memberships or transportation
Cost overview:
Many Medicare Advantage plans have $0 premiums beyond your Part B premium. However, they often use provider networks and may have different cost-sharing than Original Medicare.
Prescription Drug Plans
Original Medicare does not cover most prescription drugs. Part D is a standalone drug plan you can add to Original Medicare to help pay for the medications you take.
What it covers:
- Prescription drugs on the plan's formulary
- Medications at preferred pharmacies
- Specialty and brand-name drugs (varies by plan)
Cost overview:
Each Part D plan has a monthly premium, annual deductible, and copays or coinsurance for your medications. The specific costs depend heavily on which drugs you take.
Medicare Supplement (Medigap)
Medigap plans are sold by private insurers to help cover the 'gaps' in Original Medicare — the costs that Medicare doesn't pay, like copays, coinsurance, and deductibles.
What it covers:
- Part A and Part B deductibles
- Part A and Part B coinsurance
- Hospital costs beyond Medicare's limit
- Some international emergency care
Cost overview:
You pay a monthly premium to the private insurer in addition to your Part B premium. Premiums vary by plan type, insurer, and your location.
Medicare Enrollment Periods
Knowing when to enroll is just as important as knowing what to enroll in. Missing a deadline can mean paying higher premiums for life.
Initial Enrollment Period (IEP)
7 months: 3 months before your 65th birthday, the month of, and 3 months after
This is your first chance to enroll. Signing up on time avoids late enrollment penalties.
General Enrollment Period (GEP)
January 1 – March 31 each year
If you missed your IEP, you can enroll here — but you may pay higher premiums.
Open Enrollment Period (OEP)
October 15 – December 7 each year
You can switch Medicare Advantage plans or return to Original Medicare each fall.
Special Enrollment Period (SEP)
Triggered by qualifying life events
If you delayed Medicare because you had employer coverage, you have a Special Enrollment Period when that coverage ends.
Timing matters more than people think
Late enrollment penalties can increase your Part B premium by 10% for each 12-month period you were eligible but didn't enroll — and those penalties last for life. Ashley can help you figure out the right time to enroll based on your specific situation.
Calculate your Part B penalty →