The Basics
What is Medicare?
Medicare can feel like alphabet soup. Let's break it down in plain English — no jargon.
Quick Answer
Medicare is the federal health insurance program for people 65 and older and certain younger people with disabilities. In 2026, the standard Medicare Part B premium is $202.90 per month with a $283 annual deductible.
2026 Key Figures
Part A — Hospital Insurance
Part A generally helps cover inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. Most people don't pay a monthly premium for Part A because they (or a spouse) paid Medicare taxes while working — you can confirm your work-history eligibility through the Social Security Administration.
Part B — Medical Insurance
Part B generally helps cover doctor visits, outpatient care, preventive services like screenings and vaccines, and durable medical equipment. Most people pay a monthly premium for Part B. Signing up during your Initial Enrollment Periodhelps you avoid a late enrollment penalty.
Part C — Medicare Advantage
Part C, better known as Medicare Advantage, is a way to get your Part A and Part B benefits (and often Part D) through a private insurance company approved by Medicare. These plans often bundle in extra benefits, but typically use a provider network. See howMedicare Advantage compares to Medigap to weigh your options.
Part D — Prescription Drug Coverage
Part D helps cover the cost of prescription medications. It's offered through private insurance companies, either as its own stand-alone plan alongside Original Medicare, or bundled into a Medicare Advantage plan. Going without creditable drug coverage can lead to a lasting late enrollment penalty.
Heads up: Premiums, deductibles, and other dollar figures change every year. Rather than guess, always check Medicare.govor ask your licensed insurance agent for current figures.
Common Medicare Misconceptions
Medicare is one of the most misunderstood federal programs, partly because it changed so much over the decades and partly because the rules genuinely are complicated. For a more complete definitional walkthrough — including how Medicare compares to Medicaid — seeWhat Is Medicare? A Complete Guide. Here are a few of the misconceptions we hear most often.
"Medicare covers everything once I turn 65."
Original Medicare (Parts A and B) doesn't cover most dental, vision, or hearing care, and it doesn't cap your out-of-pocket costs. That's exactly the gap that Medicare Advantage plans and Medigap policies exist to fill — see how they compare.
"I can sign up for Medicare whenever I want."
Medicare has specific enrollment windows, and missing them can mean a permanent late enrollment penalty added to your premium for as long as you have that coverage. See our full breakdown ofwhen to enroll.
"Medicare is free."
Part A is usually premium-free if you or a spouse paid Medicare taxes while working, but Part B carries a standard monthly premium ($202.90 in 2026), and most people also pay for Part D or a Medicare Advantage plan's associated costs.
"If I have employer coverage, I don't need to think about Medicare."
Depending on the size of your employer and how their group plan coordinates with Medicare, delaying enrollment could still trigger a penalty later. See how Medicare interacts with employer coverage before you assume you're covered.
How Medicare Works With Employer Insurance
If you're still working at 65, whether Medicare or your employer plan pays first depends largely on your employer's size:
Employer with 20+ employees
Your group health plan is usually considered primary, meaning it pays first, and Medicare pays second for anything the employer plan doesn't fully cover. You can typically delay Part B enrollment without a penalty until that employer coverage ends.
Employer with fewer than 20 employees
Medicare usually becomes primary at 65, and you generally need to enroll in Part A and Part B for claims to be paid correctly — your employer plan may pay little without Medicare enrolled alongside it.
These rules are known as Medicare Secondary Payer (MSP) rules, and they determine the order in which your coverages pay a claim. Getting the order wrong — for instance, assuming your employer plan is primary when Medicare rules actually require Medicare to pay first — can result in denied claims or bills you didn't expect. If you're approaching 65 and still working, see our full guide onhow Medicare interacts with employer coverage before making any enrollment decisions.
What Medicare Does Not Cover
Original Medicare (Parts A and B) is comprehensive for hospital and medical care, but it leaves real gaps that catch many people by surprise:
- Routine dental care — cleanings, fillings, dentures, and most dental procedures are not covered.
- Routine vision care — eye exams for glasses and the glasses or contacts themselves are not covered (though some medical eye conditions are).
- Routine hearing care — hearing exams and hearing aids are not covered.
- Long-term custodial care — help with daily activities like bathing, dressing, or eating, such as extended nursing home stays, is generally not covered.
- Most care outside the United States — with limited exceptions.
These gaps are exactly what Medicare Advantage plans (which often bundle in dental, vision, and hearing benefits) and Medigap policies (which address cost-sharing but not these specific excluded services) are designed around. See ourfull coverage comparison for how to weigh these options.
Medigap: A Quick Overview
Medigap (Medicare Supplement Insurance) is private insurance that works alongside Original Medicare to help cover its cost-sharing gaps — deductibles, copayments, and coinsurance. Unlike Medicare Advantage, Medigap doesn't replace Original Medicare or use a provider network; you can see any doctor nationwide who accepts Medicare. It also doesn't include drug coverage, so it's typically paired with a separate standalone Part D plan.
Timing matters significantly with Medigap: your Medigap Open Enrollment Period is a one-time, 6-month window starting the month you're both 65+ and enrolled in Part B. During this window, insurers must generally sell you any policy they offer regardless of health history. Outside it, insurers can use medical underwriting to deny coverage or charge more. For the full breakdown of what Medigap covers, the lettered plan options, and enrollment timing, see our complete Medigap guide. And if you're deciding between Medigap and Medicare Advantage in the first place, ourcoverage options comparison walks through the full tradeoff, including how to estimate total annual cost rather than comparing premiums alone.
Frequently Asked Questions
What is Medicare Part A?
Part A is hospital insurance. It generally helps cover inpatient hospital stays, skilled nursing facility care, hospice, and some home health care. Most people don't pay a monthly premium for Part A because they or a spouse paid Medicare taxes while working.
What is Medicare Part B?
Part B is medical insurance. It generally helps cover doctor visits, outpatient care, preventive services like screenings and vaccines, and durable medical equipment. Most people pay a monthly premium for Part B.
Do I need both Part A and Part B?
Most people enroll in both. Part A alone doesn't cover doctor visits or outpatient care, and Part B alone doesn't cover hospital stays — together they form Original Medicare. Delaying Part B without other qualifying coverage can lead to a lasting late enrollment penalty.
What's the difference between Medicare Advantage and Medigap?
Medicare Advantage (Part C) replaces Original Medicare with a private plan, often bundling in Part D and extra benefits, but typically uses a provider network. Medigap works alongside Original Medicare to cover its gaps — like copays and deductibles — and lets you see any doctor nationwide who accepts Medicare, but doesn't include drug coverage.
When does Medicare coverage start?
If you sign up during the 3 months before your 65th birthday month, coverage starts the first day of your birthday month. Signing up during your birthday month or the 3 months after can delay your start date by one to three months.
Next Steps
Once you understand the basics, here's a simple checklist to work through before you enroll:
- Confirm your work-history eligibility for premium-free Part A through the Social Security Administration.
- Mark your Initial Enrollment Period on a calendar — see when to enroll to find your exact window.
- If you're still working, check how employer coverage affects your timing before you decide to delay.
- Compare Medicare Advantage and Medigap to see which path fits your situation.
- Understand how late enrollment penalties are calculated so you know what's at stake.
- When you're ready for personalized guidance, take the Medicare Decision Style Quiz or schedule a free consultation.
✓ Lesson marked complete
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