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Medicare Basics
Explained Simply
Medicare doesn't have to be confusing. Here's everything you need to know about how it works; in plain English, without the jargon.
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Understanding Medicare
From the Beginning
Medicare Advantage and Part D plans can change dramatically from one year to the next and those changes happen automatically on January 1 whether you're aware of them or not. Without a review, you might find yourself paying more for the same prescriptions, losing your doctor from the network, or missing a better plan that entered your market.
Our annual review service exists to make sure none of that happens to you and it costs you absolutely nothing.
PART A
Hospital Insurance
Part A covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health services. Most people pay $0 premium for Part A if they or their spouse worked and paid Medicare taxes for at least 10 years (40 quarters). There is a deductible per benefit period.
PART B
Medical Insurance
Part B covers outpatient services, doctor visits, preventive care, lab tests, durable medical equipment, and some home health services. The standard Part B premium in 2026 is $202.90/month, typically deducted from your Social Security benefit. Higher-income individuals pay more (IRMAA).
PART C
Medicare Advantage
Part C — Medicare Advantage — is an alternative way to receive your Medicare benefits through a private insurer approved by Medicare. These plans bundle Parts A and B, often include Part D drug coverage, and frequently add dental, vision, and hearing benefits. Often $0 additional premium.
PART D
Prescription Drug Coverage
Part D provides prescription drug coverage through private plans approved by Medicare. If you have Original Medicare with a Medigap plan, you need a standalone Part D plan. Most Medicare Advantage plans include Part D. Choosing the wrong plan can cost hundreds extra per year. We analyze your specific drugs against every available plan.
Medigap — Medicare Supplement
Medigap plans are sold by private insurers to cover the "gaps" in Original Medicare deductibles, copayments, and coinsurance. They work alongside Parts A and B and allow you to see any Medicare-accepting provider nationwide with no network restrictions. Benefits are standardized by federal law, meaning a Plan G from one company covers exactly the same things as a Plan G from another, the only difference is price.
⟶ Original Medicare path: Parts A + B + Medigap + Part D — maximum flexibility, predictable costs, nationwide provider access
⟶ Medicare Advantage path: Parts A + B + Part C (which often includes D) — often $0 premium, extra benefits, network-based
Not Sure Which Path Is Right For You?
That's exactly what we help you figure out based on your specific doctors, medications, budget, and preferences. Our consultation is free, takes about 30 minutes, and leaves you with a clear, confident decision.
COMMON QUESTIONS
Medicare Basics FAQ
When am I eligible for Medicare?
You're eligible at 65 if you're a U.S. citizen or permanent resident who has lived in the U.S. for at least 5 years. Some people under 65 qualify due to disability or certain conditions like ALS or End-Stage Renal Disease.
Do I have to sign up for Medicare at 65?
Not necessarily, if you have qualifying employer coverage from an employer with 20+ employees, you may be able to delay without penalty. If your employer has fewer than 20 employees, Medicare becomes primary at 65 and delays can create coverage gaps.
What does Medicare not cover?
Original Medicare does not cover routine dental, vision, hearing, long-term care, or most care outside the U.S. Medicare Advantage plans sometimes include dental, vision, and hearing benefits.
What is the difference between Medicare and Medicaid?
Medicare is federal health insurance based on age or disability. Medicaid is a joint federal-state program based on income and financial need. Some people qualify for both which is called 'dual eligible.'
How much does Medicare cost?
Part A is typically free. Part B is $202.90/month in 2026 (higher for higher incomes). Add Medigap ($120–$230/month) and Part D ($5–$80/month), or choose a $0-premium Medicare Advantage plan that bundles coverage.
Can I have Medicare and other insurance at the same time?
Yes, but understanding which plan is primary is critical. The rules depend on your employer size, the type of other coverage, and your specific situation. We walk through coordination of benefits for every client with dual coverage.