Medicare: An Overview

What is Medicare?

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

Medicare is an entitlement program that most US Citizens will become eligible for by working and paying Medicare taxes for a certain period of time. This period is typically working for 40 quarters or 10 years. The majority of people joining Medicare are people turning 65 years of age or when they decide to retire and leave their group health insurance.

What does Original Medicare Cover?

While on Medicare the combination of Parts A & B become our basic hospitalization and medical coverage. I would advise you to complement this coverage by either
electing a Medicare Supplement plan, or by selecting a Part C Advantage plan.

Medicare Part A

Is often called “hospital Insurance” because it gives some coverage for your care while in the hospital. It also covers some care for assisted living facilities, nursing facilities, home health care, and hospice.

Medicare Part B

Is often called medical insurance because it covers things like doctor visits, lab tests, X-Rays and other outpatient services.

Ambulance Services
Outpatient Care
Preventative Services
Clinical Research
One-Time “Welcome to Medicare” Wellness Exam
Annual “Wellness” visit every 12 months
Laboratory Tests – X-rays, blood work, etc.
Durable Medical Equipment (DME) – Wheelchairs, walkers, hospital beds, home oxygen equipment, etc.
Prosthetics & Orthotics
Mental Health Care
Medically necessary services

How Much does Part A Cost?

Most People don’t pay a monthly premium for Medicare Part A (Hospital Insurance) if you or your spouse has paid medicare taxes while working. You can get premium free part A at age 65 if:

You already get retirement benefits from Social Security or the Railroad Retirement Board.
You’re eligible to get Social Security or Railroad benefits but haven’t filed for them yet.
You or your spouse had Medicare-covered government employment.

Qualify for premium free Part A if under the age of 65 if:

You have received Social Security or Railroad Retirement Board disability benefits for 24 months.
You have End-Stage Renal Disease (ESRD) and meet certain requirements.

In most cases, if you choose to buy Part A, you must also have Medicare Part B (Medical Insurance) and pay monthly premiums for both.

Part B Costs

In 2025 the average person will pay a Part B Premium of $185.00 each month if your individual income is under $106,000 or your joint income over $212,000.

Social Security will contact high income earners who have to pay more depending on their income. The amount you pay can change each year depending on your income. If you have to pay a higher amount for your Part B premium and you disagree you will need to contact the social security office.

If you don’t sign up for Part B when you’re first eligible, you may have to pay a late enrollment penalty.

What are the parts of Medicare?

“Original Medicare” consists of Part A and Part B. Together, they provide the foundation for your health insurance coverage.

Part A – (Hospital Insurance). This give coverage for your time in the hospital (inpatient care), care in a skilled nursing facility, hospice care, home health care.

Part B – (medical Insurance) This helps cover your doctors visits and other services including: outpatient procedures, x-rays, lab tests, and preventative services.

“Medicare Advantage Plans” are known as Part C. This combines Part A and Part B coverage.

Part C – These plans are offered by private insurance carriers who have a contract with Medicare and are required to offer the same benefits as Original Medicare. You may enroll in this option to replace your “Original Medicare” (Part A and Part B).

Part D – (Medicare Prescription Drug Coverage). This is offered to everyone with Medicare. You can get coverage from a stand alone Medicare prescription drug plan. If you choose a Part C plan most cover prescription drugs; however, you may be able to add drug coverage to some plans, if they are not already included.