Part A: Hospital Insurance
Helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care.
Medicare education
Medicare Basics, Explained Simply
General information to help you understand how Medicare works. Facts on this page come from Medicare.gov, the official U.S. government site for Medicare.
Last reviewed against Medicare.gov: October 31, 2026
General education, not advice. This page explains Medicare in general terms. It doesn’t tell you which plan to choose or whether you qualify. For help with your own situation, request a consultation.
What is Medicare?
Medicare is health insurance for people 65 or older who meet citizenship or residency requirements. You may be able to get Medicare earlier if you have a disability, End-Stage Renal Disease (ESRD), or ALS (also called Lou Gehrig’s disease).
Some people get Medicare automatically, and others have to sign up. It depends on whether you start getting retirement or disability benefits from Social Security before you turn 65.
The parts of Medicare
Part B: Medical Insurance
Helps cover services from doctors and other health care providers, outpatient care, home health care, durable medical equipment (like wheelchairs, walkers, and hospital beds), and many preventive services (like screenings, vaccines, and yearly “Wellness” visits).
Part C: Medicare Advantage
A plan from a private company that contracts with Medicare that offers an alternative to Original Medicare. These “bundled” plans include Part A, Part B, and usually Part D. You must have both Part A and Part B to join.
Part D: Drug coverage
Helps pay for brand-name and generic prescription drugs. It’s optional and offered by private companies that follow rules set by Medicare. Each plan has its own list of covered drugs, called a “formulary.”
Source: Medicare.gov — Parts of Medicare
Original Medicare vs. Medicare Advantage
There are 2 main ways to get your Medicare coverage. Here are some of the general differences:
| Topic | Original Medicare | Medicare Advantage (Part C) |
|---|---|---|
| What it includes | Part A and Part B. You can add a separate drug plan (Part D) and supplemental coverage like Medigap. | Part A and Part B through a private plan that contracts with Medicare. Most plans include drug coverage (Part D). |
| Doctors and hospitals | Any doctor or hospital that takes Medicare, anywhere in the U.S. In most cases no referral is needed to see a specialist. | You may need to use doctors in the plan’s network and service area for non-emergency care, and you may need a referral to see a specialist. |
| Out-of-pocket costs | For Part B services you usually pay 20% of the Medicare-approved amount after the deductible. No yearly limit on what you pay unless you have supplemental coverage. | Costs vary by plan. Plans have a yearly limit on what you pay for covered Medicare services. |
| Prior approval | In most cases you don’t need prior authorization. | You may need approval from the plan before it covers certain services or supplies. |
| Extra benefits | Doesn’t cover some services, like routine physical exams, eye exams, and most dental care. | Plans may offer extra benefits, like some vision, hearing, and dental services. |
| Medigap | You can choose to buy Medigap to help with your share of costs. | You can’t buy Medigap to cover your out-of-pocket costs. |
Which option fits you depends on your doctors, prescriptions, travel, budget, and preferences. That’s a good conversation to have with a broker or a free SHIP counselor.
Source: Medicare.gov — Compare Original Medicare & Medicare Advantage
Medicare Supplement Insurance (Medigap)
Medigap is extra insurance you may be able to buy from a private health insurance company to help pay your share of out-of-pocket costs in Original Medicare, like copayments, coinsurance, and deductibles.
- Generally, you must have Part A and Part B to buy a Medigap policy.
- Policies are standardized and, in most states, named by letters (like Plan G or Plan K). The benefits in each lettered plan are the same no matter which company sells it.
- Medigap generally doesn’t cover long-term care, vision, dental, hearing aids, private-duty nursing, or prescription drugs.
- The best time to buy is usually your one-time 6-month Medigap Open Enrollment Period, which starts the first month you have Part B and are 65 or older.
Source: Medicare.gov — What’s Medicare Supplement Insurance (Medigap)?
Source: Medicare.gov — Medigap: Get ready to buy
Enrollment periods: when you can sign up or make changes
You can only sign up for Medicare, or join or change plans, at certain times.
Initial Enrollment Period
Generally when you turn 65. It lasts 7 months: it starts 3 months before the month you turn 65 and ends 3 months after the month you turn 65.
Sign up for Part A and Part B. You can also join a Medicare Advantage Plan or a drug plan.
General Enrollment Period
January 1 – March 31 each year.
Sign up for Part B (and premium Part A) if you missed your first chance. Coverage starts the month after you sign up. You might pay a late enrollment penalty.
Open Enrollment Period
October 15 – December 7 each year.
Join, drop, or switch Medicare Advantage Plans or drug plans, or switch between Original Medicare and Medicare Advantage. Coverage starts January 1.
Source: Medicare.gov — Joining a plan
Medicare Advantage Open Enrollment Period
January 1 – March 31 each year (and within your first 3 months of having Medicare). Only if you are already in a Medicare Advantage Plan.
Switch to another Medicare Advantage Plan, or drop your plan and return to Original Medicare (and join a separate drug plan).
Source: Medicare.gov — Joining a plan
Special Enrollment Periods
Varies. Only for certain life events, like moving, losing or changing other coverage, getting Medicaid, or getting Extra Help with drug costs.
Depending on your situation, join or switch plans, or sign up for Part B without a penalty.
Source: Medicare.gov — Joining a plan
Medigap Open Enrollment Period
A one-time 6-month period that starts the first month you have Part B and are 65 or older.
Buy any Medigap policy sold in your state without being turned down or charged more because of health problems.
To find out exactly when you can sign up in your situation, use Medicare.gov or call 1-800-MEDICARE (1-800-633-4227).
Common Medicare questions
Do I have to sign up for Medicare, or does it happen automatically?
It depends. Some people get Medicare automatically, and others have to sign up. It depends on whether you start getting retirement or disability benefits from Social Security before you turn 65.
What is a late enrollment penalty?
If you miss your Initial Enrollment Period and don’t qualify for a Special Enrollment Period, you may pay a monthly late enrollment penalty for Part B for as long as you have Part B. There can also be a Part D penalty if you go 63 days or more without creditable drug coverage after you first get Medicare.
What’s the difference between Medicare and Medicaid?
Medicare is federal health insurance for people 65 and older and some younger people with certain disabilities or conditions. Medicaid is a joint federal and state program that provides health coverage for certain people with low income, as well as some older adults and people with disabilities. Some people qualify for both.
Source: Medicare.gov — Parts of Medicare
Is the yearly “Wellness” visit the same as a physical?
No. Part B covers a yearly “Wellness” visit once every 12 months to create or update a personalized prevention plan. It isn’t a routine physical exam, and Original Medicare doesn’t cover routine physicals. You pay nothing for the Wellness visit if your provider accepts assignment, but extra tests or services during the same visit may cost you.
Does Medicare pay for long-term care?
Medicare doesn’t pay for most long-term care, such as help with bathing, dressing, and other everyday activities, and Medigap doesn’t either. Some people get long-term care through Medicaid if they meet their state’s rules, or buy private long-term care insurance.
Source: Medicare.gov — Long-term care
Where can I compare every plan in my area?
Medicare’s Plan Finder at Medicare.gov/plan-compare lists plans in your area. You can also call 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048, or contact your State Health Insurance Assistance Program (SHIP) for free counseling.
Source: Medicare.gov — Joining a plan
Sources
All Medicare facts on this page were checked against these Medicare.gov pages on October 31, 2026:
- Get started with Medicare
- Parts of Medicare
- Your coverage options
- Compare Original Medicare & Medicare Advantage
- What’s Medicare drug coverage (Part D)?
- What’s Medicare Supplement Insurance (Medigap)?
- Medigap: Get ready to buy
- When does Medicare coverage start?
- Joining a plan
- Yearly “Wellness” visits
- Long-term care
- Medicare Plan Finder
Raspberry LLC is not connected with or endorsed by the U.S. government or the federal Medicare program. Medicare.gov is the official U.S. government site for Medicare.
Questions about your own situation?
Pauletta can talk through your options with you. Request a consultation and she will contact you to confirm a time.