MEDICARE, EXPLAINED
IN PLAIN LANGUAGE
Turning 65, or helping a parent who is? Understand the pieces, the deadlines, and the questions worth asking before you choose.
Download the Medicare 101 Guide (PDF)Free, printable 2-page handout
THE FOUR PARTS OF MEDICARE
Inpatient hospital stays, skilled nursing facility care, hospice, and some home health care. Most people pay no monthly premium if they or a spouse worked and paid Medicare taxes long enough.
Doctor visits, outpatient care, preventive services, and some medical equipment. There is a monthly premium.
An alternative way to get Parts A and B, offered by private insurance companies approved by Medicare. Most plans include drug coverage and may add extras. You still have Medicare and still pay your Part B premium.
Offered by private companies, either as a stand-alone plan or inside a Medicare Advantage plan. Each plan has its own list of covered drugs (a formulary). Medicare Advantage plans with prescription drug coverage generally cannot be combined with a separate stand-alone Part D plan.
TWO MAIN WAYS TO GET COVERAGE
Neither path is right for everyone. These are the things worth comparing.
| Original Medicare (Parts A and B) | Medicare Advantage (Part C) | |
|---|---|---|
| Who runs it | The federal government | Private companies approved by Medicare |
| Doctors and hospitals | Any provider in the U.S. that accepts Medicare | Usually a plan network, so check that your doctors are in it |
| Drug coverage | Added separately with a Part D plan | Often included in the plan |
| Supplement coverage | You can add a Medicare Supplement (Medigap) policy | Medigap cannot be used with a Medicare Advantage plan |
| Yearly out-of-pocket limit | Original Medicare has no annual out-of-pocket maximum for Part A and Part B services. A Medicare Supplement policy may help pay certain out-of-pocket expenses. | Medicare Advantage plans have an annual out-of-pocket maximum for covered Part A and Part B services. Limits vary by plan and may differ for in-network and out-of-network services. |
| Plan changes | Medicare coverage rules, premiums, deductibles, and cost-sharing amounts may change annually. | Benefits, costs, and networks can change every year |
What is a Medicare Supplement (Medigap) plan?
A Medigap policy is sold by private insurance companies and helps pay some costs that Original Medicare does not, such as deductibles, copays, and coinsurance. It works only with Original Medicare and does not include drug coverage. In most states, Medigap plans are standardized and labeled by letter, so the same letter offers the same basic benefits no matter which company sells it.
Timing matters: you generally get a 6-month Medigap Open Enrollment Period that starts when you are 65 or older and enrolled in Part B. After that window, companies may be allowed to ask health questions.
KEY ENROLLMENT WINDOWS
The 3 months before your birthday month, the birthday month, and the 3 months after. For most individuals first eligible at age 65, this is the initial opportunity to enroll in Medicare Parts A and B. Different rules may apply based on individual circumstances.
Sign up for Part A or B if you missed your first window. Coverage starts the month after you sign up, and a late penalty may apply.
Change your Medicare Advantage or Part D plan for the next year. New coverage starts January 1.
If you are in a Medicare Advantage plan, switch to another Medicare Advantage plan or to Original Medicare.
Starts when you are 65 or older and enrolled in Part B. During this six-month period, insurers generally cannot deny Medigap coverage or charge more because of health conditions. Additional state protections may apply.
Losing employer coverage or moving can open a separate window. Ask before you assume you have missed your chance.
Missing a deadline can cost you. If you delay Part B without a qualifying reason, you may pay a monthly late penalty for as long as you have Part B, and it goes up the longer you wait. Part D works similarly: going 63 days or more in a row without Part D or other creditable drug coverage after your first window can lead to a lifelong penalty. Ask if you are not sure whether your current coverage counts.
GOOD TO KNOW
Some people qualify before 65, including those who have received Social Security disability benefits for 24 months and people with ALS or end-stage renal disease.
Medicare is federal health insurance, mainly for people 65 and older. Medicaid is run by the state and federal governments for people with limited income, and rules vary by state. Some people have both.
Treat your Medicare number like your Social Security number. Medicare will not call you uninvited to sell something. Report suspected fraud to 1-800-MEDICARE.
For official plan information, visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227). To find your state’s free SHIP counseling program, visit shiphelp.org.
QUESTIONS ABOUT MEDICARE?
I spent 19 years as a special education teacher and program manager, and I hold a Master of Public Health. I explain things plainly so you can decide with confidence, without sales pressure.
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY 1-877-486-2048) to get information on all of your options.
This page is general education, not a recommendation of any plan. Information current as of October 2026; Medicare rules and costs change each year. Not connected with or endorsed by the U.S. government or the federal Medicare program.
