Medicare Explained: What It Covers, Who Qualifies, and How to Enroll

Medicare is a federal health insurance program designed primarily for people aged 65 and older, as well as certain younger individuals with disabilities or serious health conditions. Established in 1965, Medicare helps cover the costs of essential healthcare services and gives millions of Americans peace of mind during retirement or in times of need. Understanding how it works, what it covers, and how to enroll can help you make informed decisions about your healthcare.

What Is Medicare and Who Is Eligible?

Medicare is divided into different parts, each covering specific services. Eligibility typically begins at age 65, but younger individuals may also qualify if they have been receiving Social Security Disability Insurance (SSDI) for at least 24 months, or if they have conditions like end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS).

To be eligible for premium-free Part A, you or your spouse must have worked and paid Medicare taxes for at least 10 years. Even if you haven’t, you can still purchase Medicare coverage.

The Four Parts of Medicare: A Breakdown

Medicare is organized into four main parts, each serving a unique purpose:

• Part A (Hospital Insurance):
  Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health services. Most people don’t pay a premium for Part A.

• Part B (Medical Insurance):
  Covers outpatient care such as doctor visits, preventive services, lab tests, durable medical equipment, and some home health care. Part B requires a monthly premium.

• Part C (Medicare Advantage):
  Offered by private insurance companies approved by Medicare, these plans combine Parts A and B and often include extra benefits like vision, dental, and prescription drug coverage.

• Part D (Prescription Drug Coverage):
  Helps cover the cost of prescription drugs. Plans are offered through private insurers and require separate enrollment and a monthly premium.

What Does Medicare Cover?

Original Medicare (Parts A and B) provides broad healthcare coverage, including:

• Hospital care and inpatient services

• Outpatient services and preventive care

• Lab tests, screenings, and durable medical equipment

• Mental health care

• Home health services

However, it doesn’t cover everything. Most dental care, vision exams, hearing aids, and long-term care aren’t included in Original Medicare. That’s why many people choose to enroll in a Medicare Advantage Plan (Part C) or add a Medigap (Medicare Supplement Insurance) policy to cover out-of-pocket costs like copayments, coinsurance, and deductibles.

Enrollment Periods and How to Sign Up

You can sign up for Medicare during the following enrollment periods:

• Initial Enrollment Period (IEP): A 7-month window that begins three months before your 65th birthday, includes your birth month, and ends three months after.

• General Enrollment Period (GEP): Runs from January 1 to March 31 each year for those who missed IEP. Coverage begins July 1.

• Open Enrollment Period (OEP): From October 15 to December 7, this period lets you switch plans or add drug coverage for the following year.

• Special Enrollment Periods (SEP): Available for qualifying life events like losing employer coverage or moving to a new state.

Understanding Medicare Costs

While Part A is typically free for those who’ve paid into the system, other parts come with costs:

• Part B Premiums: Standard monthly premium in 2025 is around $174.70 (subject to change based on income).

• Deductibles and Coinsurance: Part A has a deductible per benefit period. Part B has an annual deductible and 20% coinsurance after that.

• Part D and Advantage Plans: Premiums, copays, and covered services vary by plan.

You may qualify for Medicare Savings Programs or Extra Help with drug costs if your income is limited.