Medicare 101: Understanding the Basics
- epiainsurance
- Mar 31
- 2 min read
Navigating health insurance can be overwhelming, especially when it comes to Medicare. Whether you’re approaching age 65 or helping a loved one understand their options, it’s important to know the basics. In this guide, we’ll break down what Medicare is, who qualifies, and how its different parts work.
What is Medicare?
Medicare is a federal government health insurance program primarily for individuals who are:
Age 65 or older
Under 65 and receiving Social Security Disability Insurance (SSDI) for at least 24 months
Diagnosed with End-Stage Renal Disease (ESRD) or ALS (Lou Gehrig’s disease)
Medicare helps cover the cost of healthcare services, but it’s not entirely free. Depending on your coverage, you may have premiums, deductibles, copayments, and coinsurance.
The Four Parts of Medicare
Part A – Hospital Insurance
Covers inpatient hospital stays, skilled nursing facility care, hospice, and some home health care.
Most people do not pay a premium for Part A if they paid Medicare taxes while working.
Part B – Medical Insurance
Covers outpatient care, doctor visits, preventive services, and medical supplies.
You usually pay a monthly premium for Part B.
Part C – Medicare Advantage Plans
Offered by private insurance companies approved by Medicare.
Combines Part A and Part B, and often includes Part D (prescription drugs).
May offer extra benefits like vision, hearing, dental, and wellness programs.
Part D – Prescription Drug Coverage
Helps cover the cost of prescription medications.
Offered through private insurers. Plans and drug formularies vary.
Original Medicare vs. Medicare Advantage
You can choose to receive your benefits through:
Original Medicare (Parts A & B): Allows you to see any doctor that accepts Medicare. You can add Part D and Medigap (supplemental insurance).
Medicare Advantage (Part C): All-in-one plans that may have lower out-of-pocket costs and include additional benefits, but typically have a network of providers.
Who Can Help?
Choosing the right plan can be confusing, but you don’t have to do it alone. At EPIA Inc., our licensed agents offer free consultations to help you navigate Medicare with confidence.
Contact us today to schedule your one-on-one Medicare consultation.
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