What Is Medicare?
Medicare is health insurance created and regulated by the federal government. It was signed into law on July 30, 1965, and originally included Part A and Part B. Today, Medicare remains one of the main health coverage programs for older adults and for certain people under 65 who qualify because of disability, ESRD, or ALS.
A good way to understand Medicare is to think of it as a foundation. Part A helps with inpatient hospital-related care. Part B helps with doctor visits, outpatient care, preventive services, and many medically necessary services. After you have Part A and Part B, you generally choose how you want to receive your Medicare coverage: Original Medicare, often paired with a separate Part D drug plan and sometimes a Medicare Supplement policy, or a Medicare Advantage plan, also called Part C.
Medicare is health insurance created and regulated by the federal government. It was signed into law on July 30, 1965, and originally included Part A and Part B. Today, Medicare remains one of the main health coverage programs for older adults and for certain people under 65 who qualify because of disability, ESRD, or ALS.
A good way to understand Medicare is to think of it as a foundation. Part A helps with inpatient hospital-related care. Part B helps with doctor visits, outpatient care, preventive services, and many medically necessary services. After you have Part A and Part B, you generally choose how you want to receive your Medicare coverage: Original Medicare, often paired with a separate Part D drug plan and sometimes a Medicare Supplement policy, or a Medicare Advantage plan, also called Part C.
Medicare Part A: Hospital Insurance
Part A is the part of Medicare most people associate with hospital coverage. It helps pay for inpatient hospital care, skilled nursing facility care, hospice care, and some home health care.
A common misunderstanding is that Part A pays for everything that happens in a hospital. That is not always true. For example, certain outpatient procedures, doctor services, observation stays, and physician charges may fall under Part B rather than Part A.
Part A can also have deductibles and coinsurance. Medicare is valuable coverage, but it is not the same as having every health care bill paid in full.
Medicare Part B: Medical Insurance
Part B covers many outpatient and physician-related services, including doctor visits, preventive services, lab work, ambulance services, outpatient surgery, durable medical equipment, and many medically necessary treatments.
Part B is especially important because it covers many services people use outside of a hospital stay. Without Part B, someone may be exposed to significant costs for outpatient care, doctor services, cancer treatments, kidney dialysis, injections, and other medical services.
In 2026, the standard Part B premium is $202.90 per month and the annual deductible is $283. Higher-income beneficiaries may pay more because of IRMAA.
Medicare Part C: Medicare Advantage
Medicare Advantage, also called Part C, is not a separate government benefit that you enroll in through Social Security. It is an alternative way to receive your Medicare-covered services through a Medicare-approved private insurance company.
Medicare Advantage plans must cover almost all medically necessary services that Original Medicare covers, and many plans include extra benefits such as dental, vision, hearing, fitness, transportation, over-the-counter allowances, and prescription drug coverage. Benefits vary by plan and county.
The tradeoff is that Medicare Advantage plans often use provider networks, referrals, prior authorization, formularies, and plan-specific rules. A plan that works well for one person may not be the best fit for another person because doctors, medications, travel patterns, and health needs differ.
Medicare Part D: Prescription Drug Coverage
Part D helps cover outpatient prescription drugs. You can get Part D by joining a stand-alone prescription drug plan with Original Medicare or by choosing a Medicare Advantage plan that includes drug coverage.
Every Part D plan has a formulary, which is the list of covered drugs. Plans may place medications on different tiers, use preferred pharmacies, and require prior authorization, quantity limits, or step therapy.
A major misconception is that all Part D plans cover all prescriptions the same way. They do not. Reviewing prescriptions, pharmacy preferences, and annual plan changes can help avoid unpleasant surprises.
Original Medicare vs. Medicare Advantage: The Basic Choice
After enrolling in Part A and Part B, most people choose between two broad paths.
Path 1: Original Medicare. You keep Part A and Part B as your primary Medicare coverage. You may add a separate Part D prescription drug plan and may consider a Medicare Supplement policy, also called Medigap, to help with some out-of-pocket costs.
Path 2: Medicare Advantage. You receive Part A and Part B services through a Medicare-approved private plan. Many plans include Part D and extra benefits, but you need to understand the provider network, medication coverage, prior authorization rules, and expected costs.
When Should You Enroll in Medicare?
For many people, the first Medicare enrollment opportunity is the 7-month Initial Enrollment Period around the 65th birthday. This window starts 3 months before the month you turn 65, includes your birthday month, and ends 3 months after that month.
You enroll in Part A and Part B through the Social Security Administration, not through an insurance company. If you already receive Social Security benefits before turning 65, you may be automatically enrolled. If you are not receiving Social Security benefits, you generally need to sign up yourself.
If you are still working and covered by active employer group health coverage, your timing can depend on employer size, whether coverage is based on current employment, and whether your drug coverage is creditable. COBRA and retiree coverage are not the same as active employer coverage for Medicare enrollment purposes.
Part A is the part of Medicare most people associate with hospital coverage. It helps pay for inpatient hospital care, skilled nursing facility care, hospice care, and some home health care.
A common misunderstanding is that Part A pays for everything that happens in a hospital. That is not always true. For example, certain outpatient procedures, doctor services, observation stays, and physician charges may fall under Part B rather than Part A.
Part A can also have deductibles and coinsurance. Medicare is valuable coverage, but it is not the same as having every health care bill paid in full.
Medicare Part B: Medical Insurance
Part B covers many outpatient and physician-related services, including doctor visits, preventive services, lab work, ambulance services, outpatient surgery, durable medical equipment, and many medically necessary treatments.
Part B is especially important because it covers many services people use outside of a hospital stay. Without Part B, someone may be exposed to significant costs for outpatient care, doctor services, cancer treatments, kidney dialysis, injections, and other medical services.
In 2026, the standard Part B premium is $202.90 per month and the annual deductible is $283. Higher-income beneficiaries may pay more because of IRMAA.
Medicare Part C: Medicare Advantage
Medicare Advantage, also called Part C, is not a separate government benefit that you enroll in through Social Security. It is an alternative way to receive your Medicare-covered services through a Medicare-approved private insurance company.
Medicare Advantage plans must cover almost all medically necessary services that Original Medicare covers, and many plans include extra benefits such as dental, vision, hearing, fitness, transportation, over-the-counter allowances, and prescription drug coverage. Benefits vary by plan and county.
The tradeoff is that Medicare Advantage plans often use provider networks, referrals, prior authorization, formularies, and plan-specific rules. A plan that works well for one person may not be the best fit for another person because doctors, medications, travel patterns, and health needs differ.
Medicare Part D: Prescription Drug Coverage
Part D helps cover outpatient prescription drugs. You can get Part D by joining a stand-alone prescription drug plan with Original Medicare or by choosing a Medicare Advantage plan that includes drug coverage.
Every Part D plan has a formulary, which is the list of covered drugs. Plans may place medications on different tiers, use preferred pharmacies, and require prior authorization, quantity limits, or step therapy.
A major misconception is that all Part D plans cover all prescriptions the same way. They do not. Reviewing prescriptions, pharmacy preferences, and annual plan changes can help avoid unpleasant surprises.
Original Medicare vs. Medicare Advantage: The Basic Choice
After enrolling in Part A and Part B, most people choose between two broad paths.
Path 1: Original Medicare. You keep Part A and Part B as your primary Medicare coverage. You may add a separate Part D prescription drug plan and may consider a Medicare Supplement policy, also called Medigap, to help with some out-of-pocket costs.
Path 2: Medicare Advantage. You receive Part A and Part B services through a Medicare-approved private plan. Many plans include Part D and extra benefits, but you need to understand the provider network, medication coverage, prior authorization rules, and expected costs.
When Should You Enroll in Medicare?
For many people, the first Medicare enrollment opportunity is the 7-month Initial Enrollment Period around the 65th birthday. This window starts 3 months before the month you turn 65, includes your birthday month, and ends 3 months after that month.
You enroll in Part A and Part B through the Social Security Administration, not through an insurance company. If you already receive Social Security benefits before turning 65, you may be automatically enrolled. If you are not receiving Social Security benefits, you generally need to sign up yourself.
If you are still working and covered by active employer group health coverage, your timing can depend on employer size, whether coverage is based on current employment, and whether your drug coverage is creditable. COBRA and retiree coverage are not the same as active employer coverage for Medicare enrollment purposes.
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Common Enrollment Periods to Know
Initial Enrollment Period: The first 7-month window around turning 65 for most people.
General Enrollment Period: January 1 through March 31 for people who missed Part A or Part B and do not qualify for a Special Enrollment Period. Late penalties may apply.
Annual Open Enrollment: October 15 through December 7. This is when people with Medicare can review, join, switch, or drop Medicare Advantage and Part D plans for coverage effective January 1.
Medicare Advantage Open Enrollment Period: January 1 through March 31. This applies only to people already in a Medicare Advantage plan. They can switch to another Medicare Advantage plan or return to Original Medicare and join a separate Part D plan.
Special Enrollment Periods: These apply when certain events happen, such as moving, losing employer coverage, gaining or losing Medicaid or Extra Help, or other qualifying circumstances
Initial Enrollment Period: The first 7-month window around turning 65 for most people.
General Enrollment Period: January 1 through March 31 for people who missed Part A or Part B and do not qualify for a Special Enrollment Period. Late penalties may apply.
Annual Open Enrollment: October 15 through December 7. This is when people with Medicare can review, join, switch, or drop Medicare Advantage and Part D plans for coverage effective January 1.
Medicare Advantage Open Enrollment Period: January 1 through March 31. This applies only to people already in a Medicare Advantage plan. They can switch to another Medicare Advantage plan or return to Original Medicare and join a separate Part D plan.
Special Enrollment Periods: These apply when certain events happen, such as moving, losing employer coverage, gaining or losing Medicaid or Extra Help, or other qualifying circumstances
What Medicare Does Not Usually Cover
Original Medicare does not cover everything. Common items not covered by Original Medicare may include long-term custodial care, routine dental care, dentures, routine vision exams for eyeglasses, hearing aids and fitting exams, cosmetic surgery, massage therapy, and most care outside the United States.
Some Medicare Advantage plans may include extra dental, vision, hearing, transportation, fitness, or over-the-counter benefits. Those benefits are plan-specific and should be reviewed carefully before enrolling
Misguided Medicare Information to Watch For:
Myth: Medicare is free. Reality: Many people pay $0 for Part A, but Part B usually has a monthly premium, and deductibles, copays, coinsurance, and drug costs may apply.
Myth: Medicare automatically covers everything after age 65. Reality: Medicare covers many medically necessary and preventive services, but it does not cover all services or all costs.
Myth: You can enroll any time. Reality: Medicare has specific enrollment periods. Missing the right window can create gaps in coverage and late enrollment penalties.
Myth: Medicare Advantage and Medicare Supplement are the same thing. Reality: They are different. Medicare Advantage is a way to receive Medicare benefits through a private plan. A Medicare Supplement policy works with Original Medicare and helps pay some out-of-pocket costs.
Myth: I do not need to review my plan every year. Reality: Medicare Advantage and Part D plan benefits, premiums, drug formularies, provider networks, pharmacy networks, and out-of-pocket costs can change each year.
Myth: COBRA lets me delay Medicare safely. Reality: COBRA is usually not treated the same as active employer coverage for Medicare enrollment purposes. People relying on COBRA should review Medicare timing carefully
Everyday Medicare FAQs
Is Medicare the same as Medicaid?
No. Medicare is federal health insurance mainly for people 65 and older and certain younger people with disabilities or conditions. Medicaid is a joint federal and state program for certain people with limited income and resources. Some people qualify for both.
Do I have to enroll in Medicare at 65 if I am still working?
Not always. It depends on whether you have active employer group coverage, employer size, and whether the coverage is considered creditable. This is one of the most important areas to review before delaying Part B or Part D.
Do I enroll in Medicare through an insurance company?
You enroll in Part A and Part B through Social Security. Private insurance companies may offer Medicare Advantage, Part D, and Medicare Supplement plans.
Can I have both Medicare Advantage and a Medicare Supplement?
No. You generally cannot use a Medicare Supplement policy to pay Medicare Advantage plan costs. These are different coverage paths.
Does Medicare cover prescription drugs automatically?
Original Medicare does not automatically include most outpatient prescription drug coverage. You usually need a separate Part D plan or a Medicare Advantage plan that includes drug coverage.
Can I change my Medicare plan every month?
Usually no. Most plan changes must happen during valid election periods unless you qualify for a Special Enrollment Period.
Does Medicare cover dental, vision, and hearing?
Original Medicare generally does not cover routine dental, routine vision, or hearing aids. Some Medicare Advantage plans may include these extra benefits.
What happens if I miss my Medicare enrollment window?
You may have to wait for another enrollment period, and late enrollment penalties may apply. Part B penalties can last as long as you have Part B, and Part D penalties can last as long as you have Part D coverage.
Do spouses have to choose the same Medicare plan?
No. Medicare is individual coverage. A spouse can choose a different path based on doctors, prescriptions, health conditions, and budget.
Why should I review Medicare coverage every year?
Plans can change premiums, benefits, networks, drug formularies, pharmacy pricing, copays, and prior authorization rules. A yearly review helps confirm that the plan still fits your needs.
Original Medicare does not cover everything. Common items not covered by Original Medicare may include long-term custodial care, routine dental care, dentures, routine vision exams for eyeglasses, hearing aids and fitting exams, cosmetic surgery, massage therapy, and most care outside the United States.
Some Medicare Advantage plans may include extra dental, vision, hearing, transportation, fitness, or over-the-counter benefits. Those benefits are plan-specific and should be reviewed carefully before enrolling
Misguided Medicare Information to Watch For:
Myth: Medicare is free. Reality: Many people pay $0 for Part A, but Part B usually has a monthly premium, and deductibles, copays, coinsurance, and drug costs may apply.
Myth: Medicare automatically covers everything after age 65. Reality: Medicare covers many medically necessary and preventive services, but it does not cover all services or all costs.
Myth: You can enroll any time. Reality: Medicare has specific enrollment periods. Missing the right window can create gaps in coverage and late enrollment penalties.
Myth: Medicare Advantage and Medicare Supplement are the same thing. Reality: They are different. Medicare Advantage is a way to receive Medicare benefits through a private plan. A Medicare Supplement policy works with Original Medicare and helps pay some out-of-pocket costs.
Myth: I do not need to review my plan every year. Reality: Medicare Advantage and Part D plan benefits, premiums, drug formularies, provider networks, pharmacy networks, and out-of-pocket costs can change each year.
Myth: COBRA lets me delay Medicare safely. Reality: COBRA is usually not treated the same as active employer coverage for Medicare enrollment purposes. People relying on COBRA should review Medicare timing carefully
Everyday Medicare FAQs
Is Medicare the same as Medicaid?
No. Medicare is federal health insurance mainly for people 65 and older and certain younger people with disabilities or conditions. Medicaid is a joint federal and state program for certain people with limited income and resources. Some people qualify for both.
Do I have to enroll in Medicare at 65 if I am still working?
Not always. It depends on whether you have active employer group coverage, employer size, and whether the coverage is considered creditable. This is one of the most important areas to review before delaying Part B or Part D.
Do I enroll in Medicare through an insurance company?
You enroll in Part A and Part B through Social Security. Private insurance companies may offer Medicare Advantage, Part D, and Medicare Supplement plans.
Can I have both Medicare Advantage and a Medicare Supplement?
No. You generally cannot use a Medicare Supplement policy to pay Medicare Advantage plan costs. These are different coverage paths.
Does Medicare cover prescription drugs automatically?
Original Medicare does not automatically include most outpatient prescription drug coverage. You usually need a separate Part D plan or a Medicare Advantage plan that includes drug coverage.
Can I change my Medicare plan every month?
Usually no. Most plan changes must happen during valid election periods unless you qualify for a Special Enrollment Period.
Does Medicare cover dental, vision, and hearing?
Original Medicare generally does not cover routine dental, routine vision, or hearing aids. Some Medicare Advantage plans may include these extra benefits.
What happens if I miss my Medicare enrollment window?
You may have to wait for another enrollment period, and late enrollment penalties may apply. Part B penalties can last as long as you have Part B, and Part D penalties can last as long as you have Part D coverage.
Do spouses have to choose the same Medicare plan?
No. Medicare is individual coverage. A spouse can choose a different path based on doctors, prescriptions, health conditions, and budget.
Why should I review Medicare coverage every year?
Plans can change premiums, benefits, networks, drug formularies, pharmacy pricing, copays, and prior authorization rules. A yearly review helps confirm that the plan still fits your needs.
Need Local Medicare Guidance in Las Vegas or Nevada?
Medicare can be confusing, but you do not have to sort through it alone. David Karel, Nevada Licensed Insurance Agent License #210603, can help you compare Medicare Advantage, Medicare Supplement, and Part D options available in your area, review your current plan, and understand how Medicare works with employer coverage.
Call: 702.403.6348 (TTY: 711) | Visit: www.medicareinlasvegas.com
Medicare can be confusing, but you do not have to sort through it alone. David Karel, Nevada Licensed Insurance Agent License #210603, can help you compare Medicare Advantage, Medicare Supplement, and Part D options available in your area, review your current plan, and understand how Medicare works with employer coverage.
Call: 702.403.6348 (TTY: 711) | Visit: www.medicareinlasvegas.com
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Learn about Medicare Basics
Find out more. Just Touch the pictures
To Find out more about What Benefits "Original Medicare" covers,
touch the "Your Medicare Benefits" picture below.
To explore more about Medicare Insurance Coverage
touch the 2026 Medicare and You Guide
Below
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