What Is Medicare?
Understand what the federal program covers, what it does not, and where private insurance fits.
Who the federal program serves
Medicare is federal health insurance generally for people age 65 or older who meet the citizenship or residency rules. Earlier eligibility may apply to people with qualifying disability benefits, End-Stage Renal Disease or ALS. Eligibility for the program, automatic enrollment, premium-free Part A, and a chosen private plan are separate determinations; confirm each before treating coverage as effective.
Official source: Medicare: Get started ↗ · Medicare: Eligibility paths ↗
What Original Medicare pays for
Part A and Part B address different settings. Part A helps with qualifying inpatient hospital, skilled nursing, hospice and some home health care; Part B helps with doctors, outpatient services, medically necessary supplies and preventive services. Coverage still depends on service, setting and Medicare conditions. A hospital visit classified as outpatient observation does not become a Part A inpatient stay merely because it lasts overnight.
Official source: Medicare: Parts of Medicare ↗ · Medicare: Part A coverage ↗ · Medicare: Part B coverage ↗
What it leaves to the beneficiary
Original Medicare has premiums for some people, deductibles and cost sharing. In 2026 most people pay the standard $202.90 monthly Part B premium. Part A’s $1,736 inpatient deductible applies per benefit period. Original Medicare does not set a yearly ceiling on Part A and B spending unless other coverage protects you. Routine dental care and long-term custodial care generally are not covered under Original Medicare.
Official source: Medicare: 2026 costs ↗ · Medicare: Original versus Advantage ↗
Private options do different things
Medicare Advantage is another way to receive Part A and Part B benefits through an approved plan; most include Part D. A standalone Part D plan adds prescription coverage to Original Medicare. Medigap may pay some Original Medicare cost sharing and does not pay Advantage plan copays. The choice changes provider access, paperwork, drug arrangements and annual exposure.
Official source: Medicare: Original versus Advantage ↗ · Medicare: Parts of Medicare ↗
Start with a verified record
Social Security manages applications for Parts A and B. Medicare’s plan comparison service shows available Advantage and Part D plans by location. Keep your Medicare number and A/B effective dates, then check the exact plan’s providers, drugs, service area, premium and Evidence of Coverage before applying. Eligibility alone is not proof that a provider or drug is covered.
Official source: SSA: Sign up for Medicare ↗ · Medicare: Joining a plan ↗ · Medicare: Compare plans ↗