What is Medicare and how does it work?
Medicare is the federal health insurance program mainly for people age 65 and older, and also for certain younger people with a disability or specific conditions. Coverage is organized into different parts, which help pay for hospital stays, medical services, prescription drugs, and other health care.
You can get Medicare in two main ways: through Original Medicare (Part A and Part B) or through a Medicare Advantage plan (Part C) offered by a private company approved by Medicare.
Who can qualify for Medicare?
Medicare is mainly for people age 65 and older, but certain people under 65 can also qualify in specific situations.
Having 40 work credits isn’t a general requirement to have Medicare — that history mainly relates to getting Part A without a monthly premium. People with fewer credits may, in certain situations, be able to buy Part A by paying a premium.
When can I enroll?
For many people turning 65, the Initial Enrollment Period lasts seven months: it starts three months before your birthday month, includes your birthday month, and ends three months after.
There are also other windows, such as a Special Enrollment Period, which can apply, for example, to people who have certain coverage through a current employer. Rules vary based on individual circumstances.
Need help understanding your options?
Assureline Insurance can help you understand the Medicare options available in your area, compare plan features, and check factors like doctors, medications, costs, and coverage needs.
Talk to our team to request a review of the options available for your situation.
What are the parts of Medicare?
Medicare coverage is divided into parts, each responsible for a type of service.
With Original Medicare, you have Part A and Part B and can use doctors and hospitals that accept Medicare. You can also add a Part D plan for prescription drugs and, where applicable, a Medigap policy to help with certain out-of-pocket costs.
With Medicare Advantage, you get your benefits through a private plan approved by Medicare. Depending on the plan, there may be doctor networks, referral rules, prior authorization, and different costs for the services you use.
| Part |
What it helps cover |
Part A
Hospital Insurance |
Inpatient hospital stays, eligible care in skilled nursing facilities, hospice, and certain home health care services |
Part B
Medical Insurance |
Doctor services, outpatient care, durable medical equipment, and many preventive services |
Part D
Drug Coverage |
Prescription drugs — can be purchased separately or is already included in many Medicare Advantage plans |
Part C
Medicare Advantage |
Includes Part A and Part B benefits, and in most cases Part D as well; some plans offer extra benefits like vision, hearing, or dental |
Good to know: plan availability and costs vary by ZIP code, county, insurer, and plan year.
What’s the difference between Original Medicare and Medicare Advantage?
Original Medicare
You have Part A and Part B and can use doctors and hospitals that accept Medicare.
You can add a Part D plan for prescription drugs and, where applicable, a Medigap policy to help with certain out-of-pocket costs.
Medicare Advantage
You get your benefits through a private plan approved by Medicare.
Depending on the plan, there may be doctor networks, referral rules, prior authorization, and different costs for the services you use.
What is Medicare Supplement, or Medigap?
How it works
Medigap is supplemental insurance that works alongside Original Medicare. It can help pay for certain costs you’re otherwise responsible for, like copayments, coinsurance, and some deductibles, depending on the plan you choose.
What’s important to know
Medigap doesn’t replace Medicare and isn’t used alongside Medicare Advantage. Available options and eligibility should be reviewed individually.
How much does Medicare cost?
Costs depend on the coverage you use. You may have premiums, deductibles, copayments, and coinsurance.
Premium
Deductible
Copayment
Coinsurance
Most people don’t pay a premium for Part A because they, or a spouse, have enough work history. Part B has a monthly premium, and the amount can be higher for people in certain income brackets.
Part D, Medicare Advantage, and Medigap have costs that vary by plan, region, and other conditions.
How do I compare Medicare options?
Your choice shouldn’t come down to the monthly premium alone. Before picking an option, it’s worth reviewing:
- your doctors and hospitals;
- your prescription drugs;
- the provider network;
- deductibles, copays, and coinsurance;
- the annual spending limit, where it applies;
- whether referrals or prior authorization are needed;
- extra benefits;
- how often you travel;
- total costs you can expect over the year.
Talk to a Medicare specialist
Assureline Insurance can help you understand the options available in your area and compare plans based on your doctors, medications, and budget. Talk to our team to request a review of your situation.
This content was reviewed based on official Medicare rules and guidance from the Centers for Medicare & Medicaid Services (CMS). Eligibility rules, costs, enrollment periods, and coverage are subject to change. Always check the most current official information or request an individual review of your situation.
www.Medicare.gov and CMS.gov
Last updated: September 2026
