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What Is Medicare?
How it works, what it leaves out, and the two paths you can take once you have it.
Medicare is the federal health insurance program for people age 65 and older, and for younger people with certain disabilities. Getting the card is the easy part. The decision that actually shapes what you pay comes right after, and this page walks through it.
Original Medicare Is Only Two Parts
When people say "Original Medicare," they mean Part A and Part B together. This is the coverage that comes directly from the federal government.
| Part | What It Covers | What You Pay |
|---|---|---|
| Part A Hospital |
Inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care. | No premium for most people, but a deductible applies to each benefit period, plus daily coinsurance on longer stays. |
| Part B Medical |
Doctor visits, outpatient care, preventive services, lab work, and durable medical equipment. | A monthly premium and an annual deductible, then generally 20 percent of the Medicare-approved amount. |
Most people get Part A with no premium if they or a spouse paid Medicare taxes for at least 10 years. Everyone pays a Part B premium, and it can be higher depending on your income.
The part that surprises people
Original Medicare does not cover 100 percent of your costs, and it has no annual out-of-pocket maximum. There is no ceiling on what a serious year could cost you. That single gap is the reason most people add something to it.
What Original Medicare Does Not Cover
Knowing the gaps matters more than memorizing the benefits, because the gaps are what you end up paying for out of pocket.
Prescription drugs are the big one. Original Medicare does not include them, which is why Part D exists as a separate plan. Routine dental, vision, and hearing care are not covered either, and neither is long-term custodial care or most care outside the United States.
Not covered by Parts A and B
- Prescription drugs, which need a separate Part D plan
- Routine dental, vision, and hearing care
- Long-term custodial care
- Care outside the United States, apart from limited emergencies
Your Two Paths After Enrolling
Once you have Part A and Part B, there are two established ways to close the gaps. Neither one is automatically better. They suit different people.
Original Medicare plus a Supplement
A Medicare Supplement plan, also called Medigap, sits alongside Original Medicare and helps pay the deductibles, coinsurance, and copayments you would otherwise owe.
- See any doctor in the country who accepts Medicare
- No network to check before an appointment
- Needs a separate Part D plan for prescriptions
- You pay the Medigap premium on top of your Part B premium
A Medicare Advantage plan
Medicare Advantage, also called Part C, replaces the way you receive Original Medicare with a private plan that bundles your coverage into one card.
- Covers everything Parts A and B cover, by law
- Usually includes prescription drug coverage
- Often adds dental, vision, hearing, and fitness benefits
- Has an annual out-of-pocket maximum, which Original Medicare lacks
- Uses a provider network, so you check that your doctors are in it
Seeing the Three Side by Side
The same five questions answered for each route, so you can compare them on the things that actually differ.
| Original Medicare | Original Medicare + Supplement | Medicare Advantage | |
|---|---|---|---|
| Who provides it | Federal government | Government, with a private plan added on | A private carrier, under contract with Medicare |
| Choice of doctors | Any provider who accepts Medicare | Any provider who accepts Medicare | Plan network, which varies by plan and area |
| Prescription drugs | Separate Part D plan needed | Separate Part D plan needed | Usually built in |
| Out-of-pocket limit | None | None, but the plan absorbs most costs for you | Required annual maximum |
| Extra benefits | Limited | Medical costs only | Often dental, vision, hearing, and fitness |
So Which One Fits You?
It usually comes down to a trade you make on purpose. A Supplement plan buys you freedom of choice and very predictable costs, and you pay a monthly premium for it. A Medicare Advantage plan lowers what you pay each month and adds extras, and you agree to work inside a network.
The right answer depends on the doctors you want to keep, the medications you take, how often you travel, and what your budget looks like. That is the conversation to have before you enroll, not after.
Keep Learning About Medicare
Medicare TPMO Compliance Statement
Complete Family Protection is not connected with or endorsed by any government entity or the federal Medicare program. Complete Family Protection represents Medicare Advantage HMO, PPO, and PFFS organizations, as well as standalone prescription drug plans that have a Medicare contract. Enrollment depends on the plan's contract renewal. We have access to plan information nationwide and can help you search among many options, but we do not offer every plan available in your area. We search and recommend plans even when we do not directly offer them. Contact a licensed Complete Family Protection agent to find out the number of products available in your specific area. You may also contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.