What is Medicare?

What is Medicare and Who Qualifies?

Medicare is a government-run health insurance program established in 1965 to provide healthcare coverage for older Americans and specific groups with disabilities. The program serves as the primary health insurance for over 65 million beneficiaries across the United States.

Eligibility Requirements

You qualify for Medicare if you meet any of these criteria:

• You’re 65 years or older and a U.S. citizen or legal resident who has lived in the country for at least five consecutive years
• You’re under 65 with a qualifying disability and have received Social Security Disability Insurance (SSDI) for 24 months
• You have End-Stage Renal Disease (ESRD) requiring dialysis or a kidney transplant
• You have Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease

The Four Parts of Medicare Explained

Medicare Part A (Hospital Insurance)

Medicare Part A covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health services. Most people receive Part A premium-free if they or their spouse paid Medicare taxes while working. However, you’ll still pay deductibles and coinsurance for covered services.

Medicare Part B (Medical Insurance)

Medicare Part B covers outpatient medical services, including doctor visits, preventive care, medical equipment, and some home health services. Unlike Part A, Part B requires a monthly premium that varies based on your income level. Standard monthly premiums for 2026 start at $202.90.

Medicare Part C (Medicare Advantage)

Medicare Advantage plans are private insurance alternatives that combine Parts A and B coverage, often including prescription drug coverage (Part D) and additional benefits like dental, vision, or wellness programs. These plans may have different costs and coverage rules than Original Medicare.

Medicare Part D (Prescription Drug Coverage)

Medicare Part D provides prescription drug coverage through private insurance companies. You can add Part D to Original Medicare or choose a Medicare Advantage plan that includes drug coverage. Monthly premiums vary by plan and income level.

When and How to Enroll

Initial Enrollment Period

Your Initial Enrollment Period begins three months before your 65th birthday month and extends three months after. During this seven-month window, you can enroll in Medicare Parts A and B without penalty.

Special Enrollment Periods

If you have qualifying employer coverage when you turn 65, you may be eligible for a Special Enrollment Period that allows you to delay Medicare enrollment without penalties. This period typically lasts eight months after your employer coverage ends.

Annual Open Enrollment

From October 15 to December 7 each year, you can make changes to your Medicare coverage, including switching between Original Medicare and Medicare Advantage plans or changing prescription drug plans.

For complete coverage of Medicare basics, you can visit the official U.S. government site for Medicare at Medicare.gov. Now that you know what is Medicare, contact Insurance Connection USA to help navigate enrollment or call us with questions.