What Is Medicare?
Medicare is the federal health insurance program for Americans 65 and older, and for certain younger people with disabilities. It is one of the most important financial decisions you will make, and understanding it does not have to be complicated.
The Basics of Medicare
Medicare is a federal health insurance program administered by the Centers for Medicare and Medicaid Services (CMS). It was signed into law in 1965 and today covers more than 67 million Americans.
Unlike employer-sponsored insurance, Medicare is not tied to your job. It is earned through your work history and funded through payroll taxes you paid throughout your career. Most people who worked at least 10 years (40 quarters) receive Part A at no premium cost.
Medicare is divided into four parts: A, B, C, and D. Each covers a different category of care. Understanding how they work together is the key to building a coverage plan that fits your health needs and budget.
Medicare vs. Medicaid: What Is the Difference?
- Federal program only
- Based on age (65+) or disability
- Available regardless of income
- Earned through payroll taxes
- Consistent benefits nationwide
- Federal and state program
- Based on financial need
- Available at any age
- Income and asset limits apply
- Benefits vary by state
Some people qualify for both Medicare and Medicaid at the same time. This is called dual eligibility, and it can significantly reduce your out-of-pocket healthcare costs. If you think you may qualify, our agents can help you understand your options.
The Four Parts of Medicare
Medicare is not a single plan. It is a system of four distinct parts, each covering a different type of care. Most beneficiaries use a combination of two or more.
Covers inpatient care
What It Covers
- Inpatient hospital stays
- Skilled nursing facility care
- Hospice care
- Some home health services
Covers outpatient care
What It Covers
- Doctor visits and specialist care
- Outpatient procedures
- Preventive screenings
- Medical equipment (wheelchairs, walkers)
- Mental health services
All-in-one private plans
What It Covers
- Everything Parts A and B cover
- Often includes Part D drug coverage
- Frequently adds dental, vision, hearing
- May include fitness benefits
Covers prescription drugs
What It Covers
- Brand-name and generic drugs
- Drugs on the plan's formulary
- Vaccines not covered by Part B
Original Medicare (Parts A and B) covers about 80% of approved costs, leaving you responsible for the other 20% with no annual cap. A Medigap policy fills those gaps, covering copays, coinsurance, and deductibles. Plan G is the most popular option for new enrollees.
Who Is Eligible for Medicare?
Medicare eligibility is based on age, disability status, or certain medical conditions. You do not need to be retired to enroll, and your income does not affect your eligibility for basic coverage.
Part A Premium Eligibility
Whether you pay a premium for Part A depends on your work history:
Not sure if you qualify? We can check your eligibility in minutes. Call us at 813-699-5559 or request a free consultation.
When to Enroll in Medicare
Timing your Medicare enrollment correctly is one of the most important decisions you will make. Missing a window can mean permanent penalties or gaps in coverage.
Starts 3 months before your birthday month, includes your birthday month, ends 3 months after. Best time to enroll.
If you delayed Medicare because of active employer coverage, you have 8 months after that coverage ends to enroll without penalty.
If you missed your IEP and do not qualify for an SEP, you can enroll here. Coverage starts July 1. Late penalties may apply.
Switch between Original Medicare and Medicare Advantage, or change your Part D plan. Changes take effect January 1.
The Part B late enrollment penalty adds 10% to your premium for every 12-month period you were eligible but did not enroll. This penalty lasts for as long as you have Medicare. The Part D penalty is 1% per month. These are avoidable with proper planning.
2026 Medicare Costs at a Glance
These are the standard federal costs. Your actual costs may differ based on income, the plan you choose, and your healthcare usage.
| Part | Monthly Premium | Annual Deductible | Cost Sharing |
|---|---|---|---|
| Part A | $0 (if 40+ work quarters) | $1,736 per benefit period | $0 days 1-60; $422/day days 61-90 |
| Part B | $202.90/month (standard) | $283/year | 20% after deductible |
| Part C | Varies ($0 to $100+/month) | Varies by plan | Varies by plan; has out-of-pocket max |
| Part D | ~$38.99/month average | Up to $590/year | Varies by drug tier |
Source: CMS.gov. Figures are for 2026. IRMAA surcharges may apply to higher-income beneficiaries.
Frequently Asked Questions
Answers to the questions we hear most often from people new to Medicare.
Ready to Talk with a Licensed Medicare Agent?
Medicare Information Project serves beneficiaries across Florida, Georgia, North Carolina, Arkansas, Kansas, and Texas. Our agents are independent, which means we represent all major carriers and recommend the plan that is right for you, not the one that pays the highest commission.
We do not offer every plan available in your area. Currently we represent 17 organizations which offer 149 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local SHIP for information on all options.