What is Medicare?

Medicare: The Basics (Parts A, B, C, and D)

Medicare is a federal health insurance program for people aged 65 and older, and for some people with disabilities. It’s broken into four main parts:

Part A – Hospital Insurance

Usually free if you’ve worked and paid into Medicare taxes. It covers:

• Hospital stays

• Skilled nursing facility care

• Hospice care

• Some home health services

  
  

Part B – Medical Insurance

This has a monthly premium and covers:

• Doctor visits

• Outpatient care

• Preventive services (like screenings and vaccines)

• Some home health care

  
  

Part C – Medicare Advantage

These are private plans that include Parts A and B — and often extras like dental, vision, hearing, and wellness programs. Some include prescription coverage too.

Part D – Prescription Drug Coverage

Part D helps pay for medications. Plans vary based on what drugs they cover (called a formulary), so it’s important to review annually during open enrollment.

Medicaid & Long-Term Care Support

Medicaid is a state and federally funded program for people with low income. Unlike Medicare, it can cover long-term care, including:

• Nursing homes

• In-home caregivers

• Adult day care

• Medical equipment

  
  

If you're “dual eligible” (you qualify for both Medicare and Medicaid), you might get more comprehensive coverage with little or no out-of-pocket costs.

Tip: Even if you don’t think you qualify, it’s worth checking — especially if your income or savings are limited.

Help Paying for Prescriptions

Medications can get expensive fast — but there’s help:

• Extra Help: A program that reduces the cost of Medicare Part D for low-income seniors.

  
  

• State Pharmaceutical Assistance Programs (SPAP): Available in some states to cover gaps. To find out more check out our State Pharmacy Assistance Programs (SPAPs) blog page.

  
  

• $0 Generic Programs: Offered at some pharmacies like Walmart, Kroger, or GoodRx discounts.

  
  

• Mail-Order Pharmacies: Often cheaper, especially for long-term medications.

  
  

Medigap (Supplemental Insurance)

Medicare doesn’t cover everything. That’s where Medigap plans come in. These are private plans that help pay for:

• Copays

• Deductibles

• Coinsurance

Medigap doesn’t include dental, vision, or prescriptions — so it’s common to pair it with a standalone Part D plan.

Heads-Up: You must enroll in Medigap during your initial enrollment window to avoid denial or higher premiums based on your health.

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