The two ways to get Medicare
Everyone starts with Original Medicare — Part A (hospital) and Part B (medical). From there you choose one of two paths.
Path one keeps Original Medicare and adds a Medicare Supplement (Medigap) to cover the gaps, plus a standalone Part D drug plan. Path two replaces the delivery of your benefits with a Medicare Advantage plan (Part C) from a private insurer, which usually bundles drug coverage and extras.
What each part covers
Here's the shorthand most people find easiest to remember:
- Part A: inpatient hospital stays, skilled nursing, hospice, some home health. Most people pay no premium because they paid in through payroll taxes.
- Part B: doctor visits, outpatient care, preventive services, durable medical equipment. It carries a standard monthly premium set each year.
- Part C (Medicare Advantage): a private plan that provides your Part A and B benefits, usually with Part D and extras like dental or vision built in.
- Part D: prescription drugs, offered through standalone plans or built into most Advantage plans.
Who's eligible
Medicare is a federal program run by the Centers for Medicare & Medicaid Services (CMS) — not the same as Medicaid, which is a state program based on income. You generally qualify if you're:
- Age 65+ — a U.S. citizen or a permanent resident who has lived here at least 5 continuous years.
- Under 65 with a disability — after receiving Social Security Disability Insurance (SSDI) for 24 months.
- Diagnosed with End-Stage Renal Disease (ESRD) — kidney failure requiring dialysis or a transplant.
- Diagnosed with ALS (Lou Gehrig's disease) — eligible immediately upon SSDI approval.
Original Medicare vs. Medicare Advantage at a glance
The two paths differ most in provider choice, cost structure, and extras:
| Feature | Original Medicare (A+B) | Medicare Advantage (C) |
|---|---|---|
| Provider choice | Any doctor that accepts Medicare | Network-based (HMO/PPO) |
| Drug coverage | Add a separate Part D plan | Usually included |
| Extra benefits | None (add Medigap for gaps) | Dental, vision, hearing, fitness |
| Out-of-pocket max | None unless you add Medigap | Annual cap required by law |
What Medicare doesn't cover
Original Medicare leaves some notable gaps. It generally does not cover:
- Most dental, vision, and hearing care
- Long-term (custodial) nursing-home care
- Cosmetic surgery
- Most care outside the United States
- Routine foot care and acupuncture (with limited exceptions)
You don't have to memorize all this
That's what we're for. In one conversation we translate your doctors, medications, and budget into a specific recommendation — and we do it at no cost to you, because we're paid by the carriers, not by you.