New to Medicare? Your Complete Introduction

Medicare is a federal health insurance program primarily for people 65 and older. It isn't one single plan — it's a system of parts, each covering something different. Understanding how they fit together is the first step to making a confident decision.

The four parts of Medicare

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Part A — Hospital Insurance

Inpatient care · Skilled nursing · Hospice

Covers inpatient hospital stays, skilled nursing facility care, hospice, and some home health. Most people pay no monthly premium for Part A if they worked and paid Medicare taxes for at least 10 years.

A deductible applies per benefit period — not per year, per hospital stay

Cost-sharing structure changes the longer a hospital stay lasts

Skilled nursing facility carries its own cost-sharing structure after an initial covered period

Does not cover long-term custodial care, private-duty nursing, or routine dental/vision

Full Medicare 101 Guide →

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Part B — Medical Insurance

Doctor visits · Outpatient · Preventive care

Covers doctor visits, outpatient care, lab tests, preventive screenings, and durable medical equipment. You pay a monthly premium — set annually by the federal government.

An annual deductible applies, then you're responsible for a share of Medicare-approved costs

No out-of-pocket cap — your share continues indefinitely (Medigap or Advantage fixes this)

Higher earners pay more through IRMAA — based on income from 2 years prior

Covers mental health, home health, and most preventive services at no extra cost

See All 2026 Costs →

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Part C — Medicare Advantage

Bundled private plans · A + B + usually D

An all-in-one alternative to Original Medicare offered by private carriers. Bundles Parts A and B (and usually D) with a yearly out-of-pocket cap. Plans have room to structure their offerings differently from one another beyond the required minimum coverage.

Must use the plan's provider network — out-of-network care costs more or may not be covered

Built-in yearly out-of-pocket cap — once you hit it, the plan pays 100%

Plan structure and any additional coverage vary significantly by plan and location

You still pay the Part B premium on top of any plan premium

Plans can change benefits, costs, and networks every January — review annually

Advantage vs. Original Medicare →

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Part D — Prescription Drug Coverage

Drug formularies · Tiers · Cost caps

Covers prescription medications through private plans. Either added to Original Medicare as a standalone plan, or bundled inside a Medicare Advantage plan. Your out-of-pocket drug costs are capped annually under federal law.

Each plan maintains its own list of covered drugs, organized into cost tiers

Generics are generally the lowest-cost tier; specialty drugs are generally the highest

Insulin costs are separately capped under federal law regardless of plan or tier

Delay enrolling without other creditable drug coverage = permanent late penalty added to your premium for life

Review your coverage every fall — which drugs are covered can change each year

How Drug Coverage Works →

Your two main paths

Path 1

Original Medicare + Medigap + Part D

Keep Parts A and B (government Medicare), add a Medigap supplement to cover your remaining cost-sharing, and add a standalone Part D plan for prescriptions. See any Medicare-accepting doctor in the U.S. — no networks.

Best for: travelers, people with complex health needs, those who want maximum provider choice and predictable costs.

Path 2

Medicare Advantage (Part C)

Replace Original Medicare with a private plan that bundles everything — A, B, and usually D — with an out-of-pocket cap. One card, one plan, usually lower monthly cost.

Best for: people who prefer simplicity, are comfortable with a local provider network, and want a built-in cost cap.

Supplements & savings programs

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Medigap (Medicare Supplement)

Fills Original Medicare's cost gaps

Sold by private insurers to cover what Original Medicare doesn't. Your most important window to enroll is the 6-month open enrollment period starting when you turn 65 and have Part B.

After your 6-month window, insurers can deny coverage or charge more based on health history

Plan G is the most comprehensive — covers everything except the Part B deductible

Does not work with Medicare Advantage — only with Original Medicare

Does not include drug coverage — you still need a separate Part D plan

Full Medigap Guide →

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Medicare Savings Programs

State programs that help pay Medicare costs

If your income is limited, your state may help pay your Part B premium and other Medicare costs through Medicare Savings Programs. Many people who qualify don't know they do.

QMB covers your Part B premium, deductibles, and coinsurance — the most comprehensive level

SLMB and QI cover your Part B premium — a real recurring savings for those who qualify

All three automatically qualify you for Extra Help with Part D drug costs

Income limits are higher than most people expect — always worth applying

Medicare Savings Programs Guide →

When to enroll

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Enrollment Windows

IEP · AEP · OEP · SEP

Medicare enrollment is time-sensitive. Most people have a 7-month Initial Enrollment Period around their 65th birthday. Missing it without qualifying coverage elsewhere triggers a permanent late enrollment penalty.

IEP: 3 months before + month of + 3 months after your 65th birthday — your first and most important window

AEP: October 15 – December 7 each year — when most beneficiaries can change plans

OEP: January 1 – March 31 — one chance to switch if you're already in Medicare Advantage

SEP: Triggered by life events — moving, losing employer coverage, qualifying for Medicaid

Late Part B penalty: a permanent increase added to your premium for every 12-month period you delayed without qualifying coverage

All Enrollment Windows Guide →

Your new to Medicare checklist

Enroll in Parts A and B

Contact Social Security at ssa.gov or call 1-800-772-1213. Do this during your 7-month Initial Enrollment Period.

Choose your coverage path

Original Medicare + Medigap + Part D, or Medicare Advantage. Your doctors, medications, and budget all factor in.

Check how your medications are covered

Before enrolling in any plan, verify your specific medications are covered.

Check for income assistance

Even if you don't think you qualify, check for Medicare Savings Programs and Extra Help — limits are often higher than expected.

Review your plan every fall

Plans change every year. During AEP (Oct 15–Dec 7), compare your options — what worked last year may not be best this year.

Not sure where to start?

A PharmSurance advisor will walk through every one of these decisions with you — checking your doctors, your medications, and your budget — and help you enroll correctly. At no cost to you.

PharmSurance.com

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY 1-877-486-2048) to get information on all of your options. If you submit your information on this site, it will be provided to one or more licensed insurance agents, who may call, email, or text you about Medicare Advantage, Medicare Supplement, and Prescription Drug Plan options. This is a general educational overview only, not specific to any plan. See the Medicare & You 2026 handbook for complete official information.