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Financial Solutions
Uplift Path
What is Medicare?
Medicare is the U.S. federal health insurance program for people who are 65 or older, as well as some younger individuals with certain disabilities or specific medical conditions (such as permanent kidney failure or ALS).
Once eligible, Medicare helps pay for many medically necessary services — from hospital stays to doctor visits, home health care, and prescription drugs.
The Different Parts of Medicare
Medicare is divided into several “parts,” each covering different types of care. The main ones are:
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Medicare Part A (Hospital Insurance)
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Medicare Part B (Medical Insurance)
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Medicare Part D (Prescription Drug Coverage)
Some people also use Medicare Advantage (Part C) or supplemental plans to enhance their coverage, but Parts A, B and D form the core options
How Medicare Works & What You Need to Know
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Once eligible, many people automatically get Part A (if they or their spouse worked enough and paid taxes). If not, you may need to pay a monthly premium.
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You can choose to get coverage through Original Medicare (Parts A + B), or you may pick a Medicare Advantage plan (Part C) offered by a private insurer — these typically include A, B, and often D coverage, and sometimes extra benefits.
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If you keep Original Medicare and want drug coverage, you must enroll in a Part D plan.
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Original Medicare generally lets you use any provider across the U.S. who accepts Medicare. With Medicare Advantage, your choice of providers may be limited by plan networks.
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Because Original Medicare doesn’t cover everything, many beneficiaries add supplemental coverage (sometimes called “Medigap”) or rely on additional insurance to help with co‑payments, deductibles, prescription costs, etc.
How to Get Started & What to Consider
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When you first become eligible (usually around your 65th birthday or after qualifying for disability), you’ll need to sign up for Parts A and B — sometimes this happens automatically if you already receive Social Security or Railroad Retirement benefits.
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Then decide whether you want Original Medicare — or go with a Medicare Advantage plan, which bundles several coverages.
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If you expect to need regular prescription medications, strongly consider enrolling in Part D (or choosing a Medicare Advantage plan that includes drug coverage).
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Because Original Medicare may leave gaps, also think about supplemental coverage (Medigap, Medicaid if eligible, employer/retiree coverage, etc.) if you want to reduce out-of-pocket costs.
Who Qualifies
In general you qualify for Medicare if you:
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Are age 65 or older, and meet residency and citizenship (or lawful permanent resident) requirements; or
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Are under 65 but have a qualifying disability and have been receiving disability benefits for a set period; or
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Have certain conditions such as permanent kidney failure or ALS.
If you or your spouse worked and paid Medicare taxes for at least 10 years while working, you’re likely eligible for premium‑free Part A
Medicare
Medicare Part A – Hospital Coverage
Part A helps cover care you get in a hospital (while admitted as an inpatient). For many people, Part A comes without a monthly premium — usually because they or their spouse worked long enough and paid Medicare taxes.
Covers inpatient hospital care, skilled nursing, hospice, and some home health services.
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Most people pay $0 for Part A because they’ve worked 40 quarters.
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If you delay enrolling and don’t qualify for premium-free A, you may face a late enrollment penalty that can last for life.
Medicare Part B – Medical Coverage
Most people pay a monthly premium for Part B. After you meet the yearly deductible, Medicare typically covers 80% of the Medicare-approved amount — then you pay the remaining 20%
Covers doctor visits, outpatient care, preventive services, durable medical equipment, etc.
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Monthly premium (set annually by Medicare).
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If you don’t enroll when first eligible (unless you have valid employer coverage), you may face:
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A 10% penalty for every 12 months you delayed, added to your premium for life.
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What isn’t covered under A & B: long-term custodial care (e.g. non-skilled nursing home care), routine dental, vision or hearing, most hearing aids, cosmetic surgery, and some other services.
Medicare Part D – Prescription Drug Coverage
Part D provides coverage for outpatient prescription drugs. These plans are offered by private insurance companies approved by Medicare, and you join a plan and pay a separate premium.
Because Original Medicare (Parts A & B) doesn’t cover most prescription drugs you get outside a hospital, enrolling in Part D can save you a lot if you take regular medications
Offered by private insurers.
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If you go without creditable drug coverage for 63+ days after becoming eligible, you may face:
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A permanent penalty added to your monthly premium.
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Filling the 20% Medicare Doesn’t Cover
Original Medicare (A & B) only covers about 80% of approved medical costs. You can choose one of two paths to fill the gap:
Option 2: Medigap (Supplement Insurance)
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Pays your portion of Medicare’s 20% coinsurance and deductibles.
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Lets you go to any doctor nationwide that accepts Medicare.
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You pair it with a standalone Part D plan.
Option 1: Medicare Advantage (Part C)
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All-in-one plans that bundle A, B, and usually D.
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Often include extras like dental, vision, hearing, OTC benefits, and gym memberships.
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Typically have low or $0 premiums.
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You must use the plan’s network.
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