How Medicare Works
If you’re turning 65 soon, you may be asking: “How does Medicare actually work?” With multiple parts, private plan options, and enrollment deadlines, it’s easy to feel overwhelmed. The truth is—once you break it down, Medicare is more straightforward than it seems.
At Covered by Tara, I help seniors and families simplify Medicare every day. Here’s a step-by-step guide to understanding how Medicare works.
The Basics: What Is Medicare?
Medicare is a federal health insurance program that covers:
- People 65 and older
- Certain younger individuals with disabilities
- People with End-Stage Renal Disease (ESRD) or ALS
It’s funded by a combination of payroll taxes, premiums, and federal revenue.
The Four Parts of Medicare
Medicare is divided into four parts, each covering different services:
- Part A (Hospital Insurance): Covers inpatient hospital stays, skilled nursing, hospice, and some home health.
- Part B (Medical Insurance): Covers doctor visits, outpatient care, preventive services, and durable medical equipment.
- Part C (Medicare Advantage): Private insurance plans that bundle Parts A & B (and often Part D), plus extras like dental, vision, and fitness.
- Part D (Prescription Drugs): Stand-alone drug plans (or included with Advantage) that cover medications at the pharmacy.
Original Medicare = Part A + Part B. Most people add either Part D + Medigap (Supplement) or choose a Medicare Advantage plan.
How Costs Work
- Part A: Usually premium-free if you or your spouse paid Medicare taxes for 10+ years.
- Part B: Monthly premium (standard in 2025: $185.00; higher for higher incomes).
- Part C (Advantage): Premiums vary—some as low as $0, plus copays/coinsurance.
- Part D: Monthly premiums vary by plan.
- Medigap: Extra premium, but reduces out-of-pocket costs with Original Medicare.
Enrollment Timeline
- Initial Enrollment Period (IEP): 7-month window around your 65th birthday.
- Special Enrollment Period (SEP): If you’re still working with employer coverage, you may qualify to delay Part B and Part D.
- General Enrollment Period (GEP): Jan 1 – Mar 31 each year if you missed IEP (penalties may apply).
- Annual Enrollment Period (AEP): Oct 15 – Dec 7 to review and change Advantage or Part D plans.
Medicare Advantage vs. Medicare Supplement
This is one of the most important decisions you’ll make:
- Medicare Advantage (Part C): All-in-one coverage with extras, lower premiums, network-based.
- Medicare Supplement (Medigap): Works with Original Medicare, higher premiums, freedom to see any doctor nationwide, predictable costs.
Neither is “better” — the best option depends on your health, budget, and lifestyle.
Covered by Tara: Making Medicare Work for You
Medicare is not one-size-fits-all. As an independent broker, I:
- Compare plans across multiple carriers.
- Explain the trade-offs between Advantage, Supplements, and Part D.
- Help you avoid penalties and costly mistakes.
- Ensure your plan fits your unique needs and budget.
With me, you’re not just covered—you’re held.
Next Steps
If you’re asking, “How does Medicare work?”—the answer is: it depends on your choices. The foundation is Parts A and B, but the real decisions come when you decide how to fill in the gaps.
Schedule your free Medicare review today.
Together, we’ll create a simple plan so Medicare works for you.
