Medicare is structured into four main sections: A, B, C, and D. Part A covers essential services like hospital stays, skilled nursing care, and hospice treatment. Part B handles outpatient care, such as doctor visits and preventive services. Part D is focused on helping cover the cost of prescription medications that are taken by the patient at home. Lastly, Part C, or Medicare Advantage, gives individuals the option to join private health plans that combine the coverage of Parts A and B, often offering additional benefits not included in traditional Medicare.


The origins of Medicare

Medicare is a vital federal health insurance program that has significantly shaped the healthcare landscape in the United States. Launched in 1965 under President Lyndon B. Johnson, it was designed to address the lack of affordable healthcare options for seniors, who often struggled to obtain private insurance due to the high costs or age-related exclusions. At its inception, Medicare provided coverage through two main components: Part A, which covers hospital insurance, and Part B, which covers medical insurance, including doctor’s visits, outpatient care, and certain medical supplies.Over the years, Medicare has evolved to meet the changing needs of its beneficiaries. In 1997, the introduction of Medicare Part C (also known as Medicare Advantage) allowed beneficiaries to receive their Medicare benefits through private insurance plans. These plans often include additional services, such as dental or vision care, beyond what is offered in the original Medicare program. Then, in 2003, Medicare Part D was established to provide prescription drug coverage, helping to ease the burden of rising medication costs for seniors.

The program continued to adapt with the passage of the Affordable Care Act (ACA) in 2010, which included provisions to close the “donut hole” in Medicare Part D, reducing out-of-pocket costs for prescription drugs. Medicare's role in the U.S. healthcare system remains a subject of ongoing debate, particularly regarding its funding and long-term sustainability. As the population ages, ensuring that Medicare can continue to provide comprehensive and affordable care for millions of beneficiaries is a significant challenge that policymakers continue to address.

Despite these challenges, Medicare remains one of the most important health insurance programs in the United States, ensuring that older adults and people with disabilities have access to the healthcare services they need. Through its various expansions and reforms over the years, Medicare has not only provided essential coverage but has also helped shape the broader U.S. healthcare system.


Services Covered By Medicare

Part A Coverage - Medicare Part A covers hospital stays and inpatient care, including:

• A semi-private room

• Your hospital meals

• The first 3 units of blood

• Care in special units, such as intensive care

• Drugs, medical supplies and medical equipment used during an inpatient stay

• Labs tests, X-rays and medical equipment as an inpatient

• Operating room and recovery room services

• Some blood transfusions in a hospital or skilled nursing facility

• Part-time, skilled care for the home-bound after a qualified inpatient stay

• Hospice care, including medications to manage symptoms and control pain

• Home health services - medically necessary part-time or intermittent skilled nursing care, physical therapy, speech-language pathology services, or occupational therapy services

• Inpatient or outpatient rehabilitation services after a qualified inpatient stay

​

Part B Coverage - Medicare Part B covers doctors visits and outpatient care, including:

• Doctors visits, including when you are in the hospital

• Medications administered in provider’s office

• An annual wellness visit and preventive services, like flu shots and mammograms

• Clinical laboratory services, like blood and urine tests

• X-rays, MRIs, CT scans, EKGs and some other diagnostic tests

• Some health programs, like smoking cessation, obesity counseling and cardiac or pulmonary rehabilitation

• Physical therapy, occupational therapy and speech-language therapy

• Diabetes screenings, diabetes education and certain diabetes supplies

• Mental and Behavioral health care

• Durable medical equipment for use at home, like oxygen, CPAP, wheelchairs and walkers

• Ambulatory surgery center services

• Ambulance and emergency room services

Services Not Covered By Medicare​​

• Dental care: Routine dental checkups, cleanings, fillings, and dentures.

• Vision care: Eye exams for glasses or contact lenses (unless related to a medical condition).

• Hearing aids: Medicare does not cover hearing aids or the exams to fit them.

• Long-term care: Extended stays in nursing homes or assisted living facilities are not covered.

• Cosmetic surgery: Procedures that are purely cosmetic and not medically necessary.

• Routine foot care: Medicare doesn’t cover services like regular foot exams or treatment for routine foot problems, such as corns or bunions.

• Acupuncture: Medicare doesn’t typically cover acupuncture treatments.

• Prescription medications: Unless you have Part D, Medicare doesn’t cover most outpatient prescription drugs.

Common Misconceptions About Medicare  
Many people have misunderstandings about Medicare, which can lead to costly mistakes. Let’s clear up some of the most common myths:

Medicare Isn't Free  
It’s important to remember that Medicare isn’t completely free. While many people qualify for premium-free Part A thanks to their work history, Part B requires a monthly premium, which everyone must pay.

You Won't Receive Automatic Enrollment Notifications  

The government doesn’t notify you when it's time to enroll in Medicare. If you're not already receiving Social Security benefits at least four months before your 65th birthday, you won’t be automatically enrolled. You’ll need to apply on your own during your initial enrollment period.

Missed Enrollment Can Lead to Lifelong Penalties  
If you don’t sign up for Part B when you're first eligible and you don't qualify for a Special Enrollment Period, you’ll face a monthly penalty. This penalty will be added to your regular Part B premium for as long as you have Part B coverage. The longer you wait to enroll, the higher your penalty will be.

If you also miss signing up for Part A, and you end up paying a penalty, you’ll have to pay it for twice as long as the period you went without Part A coverage. To avoid extra costs, it’s important to sign up for Medicare when you’re first eligible.

Failing to enroll in Medicare when you're first eligible can result in permanent penalties that you'll have to pay for as long as you're enrolled in the program. It’s essential to sign up on time to avoid these lifelong extra costs.

Navigating the Medicare Enrollment Process: Why It’s Crucial to Get It Right  
Medicare can be complex, and one small mistake can have long-term consequences. That’s why it’s crucial to understand the system and make informed decisions about your coverage.

Get Expert Help with Your Medicare Options  

Confused about which coverage options suit your needs? Medicare can be overwhelming, but we’re here to help. Our experts can walk you through the basics and assist you in selecting the right plan. Call us today at (407) 499-1097 to get started on your path to affordable healthcare coverage!

Important Medicare Facts to Know  
Medicare consists of four parts: Part A, Part B, Part C, and Part D.

Private insurance companies sell Part C (Medicare Advantage), Part D (Prescription Drug Plans), and Medigap policies — not the government.

When you enroll in Part A and Part B, you have two main options: either combine a Medigap plan with a Part D plan, or go for a Medicare Advantage plan.

​

Centers for Medicare & Medicaid Services

​

Centers for Medicare & Medicaid Services (Spanish)