How Does Medicare Work?: A Straightforward Guide With What You Need to Know


Staying healthy is important. In fact, it’s the key to living a long and happy life.

And yet it’s no secret that maintaining good health isn’t easy. You simply never know when you’ll get sick or injured. This becomes an especially big concern as you age. That’s why Medicare was created. It provides healthcare for those over 65 as well as individuals with specific needs that can’t afford proper healthcare coverage elsewhere.

If you’ve ever wondered how Medicare works, you’ve come to the right place for answers. This article takes a look at everything you need to know to get started. You can also review plan comparisons for Medicare Advantage plans or Medicare Supplement plans to find the best fit for your life. 

The Basics

The basic concept of Medicare is that a U.S. Citizen pays into the system over the course of their lifetime, and will then be able to start using Medicare benefits at the age of 65 or older.

It’s important to note that Medicare won’t automatically cover all of your expenses, thus you’ll likely need to purchase supplemental insurance in order to bridge the gap in medical expenses not covered by the program.

Hospital Coverage

Medicare covers a number of different types of hospital stays. These typically include inpatient surgeries or during a major illness. 

This is covered under Medicare Part A, which also covers other services such as hospice care, a stay at a rehabilitation center, or a nursing facility. 

Keep in mind that you’ll likely be responsible for covering a large deductible, as well as some rather substantial out-of-pocket expenses.

Medical Coverage

Next is Medicare Part B. This part of the system covers visits to the doctor. It also covers a host of outpatient services. Under Medicare Part B, you will pay a monthly premium and will be responsible for meeting the deductible required before receiving any coverage provided under the plan.

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Original Medicare

Medicare has undergone changes over the years. Part A and Part B served at the foundation for the original program and thus are typically referred to as “Original Medicare”. Over the years, Part C and Part D have also been added to the overall Medicare system. Knowing the difference between the different programs will enable you to find out if your expenses can be covered when you visit


Medigap is a Medicare supplement plan that helps cover certain costs that aren’t covered by Original Medicare. In other words, Medigap can help to bridge the gap so that you will only face minimal out-of-pocket costs.

Medicare Advantage Plans

Medicare Advantage Plans, or Medicare Part C plans, allow private healthcare providers to offer the benefits of Part A and Part B, along with Part D and other benefits.

With this plan, doctors and hospitals get reimbursed by the insurance company issued the coverage under Part C.

Prescription Drug Coverage

This is obviously an incredibly important aspect of Medicare coverage. After all, you will eventually need access to quality prescription drugs. While not all drugs are covered under Medicare, all plans are required to offer at least a standard level of coverage. Thus it’s important to confirm that your prescriptions are part of the formulary on an individual plan prior to enrollment.

Hearing Aids

Medicare doesn’t cover hearing aids or exams for fitting hearing aids. You may need to pay 100% for hearing aids. Some Medicare Advantage Plans (Part C) offer extra benefits that Original Medicare doesn’t cover – like vision, hearing, or dental. Check your own plan for more information.

What about a hearing test? In some cases, yes Medicare will cover it, but only if the hearing test is recommended by your primary care doctor or another physician. In other words, you can’t go to a hearing clinic without a referral and expect Medicare to pay for it.

Your Complete Guide to How Medicare Works

Getting isn’t older might not be at the top of your favorite things to do, but it happens to everyone. That’s why it’s important to understand how Medicare works so that you’ll be ready to enroll once you turn 65.

Keep reading to discover more great lifestyle tips and advice on our blog.

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