What is Medicare?

Medicare is a federal health insurance program accessible to individuals who are 65 years and older, as well as to those under 65 with specific disabilities or medical conditions like End-Stage Renal Disease.

It comprises various components, known as Parts A, B, C, and D, each designed to meet different healthcare requirements.

Original Medicare

Medicare Parts A and B are referred to as "Original Medicare".

These parts are managed by the federal government. Some individuals who receive Social Security benefits are automatically enrolled in Original Medicare while others need to apply for it as they approach their 65th birthday.

Medicare Part A (Hospital Insurance)

Medicare Part A includes coverage for inpatient services in hospitals or skilled nursing facilities, as well as home health care and hospice care for patients with terminal illnesses.

Part A Cost

Deductible

You must first meet a Part A deductible before Part A helps with your covered medical expenses.

Options

There is no insurance premium for Part A if you or your spouse have paid into Social Security for a minimum of 10 years.

If not, you have the option to purchase Medicare Part A.

Copays

Copayments or cost-sharing might be required for certain services. This includes prolonged hospital or skilled nursing facility stays.

Coinsurance

Part A has coinsurance for:

• Inpatient hospital care lasting between 61-90 days total per benefit period.

• Inpatient mental health care lasting between 61-90 days total per benefit period.

• Skilled nursing care lasting between 21-100 days total per benefit period.

Coinsurance is also available for a limited number of additional days.

Medicare Part A:

Additional Information

You can utilize your coverage anywhere in the United States, as most hospitals in the country participate in Medicare.

Medicare Part B (Medical Insurance)

Medicare Part B provides coverage for doctor visits, durable medical equipment, speech therapy, occupational therapy, physical therapy, and various other outpatient services.

Part B Cost

Deductible

Similar to Part A, you must first meet an insurance deductible before Part B helps with your medical costs.

Copays

Copayments or cost-sharing might be required for certain services, such as those provided in an outpatient hospital setting.

Coinsurance

You are responsible for 20 percent of the cost for certain medical services, including doctor visits, outpatient therapy, and durable medical equipment.

Preventative Care

Medicare-covered preventive care services, including annual wellness visits and mammograms for women, are fully covered. No deductibles, copayments, or coinsurance are required for these services.

Premium

Medicare Part B requires a monthly insurance premium, which depends on your enrollment timing and annual household income.This premium is typically deducted from Social Security benefits.

It is distinct from the premiums for Medigap, Medicare Advantage (Part C), or Prescription Drug Coverage (Part D).

Note about Medicare Part B Limits: Medicare Part B imposes annual limits on services for physical

therapy, occupational therapy, and speech-language pathology.

Medicare Part B:

Additional Information

If you have Original Medicare under Part B and your physician accepts Medicare, you can utilize your coverage anywhere within the United States. You have the freedom to choose any doctor in the country who accepts Medicare patients.

Additionally, Part B premiums, standard deductibles, and cost-sharing amounts typically undergo annual adjustments, with changes taking effect on January 1st.

What Medicare Does Not Cover

While Original Medicare is an excellent foundation, it wasn’t designed to cover everything. It generally does not cover routine dental care, eye exams for prescription glasses, hearing aids, or long-term custodial care. It also leaves you responsible for deductibles and a 20% coinsurance for Part B services.

This is why we always look at your complete picture—helping you find the right gap coverage, like Dental/Vision plans or Critical Illness policies, to ensure a single medical event doesn't disrupt your retirement savings.

Important Questions

What is the difference between Medicare and Medicaid?

This is one of the most common points of confusion! Medicare is a federal health insurance program primarily for people aged 65 and older, regardless of income. Medicaid is a joint federal and state assistance program that helps with medical costs for people with limited income and resources. Depending on your financial situation, it is possible to be eligible for both (known as "Dual Eligible").

Do I have to enroll in Medicare at 65 if I am still working?

Not necessarily. If you (or your spouse) are actively working and you have creditable health coverage through that employer, you can usually delay enrolling in Medicare Parts A and B without facing late penalties. However, before you delay, it is always a good idea to have us compare your employer plan to Medicare—sometimes transitioning to Medicare actually provides better coverage for a lower cost.

Is Medicare a family plan, or just for me?

Medicare is an individual insurance program. Unlike employer-sponsored health insurance where you can carry a spouse or dependents on your policy, your Medicare coverage applies only to you. Your spouse will need to enroll in their own Medicare plan when they become eligible.

How much does Medicare cost?

The cost varies depending on your work history and the plans you choose. For most people, Part A is premium-free because they paid Medicare taxes while working. Part B has a standard monthly premium set by the government (which is automatically deducted from your Social Security check if you are drawing benefits). Part C (Advantage) and Part D (Prescription) plan premiums vary by the specific plan and carrier you choose—some Advantage plans even have a $0 monthly premium.

Will Original Medicare cover all my medical bills?

No. Original Medicare covers a significant portion of your hospital and medical expenses, but it has deductibles and a 20% coinsurance that you are responsible for paying. This is exactly why we sit down together to explore Medicare Supplements (Medigap) or Medicare Advantage plans to help protect your retirement savings from those out-of-pocket costs.

Will my current doctor accept my new Medicare plan?

That depends entirely on the path you choose. If you choose Original Medicare with a Supplement (Medigap) plan, you can see any doctor in the United States that accepts Medicare. If you choose a Medicare Advantage plan, you will generally need to use doctors and hospitals within the plan’s specific network (HMO or PPO). During our consultation, we always look up your specific doctors to make sure they are in-network before recommending a plan.

Why do I need an independent broker instead of calling the insurance company directly?

If you call an insurance company directly, they can only offer you their own plans—even if a competitor has a better option for your specific medications. As an independent broker, I don't work for the insurance carriers; I work for you. I have access to multiple top-rated national carriers, allowing us to shop the market, compare your options side-by-side, and find the absolute best fit for your unique needs, at zero cost to you.

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Navigating Medicare for the first time can feel overwhelming, but you don't have to figure it out alone. I'm here to cut through the confusion, review your specific doctors and prescriptions, and build a clear, actionable plan that fits your exact needs.

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1. Deep knowledge shared orally.

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Akroamatik Financial is not connected with or endorsed by the U.S. government or the federal Medicare program. 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, 1-800-MEDICARE (TTY users should call 1-877-486-2048), or your local State Health Insurance Program (SHIP) to get information on all of your options.