Medicare is a federal health insurance program for older adults aged 65 and older or for younger individuals who may have certain approved conditions and disabilities. It can be complex to understand, with many factors contributing to an overall health plan decision. Regardless of the status of employment, it may be beneficial to begin looking into Medicare well before a person turns 65, because benefits do not take effect until the person’s birth month. If you are still employed and have health insurance through the employer, you don’t have to sign up for Medicare.

Medicare parts explained

Medicare is split into several parts. Some states have additional sections. These are the standard parts nationwide:

Part A is known as hospital insurance. It covers:

• The hospital room, nursing staff and medications during a hospital stay.
• Skilled nursing facility care (short-term care after a hospital visit only).
• Hospice (specialized care for those with a limited life expectancy, emphasizing comfort, quality of life) and palliative care (comfort‑focused support for individuals with serious or terminal illnesses).
• Home health care with part‑time skilled nursing or therapy (not personal care services), limited to 1–3 times per week.

Part B is medical insurance. It covers:

• Outpatient Doctor visits.
• Preventive services such as vaccines (flu, COVID-19, Hepatitis B), screenings (cancer, diabetes) and an annual wellness visit.
• Infusion services.
• Durable medical equipment (DME) like walkers, wheelchairs and oxygen.
• Mental health care including talk therapy.
• Diagnostic x-rays, MRIs and blood tests.

“It is important to note that Medicare Parts A and B do not cover long-term care, routine dental visits, dentures, eye exams, hearing aids or cosmetic surgery,” said Shelby Greene, LCSW, MSW, coordinator of clinical social services and part of the Sanford Assessment team.

Part C, known as the Medicare Advantage plans, are privately managed and include additional benefits such as dental, vision and hearing that are not covered in Parts A and B. These plans often have lower premiums but restricted networks.

Part D is the prescription plan, which covers outpatient medications and is privately managed by outside insurance companies. Part D is voluntary but if you do not sign up for a plan when you enroll in Medicare, a penalty may be applied to your insurance premiums for as long as there is coverage. There are Medicare rules around enrollment for Part D, so it pays to take the time to investigate your options thoroughly. 

“Medicaid has its own coverage and rules based on income,” said Leslie Baker, Pharm.D., BCGP, director of geriatric pharmacy services at the Sanford Center for Aging and part of the Sanford Assessment team. “Medicaid is not part of the information provided and is considered its own separate insurance coverage.”

Supplemental plans versus Medicare Advantage plans

Medicare Supplement Insurance, also known as Medigap, is private insurance that helps pay out-of-pocket costs such as deductibles and copays that are not covered by original Medicare in Parts A and B.

Signing up for Medigap during enrollment for Parts A and B is ideal as you cannot be denied coverage due to pre-existing conditions. There are premium costs that are influenced by age, location and plan choice but you can see any doctor or specialist in the United States who accepts Medicare. The premiums may be higher with reduced costs at time of care. It also cannot be used with Medicare Advantage.

Advantage plans are managed by private insurance companies and can offer lower monthly premiums and extra benefits such as fitness programs. These plans have restricted networks, so knowing the doctors and hospitals covered in the advantage plan can prevent unexpected costs.

Determine next steps

“There are many factors to take into account and finding the information can be tricky,” said Greene. “If you are looking for education from an unbiased source, the assessment we offer can provide the necessary information to make the best choice for your health needs.”

Apart from a free Sanford Assessment, older adults can also access information from the government Medicare website, visit the Medicare Store to meet with an insurance broker who can provide education or visit the American Association of Retired Persons (AARP) for resources.

“If you enjoy international travel, it is important to sign up for travel insurance,” said Baker. “Medicare does not work outside the United States so planning ahead with travel insurance can save you money while you enjoy your retirement.”