What is Medicare
…and do I need it?
Medicare is the federal health insurance program that covers over 66 million Americans. If you're turning 65, you need to understand it and act on time. We'll make it simple.
Medicare, explained in plain English
Medicare is a federal health insurance program primarily for people age 65 and older. It was signed into law in 1965 and is run by the Centers for Medicare and Medicaid Services (CMS). Today, it covers more than 66 million Americans seniors, people with certain disabilities, and those with End-Stage Renal Disease or ALS.
Unlike employer-sponsored health insurance, Medicare is not automatic. You have to sign up and the decisions you make when you first enroll can follow you for years, sometimes with permanent financial consequences if you miss a deadline.
“Medicare isn’t one-size-fits-all. There are choices to make, and making the right ones depends on your health, your budget, and where you live.”
That's where Tailor Made Benefits comes in. We help you understand your options and choose the coverage that actually fits your life at no cost to you.
Medicare at a Glance
By the Numbers
66M+
Americans currently covered by Medicare
1965
Year Medicare was signed into law by President Johnson
4
Parts of Medicare — A, B, C, and D
7 mo
Initial enrollment window around your 65th birthday
65
Age most Americans become eligible to enroll
$0
Cost to work with a licensed Medicare agent like TMB
Who Does Medicare Cover?
Who Qualifies
Most people associate Medicare with turning 65, but there are actually three groups who qualify.
Age 65 and Older
U.S. citizens or permanent residents who have lived in the country for at least 5 years and have worked 40 quarters (10 years) paying Medicare taxes.
Under 65 with a Disability
People who have received Social Security Disability Insurance (SSDI) benefits for 24 consecutive months automatically qualify for Medicare.
Special Conditions
People diagnosed with ALS (Lou Gehrig's disease) qualify immediately. Those with End-Stage Renal Disease qualify after a waiting period and meeting certain criteria.
The Four Parts of Medicare
How It's Organized
Medicare is broken into four parts. Each covers a different type of healthcare. You don't have to enroll in all of them, but understanding what each does is essential before making any decisions.
Part A — Hospital Insurance
Covers inpatient hospital stays, skilled nursing facility care (after a qualifying hospital stay), hospice care, and some home health services. Most people pay $0 in premiums for Part A.
Part B — Medical Insurance
Covers doctor visits, outpatient services, preventive care, lab work, durable medical equipment, and mental health services. The standard 2026 premium is $202.90/month unless you fall into a higher income bracket.
Part C — Medicare Advantage
A private insurance alternative to Original Medicare that bundles Parts A and B — and usually includes Part D drug coverage, plus extras like dental, vision, and hearing. Plans vary by carrier and zip code.
Part D — Prescription Drugs
Standalone drug coverage you add to Original Medicare or some Supplement plans. Each Part D plan has its own formulary (drug list) and cost structure. Skipping Part D can result in a permanent late penalty.
What Medicare DOES NOT Cover?
Important Gaps
Original Medicare (Parts A and B alone) leaves significant gaps. Many people are surprised by what isn't covered which is exactly why additional coverage matters.
Not Covered by Original Medicare
Routine dental, vision, and hearing care • Most eyeglasses and hearing aids • Long-term custodial care (nursing home) • Cosmetic procedures • Acupuncture (with limited exceptions) • Care received outside the U.S
How People Fill the Gaps
A Medicare Supplement (Medigap) plan covers most out-of-pocket costs left by Parts A and B. A Medicare Advantage plan often bundles dental, vision, and hearing. Standalone dental or vision plans are also available.
Medicare Myths - Busted!
Common Misconceptions
-
False
If you're already receiving Social Security benefits, you'll be enrolled automatically. But if you're still working and haven't claimed Social Security, you must sign up yourself during your Initial Enrollment Period.
-
False
Original Medicare has no out-of-pocket maximum. Without supplemental coverage, a serious illness or hospital stay can cost you tens of thousands of dollars out of pocket.
-
False
Missing your enrollment window can result in a permanent late enrollment penalty added to your Part B and Part D premiums for as long as you have Medicare.
-
Truth
Medicare agents like Maggie at Tailor Made Benefits are paid by the insurance carriers - not by you. You get expert, personalized guidance at zero cost, and your premiums are the same whether you go through an agent or not.
Frequently Asked Questions
Common Questions
-
Not necessarily. If you have qualifying employer coverage through your job (or your spouse's job), you may be able to delay Part B without penalty. You'll get a Special Enrollment Period when that coverage ends. This is one of the most misunderstood areas of Medicare. We strongly recommend talking to an agent before assuming you're covered.
-
No. Medicare is a federal program primarily for people 65 and older regardless of income. Medicaid is a joint federal-state program based on financial need. Some people qualify for both — this is called being "dual eligible" — and can receive significant extra benefits.
-
With Original Medicare, you can see any doctor or specialist who accepts Medicare — and most do. With Medicare Advantage, you'll generally need to use the plan's network. With a Medicare Supplement plan, you can see any doctor or specialist nationwide who accepts Medicare.
-
Start with a free call before you do anything else. Before you contact Social Security, fill out anything online, or pick a plan from a TV commercial, let us walk you through your specific options. We look at your doctors, your prescriptions, and your budget and give you a clear picture in about 20 minutes.