What is Medicare & Who’s Eligible?

Medicare is a federally funded health insurance program created in 1965 by President Lyndon Johnson’s Great Society initiative. In 2025, 62.8 million Medicare beneficiaries are about 18% of the United States’ 347 million population. If you’re Medicare-eligible, you’re in good company.

Medicare offers health insurance for individuals aged 65 and older, as well as some younger people with disabilities or specific conditions like End-Stage Renal Disease (ESRD). It helps cover doctor visits, hospital stays, and other treatments. Below, you’ll learn how Medicare works and who qualifies.

What Are the Parts of Medicare?

Medicare comprises several parts, combining public (government) coverage with optional private plans. Here’s a quick breakdown:

• Original Medicare Part A (government coverage): Hospital insurance covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health services.
• Original Medicare Part B (government coverage): Medical insurance covers doctor visits, outpatient care, preventive services like vaccines and screenings, and some home health care. It helps pay for medically necessary services and supplies to diagnose or treat health conditions.
• Medicare Part C (Medicare Advantage): Private plans bundling Parts A & B, often with drug coverage and extra benefits such as dental, vision, hearing, wellness programs, and sometimes gym memberships or transportation to medical appointments.
• Medicare Part D: Private stand-alone prescription drug plans, often paired with Original Medicare or a Medigap plan.
• Medicare Supplement (Medigap): Private plans that may help reduce out-of-pocket costs. 

Understanding Medicare

This chart outlines your Medicare coverage options in two steps. Step 1: Enroll in Original Medicare (Parts A and B) when you become eligible, which is government-provided. Step 2: If you need more coverage, choose between keeping Original Medicare and adding Medicare Supplement (Medigap) and/or Part D, or selecting a single Medicare Advantage (Part C) plan that bundles benefits and often includes prescription drugs.

Your Medicare Coverage Options

Medicare covers hospital stays, doctor visits, lab tests, home health care, and prescription drugs. Coverage depends on your plan:

• Original Medicare (Parts A & B) does not include prescription drugs.
• Adding Part D or choosing a Medicare Advantage plan may help cover medications and extra benefits like dental, vision,  hearing, and more preventive services.

See our article ”Your Medicare Plan Options’’ for details.

A local licensed Connie Health agent can also walk you through enrolling in Medicare for the first time. Call (623) 223-8884 to speak with a local licensed agent.   

Medicare Eligibility

According to Medicare.gov, you may be eligible for Medicare if you are:

• A U.S. citizen or permanent resident age 65 or older
• Under 65 with qualifying conditions like End-Stage Renal Disease (ESRD), Amyotrophic Lateral Sclerosis (ALS, Lou Gehrig’s disease), or certain chronic illnesses
• Receiving Social Security Disability Insurance (SSDI) for 24+ consecutive months

Take the Connie Health Medicare eligibility quiz to check if you qualify.

Unsure if it’s time to enroll in Medicare? A local licensed Connie Health agent can help you navigate enrollment. Call (623) 223-8884 to speak with an agent.

How Does Medicare Work?

When you become eligible, you may be automatically enrolled in Original Medicare Part A at age 65, but you must sign up for medical coverage for Part B. If you don’t qualify for premium-free Part A, you’ll need to pay a monthly premium for hospital coverage.

1. Enroll in Part A and Part B.
2. Consider Part D if you lack other creditable prescription coverage.
3. Evaluate private plan options like Medigap or Medicare Advantage to help lower costs.

Agent tip:

“Already enrolled in Medicare Part A & B? Have your red-white-and-blue Medicare card ready when you speak with a Connie Health licensed insurance agent.“

Once you receive your red-white-and-blue Medicare card, you can decide whether to expand your Medicare coverage with private options like a Medicare Supplement (Medigap), Medicare Part D, or Medicare Advantage plan. These private plan options can lower your Medicare out-of-pocket costs.

Need help comparing plans? Call (623) 223-8884 to talk with a local licensed insurance agent who can help you choose a plan that may fit your health needs and budget.

What Is the Difference Between Medicare and Medicaid?

While both are U.S. health insurance programs:

• Medicare: Federal program for those 65+ or younger with qualifying disabilities
• Medicaid: A state-administered program for individuals with limited income and resources

Key differences:

• Medicare eligibility is based on age or disability, not income
• Medicaid may cover long-term care; Medicare typically does not

Bottom Line: Understanding Medicare and Your Next Steps

Medicare is a federal health insurance program for people age 65 and older, as well as younger individuals with certain disabilities or conditions like End-Stage Renal Disease (ESRD) or ALS. Most U.S. citizens and permanent residents qualify at age 65, while some qualify earlier due to disability or illness. 

Medicare has different parts—A, B, C (Medicare Advantage), D, and Medigap—that help cover hospital stays, doctor visits, prescription drugs, and more. The right plan depends on your health needs and budget.

Understanding these differences can help you choose the right coverage.
Need assistance? Call (623) 223-8884 to speak with a licensed insurance agent today.

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Frequently Asked Questions: Medicare Basics

When should I enroll in Medicare?

You should enroll during your Initial Enrollment Period (IEP), which begins three months before the month you turn 65, includes your birthday month, and continues for three months afterward. Enrolling during this period helps ensure you have coverage when you become eligible and can help you avoid late enrollment penalties.

Does Medicare cover dental, vision, and hearing?

Original Medicare doesn’t, but many Medicare Advantage plans may include these benefits.

Can I have both Medicare and Medicaid?

Yes, if you qualify. This is called being “dual eligible” and may provide extra benefits and cost savings.

What happens if I miss my Medicare enrollment window?

You may face late enrollment penalties for Part B or Part D. Some Special Enrollment Periods may apply.

How much does Medicare cost?

Costs vary by plan and income. Part A often has a $0 premium if you or your spouse paid Medicare taxes long enough; the monthly premium for Part B and D applies to most people.