Medicare basics
What is Medicare?
Medicare is a federal health insurance program administered by the Centers for Medicare and Medicaid Services. Here is who qualifies, what it covers, and where the gaps are.
Medicare, in one paragraph
Medicare is a health insurance program administered by the Centers for Medicare and Medicaid Services (CMS). Most people first become eligible around age 65, while some qualify earlier because of a disability, End-Stage Renal Disease or ALS. Part A and Part B together are called Original Medicare. Eligibility, premiums and the right time to enroll can depend on work history, Social Security status, residency and current coverage.
Who is eligible for Medicare?
You may qualify if you:
- Is 65 years or older
- Is under 65 years old with certain disabilities
- Is of any age with End-Stage Renal Disease
- Has been diagnosed with ALS
Is Medicare mandatory?
Medicare is not mandatory, but delaying enrollment can create coverage gaps or late penalties unless you qualify for an exception or Special Enrollment Period. Most people pay no premium for Part A, while most pay a monthly Part B premium. If you have coverage through your own or a spouse’s current employment, ask the employer’s benefits administrator and Social Security how that coverage affects your dates before deciding to delay any part of Medicare.
Where Original Medicare stops
Original Medicare was built to cover hospital stays and doctor visits. It does not cover routine dental, vision or hearing care, long-term care, or final expenses. Closing those gaps is a separate decision, and it is the part most people find confusing. Our guide to the types of Medicare plans walks through every option, and optional riders covers the supplemental policies that fill what is left.
Frequently asked
- Who is eligible for Medicare?
- Most people first become eligible around age 65. Some qualify earlier because of a disability, End-Stage Renal Disease or ALS. Eligibility, premium-free Part A and enrollment timing can depend on work history, Social Security status and residency, so confirm your dates with Social Security or Medicare.
- Is Medicare mandatory?
- Medicare is not mandatory, but delaying Part A, Part B or Part D can create coverage gaps or late penalties unless you qualify for an exception or Special Enrollment Period. Before delaying because of employer coverage, confirm that coverage with the employer's benefits administrator and Social Security.
- What does Original Medicare not cover?
- Original Medicare does not cover everything. Examples generally include routine dental care, eye exams for prescribing glasses, hearing aids and most long-term custodial care. Some related services are covered in limited circumstances, so check the specific service on Medicare.gov.
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