Medicare 101
Everything you need to know about Medicare — in plain English.
No jargon, no fine print, no pressure. Just a clear explanation of how Medicare works, what it costs, and how to make the right choice for your situation.
The Basics
What is Medicare?
Medicare is the federal health insurance program for people age 65 and older, as well as certain younger people with disabilities. It’s run by the Centers for Medicare & Medicaid Services (CMS).
Here’s the key thing most people don’t realize: Original Medicare alone has gaps. It doesn’t cover everything — and those gaps can be expensive. That’s why most people add a Supplement plan or choose Medicare Advantage to fill in the holes.
“The mail piles up, the phone calls don’t stop, and it feels like everyone wants to sell you something before you even understand what you’re buying. You deserve better than that.” — Jon Kelderman
The Parts of Medicare
Medicare is divided into four parts.
Here’s what each part covers — and what it doesn’t.
MEDICARE Part A
Hospital Insurance
Inpatient care, skilled nursing, hospice
- Inpatient hospital care
- Skilled nursing facility (limited)
- Hospice care
- Some home health care
MEDICARE Part B
Medical Insurance
Outpatient services, doctor visits, preventive care
- Doctor & specialist visits
- Outpatient procedures
- Preventive screenings
- Durable medical equipment
MEDICARE Part C
Medicare Advantage
All-in-one alternative — replaces Parts A & B
- All Part A & B benefits
- Usually includes Part D drugs
- Often includes dental/vision/hearing
- Often $0 monthly premium
MEDICARE Part D
Prescription Drugs
Standalone drug coverage for Original Medicare
- Prescription medications
- Mail-order pharmacy options
- Low Income Subsidy available
- Jon checks your drug list
The Big Decision
Medicare Supplement vs. Medicare Advantage — which is right for you?
This is the most important decision you’ll make. There’s no single right answer — it depends on your health, your doctors, and your budget.
Medicare Supplement (Medigap)
- Use any doctor — nationwide
- No network required
- Predictable, near-zero out-of-pocket costs
- Higher monthly premium
- Add Part D separately for drug coverage
- Best for travelers or specialist needs
Medicare Advantage (Part C)
- In-network doctors required
- Network-based coverage
- Variable copays per service
- Often $0 monthly premium
- Drug coverage usually included
- Best for budget-conscious, local care
- Often includes: dental, vision, hearing and additional benefits like gym memeberships
“I walk every client through both options side by side based on their specific doctors, prescriptions, and budget. There’s no one-size-fits-all answer — which is exactly why you need an independent agent, not a 1-800 number.” — Jon Kelderman
Enrollment Periods
When can you enroll in Medicare?
Timing matters. Missing a window can mean gaps in coverage or lifelong penalties.
Initial Enrollment Period (IEP)
7-month window: 3 months before your 65th birthday month, your birthday month, and 3 months after.
Missing this window without creditable coverage can result in lifetime late enrollment penalties.
Special Enrollment Period (SEP)
If you have employer coverage past 65, you get a SEP when that coverage ends. You have 8 months to enroll in Part B without penalty.
Always confirm your employer plan qualifies as creditable coverage before delaying Medicare.
Annual Enrollment Period (AEP)
October 15 – December 7 each year. Change your Medicare Advantage or Part D plan. New coverage starts January 1.
Jon reviews every client’s plan each fall during AEP — free, no obligation.
Pro tip: Contact Jon 3–6 months before you turn 65. This gives plenty of time to understand your options, compare plans, and enroll without rushing.
What Does It Cost?
Medicare costs at a glance.
These are standard 2025 costs. Your actual costs depend on the plan you choose — which is exactly what Jon helps you figure out.
Original Medicare
- Part A Premium: Usually $0 (40+ work quarters)
- Part A Deductible: $1,676 per benefit period
- Part B Premium: $185/month standard
- Part B Deductible: $257/year
Supplement & Part D
- Medigap Premium: Varies by plan, age & carrier
- Part D Premium: Avg $40–$60/month
- Out-of-pocket: Near-zero with Supplement
- Jon shops carriers to find your best rate
Medicare Advantage
- Premium: Often $0/month
- Drug coverage: Usually included
- Dental/Vision: Often included
- Out-of-pocket max: Up to $8,850/year
Important Gaps
What Medicare does NOT cover.
This is the most important thing most people don’t know before they enroll.
- Long-Term Care / Custodial Care — nursing home, assisted living, in-home help
- Dental Care — routine cleanings, fillings, extractions, dentures
- Vision Care — routine eye exams and glasses
- Hearing Aids — not covered by Original Medicare
- Most Care Outside the U.S.
- Cosmetic Surgery (unless medically necessary)
How to Fill the Gaps
These gaps are why most people add a Medicare Supplement or choose Medicare Advantage — and why Long-Term Care insurance is worth discussing separately.
- Medicare Supplement fills most cost gaps
- Some Advantage plans include dental, vision & hearing
- Long-Term Care insurance protects your savings
- Jon explains all of this at no cost to you
Common Questions
Medicare questions we hear all the time.
Do I have to sign up for Medicare when I turn 65?
Not necessarily. If you have qualifying employer coverage, you may be able to delay. But missing your Initial Enrollment Period without creditable coverage can result in permanent late enrollment penalties. Call Jon before making this decision.
Can I keep my current doctors with Medicare?
With Medicare Supplement, you can see any doctor nationwide who accepts Medicare. With Medicare Advantage, you need to stay in-network. Jon verifies your specific doctors are covered before recommending any plan.
What's the difference between Plan G and Plan N?
Medigap plans are standardized by the government, so Plan G from one carrier covers the same benefits as Plan G from another. The difference is price. Jon shops multiple carriers to find the best rate for your plan.
Does Medicare cover my prescriptions?
Original Medicare Parts A & B does not cover most prescriptions. You need a standalone Part D plan if you have a Supplement, or a Medicare Advantage plan that includes drug coverage. Jon runs your specific drug list to find the best formulary match.
Does Medicare cover long-term care?
No — this is one of the biggest misconceptions. Medicare covers short-term skilled nursing after a hospital stay, but does not cover custodial care. Long-Term Care insurance is a separate product Jon can discuss with you.
Ready to stop Googling and get a real answer?
A free 30-minute call with Jon covers everything on this page — tailored to your specific situation, your doctors, and your budget. No pressure, ever.
We do not offer every plan available in your area. Please contact Medicare.gov, 1-800-MEDICARE for information on all of your options. Jon Kelderman · Waukee, IA · License No. 19381938 · Not affiliated with Medicare or any government agency.