- Johanna Price
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The ABCs of Medicare: A 2025 Guide for New Beneficiaries
Medicare is a federal health insurance program primarily for people aged 65 and older, though it can also cover younger people with disabilities or specific medical conditions. It helps reduce the cost of health care by covering essential services like hospital stays, doctor visits and prescriptions.
For many, Medicare provides peace of mind by making health care more accessible and affordable during retirement or when managing long-term health needs.
If you're new to Medicare, understanding what’s covered — and what’s not — can help you make informed decisions about your health care.
Keep reading to get back to basics as we break it down.
What Is Original Medicare?
Original Medicare is the traditional government-run health insurance program made up of two parts:
- Part A – Hospital Insurance
- Part B – Medical Insurance
Together, they cover a range of services, such as preventive care, treatment for conditions when needed and support for overall health.
Part A: What Does It Cover?
Part A is your hospital insurance.
It typically covers the following:
- Inpatient hospital stays
- Skilled nursing facility care (short-term)
- Inpatient care in a nursing home (not long-term custodial care)
- Hospice care
- Some home health care services
Most people don’t pay a premium for Part A if they or their spouse paid Medicare taxes while working.
Part B: What Does It Cover?
Part B is your medical insurance.
It helps pay for the following:
- Doctor visits and outpatient care
- Preventive services like screenings, vaccines and counseling
- Lab tests, X-rays and diagnostic services
- Emergency ambulance transportation
- Durable medical equipment, like walkers, wheelchairs, and oxygen
- Certain outpatient medications (e.g., chemotherapy, injections)
You’ll typically pay a monthly premium for Part B, along with deductibles and coinsurance.
What Original Medicare Does Not Cover
Original Medicare doesn’t cover everything.
Here are some common exclusions:
- Prescription drugs (you’ll need Part D or a Medicare Advantage plan)
- Routine dental, vision and hearing care
- Long-term custodial care (e.g., assisted living)
- Cosmetic surgery
- Routine physical exams (Medicare covers an annual “Wellness” visit instead)
How and When to Enroll in Original Medicare
Most people become eligible for Medicare at age 65. Your Initial Enrollment Period (IEP) is a seven-month window that begins the three months before your 65th birthday, includes your birthday month and ends three months after.
If you’re already receiving Social Security benefits, you’ll be enrolled automatically. Otherwise, you’ll need to sign up through the Social Security Administration.
Once enrolled, you’ll receive your red, white and blue Medicare card in the mail. You can also check your enrollment status online.
Part C: Medicare Advantage
Private insurers offer Medicare Advantage plans and include the following:
- All benefits of Parts A and B
- Usually includes Part D (prescription drug coverage)
- Often offer extra benefits like dental, vision, hearing and transportation
- Many plans have $0 monthly premiums
Understanding Medicare Part D (Prescription Drug Coverage)
If you don’t choose a Medicare Advantage plan with drug coverage, you can enroll in a standalone Part D plan. These plans cover a range of generic and brand-name drugs, mail-order options for home delivery and offer preferred pharmacies for lower costs.
Part D Coverage Stages:
- Deductible Stage: You pay 100% until your deductible is met
- Initial Coverage: You and your plan share costs
- Coverage Gap (“Donut Hole”): You pay up to 25% of drug costs
- Catastrophic Coverage: You pay a small copay or 5% of drug costs
Final Thoughts
Original Medicare provides a strong foundation for your health care, but it’s important to understand its limits. Many people choose to add a Part D plan or enroll in a Medicare Advantage plan for more complete coverage.
More Questions?
As an AdventHealth Well 65+ patient, you’re eligible for trusted, one-on-one counseling through Chapter at no cost. Chapter is a licensed Medicare Advisor that provides one-on-one counseling and assistance to help you select the best plan to meet your needs. Please call 833-201-6576 or visit AskChapter.org/Partners/AdventHealth for more information.