What is Medicare?

Medicare covers people 65 and over and certain people under 65 with a disability, and people with end-stage renal disease.

Original Medicare is comprised of 4 parts:  Medicare parts A, B, C and D

Medicare Part A helps cover your inpatient care in hospitals, critical access hospitals and skilled nursing facilities. It also covers hospice care and some home health care.  There are large deductibles, daily limits for hospital stays and high out of pockets that will need to be covered by a Medicare Supplement plan. There is usually no premium for Medicare Part A once you have worked and paid your Medicare taxes into the Medicare system for at least 40 quarters, or the equivalent of 10 years.

Medicare Part B helps cover your doctors’ services, outpatient hospital care, and some other medical services that Medicare Part A doesn’t cover, such as some of the services of physical and occupational therapists, and some home health care. Medicare Part B helps pay for these covered services and supplies when they are medically necessary.  Generally, part B has a small deductible ($257 in 2025) and then pays on an 80%/ 20% basis with no cap on your 20% portion. There is a premium that needs to be paid for part B coverage that increases with higher incomes.  You will need part B of Medicare to purchase a  Medicare Supplement plan.

Medicare Part C, Medicare Advantage plans (MA Plans) are Medicare approved plans from private insurance companies that offer an alternative to Original Medicare for your health and drug coverage. These “bundled” plans include Part A, Part B, and usually Part D. They can be HMO’s, PPO’s or fee for service plans. Medicare pays a fixed amount for your care every month to the companies offering Medicare Advantage Plans. You may only have coverage for certain doctors, facilities, or suppliers that belong to the plan for non‑emergency or non-urgent care. In many cases, you may need to get approval from your plan before it covers certain drugs or services. Plans often have different out-of-pocket costs than Original Medicare. Plans may offer some extra benefits that Original Medicare does not offer.

At Eriksen Insurance Group, we do not offer Medicare Advantage plans. We believe Medicare Supplement plans provide greater flexibility, stability, and value for our clients, ensuring you receive the best possible coverage without unexpected limitations.

Medicare Part D, drug coverage helps pay for the brand-name and generic drugs you need. It’s optional and offered to everyone with Medicare by insurance companies and other private companies approved by Medicare. Even if you don’t take prescription drugs now, consider getting Medicare drug coverage to avoid paying a late enrollment penalty if you join a plan later.

For more coverage information you can go to “Your Medicare Coverage” at Medicare.gov.