Medicare Made Simple: How It Works, What It Covers and How to Get the Most From Your Benefits

If you’re nearing age 65 or already enrolled, Medicare can feel overwhelming. You may be asking questions like: How does Medicare work? What does Medicare cover? How do I sign up for Medicare? What plan should I choose?

Medicare offers valuable benefits that can help you stay healthy, independent and supported as you age. Understanding your options and how to maximize your benefits can make a big difference.

Who is eligible for Medicare?

You are generally eligible for Medicare if you fall into any of the following categories:

• Are 65 or older
• Are under 65 with certain disabilities
• Have end‑stage renal disease or ALS

Most people become eligible at age 65, and enrollment timing matters. Missing deadlines can lead to late penalties or gaps in coverage. You can always find the most current eligibility and enrollment details on the official Medicare website.

How does Medicare work?

Medicare is made up of four main parts: Part A, Part B, Part C and Part D. Each plays a different role in your coverage.

Medicare Part A: Hospital coverage

What does Medicare Part A cover?

• Inpatient hospital stays
• Skilled nursing facility care (not long‑term custodial care)
• Hospice care
• Some home health care

Many people don’t pay a monthly premium for Part A if they or their spouse paid Medicare taxes while working.

Medicare Part B: Medical coverage

What does Medicare Part B cover?

• Doctor visits and outpatient care
• Preventive services (like screenings and vaccines)
• Mental health services
• Durable medical equipment

Part B is especially important because it covers preventive care, including your Welcome to Medicare visit and annual wellness visits.

Medicare Part C: Medicare Advantage plans

Medicare Part C, also known as Medicare Advantage, is offered by private insurance companies approved by Medicare.

Medicare Advantage plans:

• Combine Part A and Part B
• Often include Part D prescription drug coverage
• May offer extra benefits like vision, dental, hearing and fitness programs
• Have an annual out‑of‑pocket cost limit, while Original Medicare does not

“Medicare Advantage plans can be a strong option for many patients because they focus on prevention, care coordination and whole‑person health – not just treating illness when it happens,” said Sarah Overton, chief nursing officer and vice president of Clinical Services, OSF Home Health Care.

Medicare Part D: Prescription drug coverage

Medicare Part D helps cover the cost of prescription medications.

• Included in most Medicare Advantage plans
• Available as a standalone plan if you have Original Medicare

Coverage and costs vary by plan, so it’s important to review your medications when choosing coverage.

Medicare Advantage plans vs. Medicare Supplement

Medicare Supplement, also known as Medigap, covers some things that Original Medicare doesn’t cover. So even with the Original Medicare plan, certain gaps in care are covered.

What is the difference between Medigap and Medicare Advantage?

Medicare Supplement plans:

• Work with Original Medicare
• Help pay costs Original Medicare doesn’t cover
• Typically have higher monthly premiums
• Do not include extra benefits like dental or vision

Medicare Advantage plans:

• Replace Original Medicare
• Often have lower monthly premiums
• May include prescription drugs and extra services
• Focus on preventive care and wellness

Choosing the right option depends on your health needs, budget and lifestyle.

“The best Medicare plan is the one that fits your life – your doctors, your medications and how you prefer to receive care,” Sarah said. “It’s worth taking the time to review your options each year.”

Medicare Open Enrollment

Medicare open enrollment runs every year in the fall, usually lasting about a month and a half. This is when you can:

• Change Medicare Advantage or Part D plans
• Switch between Medicare Advantage and Original Medicare
• Review coverage to make sure it still meets your needs

Health needs can change from year to year and so can plans. Reviewing your options annually helps ensure you’re not paying for coverage you don’t need or missing benefits you could use.

Using your Medicare Benefits

Choosing a plan is only the first step. To truly get the most from your Medicare benefits, it’s important to use them – especially preventive care, which helps you stay healthier and save money on potentially more serious health issues down the road.

Welcome to Medicare Visit

If you’re new to Medicare Part B, you’re eligible for a one‑time Welcome to Medicare visit within your first 12 months.

This visit helps you:

• Review your medical and family history
• Create a personalized prevention plan
• Understand what screenings and services you may need
• Get to know your care team
• Establish care with your Medicare plan

Annual Wellness Visit

After your initial Welcome to Medicare visit, Medicare covers an annual wellness visit every 12 months at no cost to you.

This visit focuses on:

• Preventing disease and other health issues
• Identifying health risks early
• Planning for long‑term health and independence
• Review your medications
• Assess risk of falling and home safety
• Screening for mood, memory and cognitive health

It’s not a physical exam, but it is one of the most important appointments you can schedule each year.

“These visits give patients and providers dedicated time to focus on staying well, not just reacting when something goes wrong,” Sarah said.

Need help choosing or using your Medicare plan?

Medicare decisions don’t have to be made alone. OSF HealthCare works with many Medicare plans and is here to help you understand your options and use your benefits with confidence.

• Explore Medicare plans accepted at OSF HealthCare
• Talk with your provider about preventive care and wellness visits
• Get trusted care from providers who know you and know Medicare