Understanding the Basics of Medicare
Medicare can feel confusing at first — but it doesn’t have to be. At Frontier Insurance Services, we help simplify the process so you can better understand your options and feel confident about your healthcare coverage.
Original Medicare is the federal health insurance program primarily designed for:
- Adults age 65 and older
- Certain individuals under 65 with disabilities
- Individuals diagnosed with End-Stage Renal Disease (ESRD) or ALS
Original Medicare is made up of two parts: Part A and Part B.
Medicare Part A
What Part A Helps Cover
Medicare Part A primarily helps cover inpatient and facility-based care, including:
- Hospital stays
- Skilled nursing facility care
- Hospice care
- Some home health services
Medicare Part B
What Part B Helps Cover
Medicare Part B helps cover many everyday medical services and preventive care needs, including:
- Doctor visits
- Preventive care
- Outpatient services
- Durable Medical Equipment (DME)
- Lab work, therapy, and more
What Original Medicare Does Not Fully Cover
While Original Medicare provides important healthcare coverage, it does not fully cover everything. Many people are surprised to learn that Original Medicare generally does not include:
- Routine dental care
- Vision exams or glasses
- Hearing aids
- Prescription drug coverage
- Certain out-of-pocket costs
Because of these gaps, many individuals explore additional coverage options such as:
- Medicare Advantage Plans
- Medicare Supplement (Medigap) Plans
- Prescription Drug Plans (Part D)
Who Is Eligible for Medicare?
You may qualify for Medicare if:
- You are turning 65
- You receive Social Security Disability benefits
- You have ESRD or ALS
- You or your spouse worked and paid Medicare taxes
Some individuals may also qualify for premium-free Part A based on work history.
Understanding Medicare Part A Costs
Many people assume Medicare covers everything — but there can still be out-of-pocket costs depending on the care you receive. Understanding these costs ahead of time can help you avoid surprises and better prepare for your healthcare needs.
Home Health Care
Medicare Part A may cover certain home health care services at no cost to you. However, you may still pay approximately 20% of the Medicare-approved amount for Durable Medical Equipment (DME), such as:
- Walkers
- Wheelchairs
- Oxygen equipment
Hospice Care
If you qualify for hospice care, Medicare generally covers most services at little to no cost. You may still have:
- A small copay (up to $5) for prescription medications related to pain or symptom management
- About 5% of the Medicare-approved amount for inpatient respite care
Please note: Room and board are generally not covered.
Hospital Inpatient Stays
Medicare Part A helps cover inpatient hospital stays, but costs can increase based on the length of your stay.
- You’ll first pay a deductible for each benefit period
- Days 1–60 are typically covered after the deductible
- Daily coinsurance costs may apply after 60 days
- Higher costs may apply if your hospital stay extends beyond 90 days
Inpatient Mental Health Care
Mental health services received during a hospital stay are generally covered under Part A, but you may still pay around 20% of the Medicare-approved amount for services provided by doctors and healthcare professionals.
Skilled Nursing Facility Care
If you qualify for skilled nursing facility care after a hospital stay:
- The first 20 days are generally covered at no cost
- Daily coinsurance may apply for days 21–100
- After 100 days, additional costs are typically your responsibility
Because Medicare costs and coverage can change yearly, it’s important to review your options regularly and understand where additional coverage may help reduce out-of-pocket expenses.
Understanding Medicare Part B Costs
Medicare Part B helps cover many of your everyday medical expenses, including doctor visits, outpatient care, preventive services, therapy, and medical equipment. While Part B provides valuable coverage, there are still some costs you may be responsible for.
Doctor Visits & Medical Services
After meeting your yearly deductible, most people typically pay about 20% of the Medicare-approved amount for:
- Doctor visits
- Outpatient therapy
- Specialist appointments
- Durable Medical Equipment (DME)
Many clinical laboratory services are covered at no additional cost.
Home Health Care
Certain home health care services may be covered at $0 cost to you. However, you may still pay approximately 20% of the Medicare-approved amount for Durable Medical Equipment (DME), such as:
- Wheelchairs
- Walkers
- Oxygen supplies
Outpatient Mental Health Services
Medicare Part B also helps cover mental health services, including:
- Depression screenings
- Counseling and therapy services
- Visits with mental health professionals
While some preventive screenings may be covered at no cost, you may still pay around 20% of the Medicare-approved amount for outpatient mental health visits and services.
Monthly Premium & Yearly Deductible
Most people enrolled in Medicare Part B pay:
- A monthly premium
- A yearly deductible
Your monthly premium is based on your income, and costs can change from year to year.
Applying for Medicare
Applying for Medicare doesn’t have to feel overwhelming. At Frontier Insurance Services, we help simplify the process so you can understand your options and avoid costly mistakes.
Some individuals are automatically enrolled in Medicare, including those who:
- Have been receiving Social Security Disability benefits for 24 months or more
- Have End-Stage Renal Disease (ESRD)
- Receive Railroad Retirement Board (RRB) benefits
If you are turning 65, you can typically apply for Medicare Part A and Part B beginning 3 months before your birthday month.
Why Timely Enrollment Matters
It’s important not to delay enrollment unless you qualify for a special enrollment period. Waiting too long to enroll may result in:
- Lifetime late enrollment penalties
- Coverage gaps
- Higher monthly costs
Late penalties can also apply to:
- Medicare Part D Prescription Drug Plans
- Medicare Supplement (Medigap) plans
Depending on your situation, you may also qualify to enroll in a Medicare Advantage plan during eligible enrollment periods.
Because every situation is different, it’s important to understand your timeline, your options, and what coverage best fits your healthcare and financial needs.
That’s where we come in — helping you solve the Medicare puzzle with confidence.
Need Help Solving the Medicare Puzzle?
Choosing the right Medicare coverage is an important decision — and you don’t have to figure it out alone.
At Frontier Insurance Services, we help you:
✔ Understand your options
✔ Compare plans with confidence
✔ Avoid costly mistakes and penalties
✔ Find coverage that fits your healthcare needs and budget
We’re here to make Medicare easier to understand — one step at a time.