What is Medicare?
Medicare is the federal health insurance program created in 1965 to provide coverage for Americans 65 and older. It also covers certain younger people with qualifying disabilities and people with End-Stage Renal Disease (ESRD) or ALS (Lou Gehrig's disease).
Medicare is administered by the Centers for Medicare & Medicaid Services (CMS), a federal agency. It is not the same as Medicaid, which is a separate income-based program. Many people confuse the two — you can learn about the Medicare Savings Program if you think you may qualify for extra help with costs.
Medicare is based on age (65+) or disability — not income. Medicaid is based on income and financial need. Some people qualify for both — they are called "dual eligibles" and often receive extra benefits.
Who qualifies for Medicare?
- 1You are 65 or older and a U.S. citizen or permanent legal resident who has lived in the U.S. for at least 5 years.
- 2You are under 65 with a disability and have received Social Security Disability Insurance (SSDI) for at least 24 months.
- 3You have End-Stage Renal Disease (ESRD) — permanent kidney failure requiring dialysis or a kidney transplant.
- 4You have been diagnosed with ALS (Amyotrophic Lateral Sclerosis) — Medicare coverage begins immediately upon receiving disability benefits.
Most people who have worked and paid Medicare taxes for at least 10 years (40 quarters) get Part A at no premium cost. If you haven't worked enough quarters, you can still buy into Medicare.
The four parts of Medicare
Medicare is divided into four parts, each covering different types of care. Understanding each one is the first step to choosing the right plan.
Covers inpatient hospital stays, skilled nursing facility care, hospice, and some home health care.
Covers doctor visits, outpatient care, preventive services, and durable medical equipment.
Private insurance alternative to Original Medicare that often includes dental, vision, hearing, and drug coverage.
Adds prescription drug coverage when you have Original Medicare (Parts A & B). Sold by private insurers.
Original Medicare vs. Medicare Advantage
When you turn 65, you have a fundamental choice: stick with Original Medicare (Parts A + B, with or without a Supplement and Part D), or switch to a Medicare Advantage plan (Part C) offered by a private insurance company.
Original Medicare (Parts A + B)
- Any doctor or hospital that accepts Medicare — nationwide
- No referrals needed to see specialists
- No annual out-of-pocket maximum (unless you add Medigap)
- Separate Part D plan needed for prescriptions
- Best for frequent travelers or those with complex conditions
Medicare Advantage (Part C)
- Often includes dental, vision, hearing, and transportation
- Many plans have $0 monthly premium
- Annual out-of-pocket maximum protects you from large bills
- Usually includes Part D drug coverage
- Network-based — verify your doctors are in-network
Not sure which path is right for you? Our licensed Miami brokers compare both options side-by-side — take our free quiz or call us at 1-800-380-6821.
What does Medicare cost?
Medicare costs depend on which parts you have, your income, and whether you choose Original Medicare or a Medicare Advantage plan.
| Part | 2026 Premium | Deductible / Costs |
|---|---|---|
| Part A | $0 for most people | $1,676 deductible per benefit period; $0 copay days 1–60 |
| Part B | $185/month (standard) | $257 annual deductible; 20% coinsurance after deductible |
| Part C | Varies — many $0 options | Plan-specific; annual OOP maximum required by law |
| Part D | Varies by plan | $590 deductible max (2026); $2,000 annual OOP cap |
| Medigap | $80–$300+/month | Fills gaps in Parts A & B — no network restrictions |
If your income is above a certain threshold, you'll pay a surcharge on top of your Part B and Part D premiums. This is called IRMAA (Income-Related Monthly Adjustment Amount). Learn how IRMAA works and how to appeal it →
When do I sign up?
Missing your Medicare enrollment window can result in permanent late penalties on your Part B and Part D premiums. Key enrollment periods to know:
- Initial Enrollment Period (IEP): A 7-month window starting 3 months before your 65th birthday month.
- Annual Enrollment Period (AEP): October 15 – December 7 each year. Changes take effect January 1.
- Special Enrollment Period (SEP): Triggered by life events like losing employer coverage or moving.
See the complete enrollment periods guide →
Find your exact enrollment window: Use our enrollment calculator to see when you can enroll based on your situation.
Medicare in South Florida
South Florida — especially Miami-Dade, Broward, and Palm Beach counties — has one of the highest concentrations of Medicare Advantage plans in the country. That means more options, but also more complexity.
Local factors that matter when choosing a plan here include: which hospitals and specialists are in-network (Baptist Health, Jackson Health, Cleveland Clinic Florida, etc.), Spanish-language support for bilingual beneficiaries, and the availability of give-back and extra-benefits programs.
Our Doral office specializes in helping Miami-area seniors navigate these choices — completely free of charge.
What's your next step?
Now that you understand the basics, explore these related guides to go deeper on your specific situation: