Your Simple Guide To How Medicare Works

Medicare Explained For Beginners

The Parts Of Medicare

Understanding Medicare in Quincy and nearby towns starts with the building blocks. This Medicare 101 guide walks through Parts A, B, C, and D so you can see how each piece fits. If you are looking for understanding Medicare Illinois in plain terms, Thomas Family Insurance is here to help you compare options when it is time to choose coverage.


Part A is hospital coverage for inpatient stays, skilled nursing after a qualifying hospital stay, and hospice. Part B is medical coverage for doctor visits, outpatient care, and most preventive services. Part C is Medicare Advantage, which replaces A and B with a private plan and often includes Part D. Part D is prescription drug coverage offered by private plans. Some people add a Medigap policy to help pay what Original Medicare leaves behind.


For a deeper comparison of plan paths, check out Medicare plans.

A family is sitting on the porch of their house next to a swimming pool.
Part A – Hospital Insurance

Part A helps with hospital stays, limited skilled nursing facility care, home health after a qualifying stay, and hospice. Many people receive Part A without a monthly premium based on their work history.

A family is standing in front of a door in a hallway.
Part B – Medical Insurance

Part B helps cover doctor visits, outpatient therapy, durable medical equipment, lab work, imaging, and preventive services like wellness visits and screenings. Most people pay a monthly Part B premium. Higher income can lead to an additional amount called IRMAA. For eligibility timing, review Medicare eligibility to avoid gaps.

Two men are standing in a kitchen talking to each other.
Medicare Advantage

Medicare Advantage plans are offered by private insurers approved by Medicare. These plans replace your Part A and Part B, and many include Part D drug coverage along with extras like dental, vision, or gym benefits. Networks and costs vary by county in Illinois, Missouri, and Iowa. For details, explore Medicare Advantage plans in our service area.

Two men are standing in a kitchen talking to each other.
Part D – Prescription Drug Plans

Part D plans help pay for outpatient prescription drugs. Formularies, pharmacy networks, and premiums differ by plan. Reviewing your medication list each year is smart.

A family is sitting in a car looking out the window.
Medigap – Medicare Supplement

Medigap policies are private plans that help pay costs like coinsurance and deductibles that Original Medicare does not cover. You can pair Medigap with Part D if you want drug coverage.

What Medicare Does Not Cover

Original Medicare leaves some gaps that matter to many families in Quincy, Hannibal, and Keokuk. Routine dental, vision exams for glasses, and hearing aids are not covered by Original Medicare. Long-term custodial care in a nursing home or extended custodial home care is not covered either. Other exclusions may include most cosmetic surgery and some alternative therapies, with limited exceptions. Thomas Family Insurance can show dental and vision options that local seniors often choose to fill these gaps.

Medicare Costs At A Glance

Most people receive Part A with no premium. There is a Part A hospital deductible per benefit period and set daily copays after long stays. Part B has a standard monthly premium and may add IRMAA for higher incomes. With only Parts A and B, you usually pay 20 percent for many outpatient services and there is no out-of-pocket maximum on Original Medicare. This is why many people in Adams County compare Medigap or Medicare Advantage to manage risk. For timing questions, review Medicare enrollment periods before you decide.

Medicare Enrollment Basics

Your Initial Enrollment Period is a seven month window surrounding your 65th birthday. If you or your spouse have creditable employer coverage, you may delay Part B without penalty and enroll later during a Special Enrollment Period. Each fall from Oct 15 to Dec 7, you can switch Medicare Advantage or Part D plans. If you are already in a Medicare Advantage plan, there is an additional window from Jan 1 to Mar 31 to make one change. Moving or losing employer coverage can open special windows as well.

Getting Started With Medicare

Check your eligibility if you are turning 65 or on disability. Enroll in Parts A and B through Social Security, then decide between a Medicare Advantage plan or a Medigap plus Part D path. If you would like personal help near Washington Park, Blessing Hospital, or anywhere in our two hour radius, Thomas Family Insurance offers one to one guidance and free seminars.

Medicare Basics FAQs

  • Who Is Eligible For Medicare

    Most people qualify at age 65 if they are a U.S. citizen or a lawful permanent resident of at least five years. Under 65, Medicare can begin after 24 months of Social Security Disability or immediately with certain conditions like ESRD or ALS.

  • How Do I Sign Up For Medicare

     Enroll through Social Security online, by phone, or at a local office. If you already collect Social Security, you are typically enrolled in A and B automatically at 65. For personal guidance, contact our team in Quincy.

  • What Is The Difference Between Original Medicare And Medicare Advantage

    Original Medicare is government provided Part A and Part B, often paired with a Medigap and a Part D plan. Medicare Advantage is an all in one private plan that replaces A and B and often includes D. Networks and extra benefits vary by plan.