What Is Medicare? A Plain-English Starting Point

Medicare is the federal health insurance program for people 65 and older, plus some younger people with disabilities or kidney failure. The Centers for Medicare & Medicaid Services (CMS) runs it, Social Security handles most sign-ups, and private insurance companies offer the optional plans that sit on top of it. In Nebraska, 398,932 people had Medicare in 2026, according to CMS.

This page is the starting point. Each section links to a deeper guide when you are ready for the details.

What is Medicare, in plain English?

Medicare is health insurance you earn by working and paying Medicare taxes, and it starts for most people at 65. It pays a large share of hospital stays, doctor visits, tests and prescriptions. It does not pay everything. You still have premiums, deductibles and coinsurance, and some services are not covered at all.

Think of it as a base layer. Many people add a second layer to fill gaps: a Medicare Supplement (Medigap) policy and a Part D drug plan, or a Medicare Advantage plan that bundles everything together.

Who qualifies for Medicare?

You qualify for Medicare if you are 65 or older, or younger than 65 in one of a few situations. Here is who is eligible, per the Medicare & You 2027 handbook:

• Age 65 or older. This is how most people get Medicare.
• Under 65 with a disability. You get Parts A and B automatically after 24 months of Social Security disability benefits (or certain Railroad Retirement Board disability benefits).
• ALS (Lou Gehrig's disease). Medicare starts the month your Social Security disability benefits begin.
• End-Stage Renal Disease (ESRD). Permanent kidney failure that needs dialysis or a transplant. You sign up with help from your dialysis facility.

New for 2027 materials: Medicare & You says you must be a U.S. citizen or national, a lawful permanent resident, a Cuban-Haitian entrant, or a COFA migrant lawfully living in the U.S. to get Part A and Part B or join a Medicare plan.

To get Part A without a monthly premium, you or your spouse generally need about 10 years (40 quarters) of work where you paid Medicare taxes. CMS says about 99% of people with Medicare pay no Part A premium. If you are under 65 on disability in Nebraska, see Medicare under 65 on disability.

What are the parts of Medicare?

Medicare has four parts, labeled A through D. Two of them (A and B) are run by the government. The other two (C and D) are sold by private companies under Medicare rules.

Parts A and B together are called Original Medicare. A Medicare Supplement (Medigap) policy is not a "part" of Medicare. It is private insurance that pays some of what Original Medicare leaves behind. For a side-by-side look at each part, read Medicare Parts A, B, C and D explained.

What does Medicare cost in 2026?

Medicare costs real money every month, even for people who pay no Part A premium. These are the official 2026 figures from CMS. The 2027 Part A and Part B amounts are not announced yet; CMS usually releases them in November.

Here is what one healthy year on Original Medicare alone looks like in 2026. Twelve months of the standard Part B premium is $2,434.80. Add the $283 Part B deductible and you have spent $2,717.80 before Medicare pays its 80% on anything. A single $5,000 outpatient surgery would add another $1,000 in coinsurance (20%).

If your income is higher, you pay more for Part B and Part D through IRMAA; see IRMAA brackets for 2026. If your income is limited, Nebraska may help pay your premiums through a Medicare Savings Program.

What is the big choice: Original Medicare or Medicare Advantage?

The biggest decision is how you want to receive your benefits. You can stay with Original Medicare and add coverage around it, or you can join a Medicare Advantage plan.

• Original Medicare + Medigap + Part D. You can see any doctor or hospital in the country that accepts Medicare, with no network. A Medigap policy covers most of your share of costs. You pay three premiums (Part B, Medigap, Part D) but have very predictable bills. Learn more on our Medicare Supplement page.
• Medicare Advantage (Part C). One private plan handles your hospital, medical and usually drug coverage. Many have low premiums, and you still pay your Part B premium. You use a network and may need prior approval for some care. Every plan has a yearly out-of-pocket limit, and the limit varies widely from plan to plan. See Medicare Advantage in Nebraska.

For 2027, CMS says Nebraska has 48 Medicare Advantage plans and 9 standalone Part D plans. Plan availability, premiums, networks and benefits vary by county and change every year. As of June 2026, about 34% of Nebraskans with Medicare were in Medicare Advantage or another health plan, per CMS enrollment data. Our Medigap vs Medicare Advantage comparison walks through the tradeoffs.

How do you sign up for Medicare?

If you already get Social Security or Railroad Retirement benefits at least 4 months before you turn 65, you are enrolled in Parts A and B automatically. Your card arrives about 3 months before your coverage starts.

If you are not drawing Social Security yet, you sign up yourself:

1. Apply online at Social Security (Medicare.gov calls this the easiest and fastest way).
2. Or call Social Security at 1-800-772-1213 (TTY 1-800-325-0778).
3. Or visit your local Social Security office.

Timing matters. Your Initial Enrollment Period is 7 months long, centered on your 65th birthday month. Miss it without other qualifying coverage and you may face a delay plus a late enrollment penalty that lasts as long as you have Part B. Our Medicare enrollment calculator shows your exact window, and the turning 65 checklist lays out the months before your birthday.

Still working at 65? You may be able to wait on Part B without a penalty. Read working past 65 before you decide.

What doesn't Medicare cover?

Original Medicare does not cover several things people assume it does. According to Medicare & You 2027, it does not cover:

• Non-medical long-term care, like help with bathing and dressing in a nursing home or at home
• Most dental care, including cleanings, fillings and dentures
• Eye exams for glasses or contacts
• Hearing aids and exams for fitting them
• Routine physical exams (it does cover a yearly "Wellness" visit)
• Most care outside the United States

Some Medicare Advantage plans add dental, vision or hearing benefits. Standalone plans are another option. The full list, with workarounds, is in what Medicare doesn't cover.

Who runs Medicare, and where can you get unbiased help?

CMS, part of the U.S. Department of Health and Human Services, runs Medicare. Social Security handles enrollment in Parts A and B and collects premiums. Private companies run Medicare Advantage, Part D and Medigap plans.

You have three kinds of help, and you can use all of them:

• Medicare itself. Call 1-800-MEDICARE (1-800-633-4227), available 24 hours a day, 7 days a week (TTY 1-877-486-2048), or use Medicare.gov.
• Nebraska SHIP. The state's counseling program (formerly called SHIIP) is part of the Nebraska Department of Insurance. Its trained volunteers give one-on-one counseling at no cost and do not sell insurance. Call 1-800-234-7119. See Nebraska SHIP and other local help.
• A licensed, independent agent. An agent can compare specific plans from several companies and help you enroll. Bill Jurey's help costs you nothing because carriers pay the agent. Talk to Bill if you want a local person to walk through it with you.