Medicare 101
What Is Medicare?
Medicare is the federal health insurance program for people age 65 and older, and for some younger people with disabilities or specific conditions. It has four parts — A, B, C, and D. Parts A and B together are called 'Original Medicare' and come straight from the federal government; Part C (Medicare Advantage) and Part D (prescription drugs) are sold by private insurance companies that Medicare approves. That mix is what confuses most people, so let's walk through it the way we would at our office on Main Street in Grand Junction.
Part A — hospital insurance
Part A covers inpatient hospital stays, skilled nursing care after a hospital stay, some home health care, and hospice. Most people pay no premium for Part A because they (or a spouse) paid Medicare payroll taxes for at least 10 years — 40 quarters of work. You still have a per-stay hospital deductible; Medicare.gov lists the current-year amount.
Part B — medical insurance
Part B covers doctor visits, outpatient care, lab work, preventive screenings, and durable medical equipment. It has a standard monthly premium that most people pay, plus a small annual deductible. Higher earners pay more through an income surcharge called IRMAA. Part B is the piece you have to enroll in on time to avoid a lifelong penalty.
Part C — Medicare Advantage
Part C, or Medicare Advantage, is a private alternative that bundles Part A, Part B, and usually Part D into one plan — often adding dental, vision, hearing, and an out-of-pocket maximum Original Medicare doesn't have. You trade some provider freedom for a network. In Mesa, Grand, and San Juan Counties the available plans change every year, so which one is 'best' depends on your doctors and drugs.
Part D — prescription drug coverage
Part D covers prescriptions, either as a standalone plan (paired with Original Medicare or a Medigap plan) or built into a Medicare Advantage plan. Every plan has its own formulary — the list of drugs it covers and what tier each one sits on. Starting in 2025 and continuing in 2026, your out-of-pocket drug spending is capped (roughly $2,100 in 2026), so the old 'donut hole' no longer leaves you exposed.
Original Medicare vs. Medicare Advantage — the real fork
This is the decision that matters most. Original Medicare + a Medigap (Supplement) plan + a Part D plan gives you go-anywhere provider freedom and predictable costs, for a higher monthly premium. Medicare Advantage lowers or zeroes the premium and adds extras, but uses a network and copays. Neither is universally better — the right answer depends on your health, whether you travel or winter out of state, and your budget.
How we help — free, no pressure
We're independent, so we don't work for any one carrier. We compare the plans we offer in your county against your specific doctors, prescriptions, and budget, then explain the two or three that actually fit. Our help costs you nothing — carriers pay licensed agents, not you. We do not offer every plan available in your area.
Local Medicare help across the Western Slope
Medicare rules are federal, but the plans, provider networks, and prices are local — and they change every year. Medicare On Main is an independent agency based in Grand Junction, Colorado (Mesa County), serving Grand Junction, Fruita, and Palisade plus Moab (Grand County) and Monticello (San Juan County), Utah — and Brian Penner is licensed in 18 states. We compare the plans we offer in your county against your own doctors, prescriptions, and budget, confirm your local providers are in-network, and stay your advisor for claims, appeals, and the annual review — at no cost to you, because carriers pay licensed agents, not you. That local, year-round help is the difference between reading about Medicare and having a plan built around your life.
Questions, answered
Is Medicare free?
Not entirely. Part A is usually premium-free if you or your spouse paid Medicare taxes for 10+ years. Part B has a standard monthly premium set each year, and Part D and Medicare Advantage premiums vary by plan — some Advantage plans are $0 premium, but $0 premium is not the same as free, because you still have copays and deductibles.
Is Medicare the same as Medicaid?
No. Medicare is federal health insurance based mainly on turning 65 (or disability), regardless of income. Medicaid is a joint state-federal program based on limited income and resources. Some people qualify for both and are called 'dual-eligible,' which often unlocks extra help.
When should I start learning about Medicare?
About 6 months before you turn 65. That gives you time to understand your options before your Initial Enrollment Period opens (the 7 months around your birthday) so coverage is ready the day you're eligible.
Do I need Part D if I don't take any medications?
Usually yes, to avoid a permanent late-enrollment penalty later. A low-cost Part D plan now is almost always cheaper than the penalty you'd owe for life if you sign up after going without creditable coverage.
Can you help me if I live in Moab or Monticello, not Grand Junction?
Yes. We're based in Grand Junction, CO and serve the whole Western Slope plus Moab (Grand County) and Monticello (San Juan County), Utah — and Brian is licensed in 18 states. We meet by phone, video, or in person.
Official Medicare sources
We point you to the federal sources so you can verify everything. For current-year figures and to compare the plans available in your area:
- Medicare.gov — the official U.S. government site for Medicare costs, coverage, and rules.
- Medicare Plan Compare — the official tool to compare Medicare Advantage and Part D plans by ZIP.
- Social Security (ssa.gov) — enroll in Medicare Parts A & B and check your eligibility.
- CMS.gov — Centers for Medicare & Medicaid Services, which runs the program.
Education and estimates only — confirm current figures on Medicare.gov before enrolling. We do not offer every plan available in your area.
Talk to a local Medicare advisor
Free, no pressure — we compare your options for you.
Last updated . Maintained by the Medicare On Main Data Desk · reviewed by Brian Penner, Independent Medicare advisor (NPN 16493717).