Understanding Medicare Basics: A Simple Guide to Help Make the Most of Your Coverage and Benefits

In this article:

• Medicare is a federal health insurance program that mainly serves patients 65 years and older. 
• Medicare Part A covers hospital and inpatient care, Part B covers medical and preventive care, and Part D covers prescription medications. Medicare Advantage, or Medicare Part C, is another way to receive your Medicare benefits equivalent to Part A and Part B.
• You can enroll within a few months of when you turn 65, and there are some exceptions in case you miss that window or you’re still working when you turn 65.
• Medicare also supports preventive health, with programs such as the Medicare Diabetes Prevention Program (MDPP) to help people with prediabetes make healthy lifestyle changes.
• New Medicare programs include ACCESS, a 10-year pilot program to use technology like digital healthcare to help patients manage chronic conditions.
• Lark can support you 24/7 as you make healthy choices to lose weight and manage blood sugar, blood pressure, or other conditions with or without GLP-1s. 

If you’re near age 65 or over, it may be time to think about Medicare - and you may have a lot of questions! What exactly is Medicare? Who is eligible for Medicare? What are Medicare Parts A, B, C, and D? And what does Medicare cover? 

There’s a lot of information to consider, but here’s a guide to help break it down. This introduction to Medicare can help you understand Medicare basics like what it is, what it covers, and how you enroll. You can also learn about ways Medicare can help you stay healthy - not just treat you when you’re sick - and help manage or prevent chronic conditions through helpful technology. 

What Is Medicare - and Who Is Eligible?

Medicare is a federal health insurance program. The Centers for Medicare and Medicaid Services (CMS) is a federal agency in the US Department of Health and Human Services (DHHS). It administers Medicare. 

Medicare provides coverage for most people age 65 or older. People with end stage renal disease and people under 65 with certain disabilities or medical conditions can also be eligible for Medicare. Medicare covers 70 million Americans, with over 90% of them being over age 65. 

Enrolling in Medicare

Keep in mind that you can only enroll in Medicare at certain times, so it’s important to know when these times are. The most common time to enroll is when you turn 65. If you do this, you can enroll during what’s called your Initial Enrollment Period. This goes from 3 months before you turn 65 to 3 months afterwards. If you are receiving Social Security benefits, you may be enrolled automatically in Medicare. 

If you don’t enroll during your Initial Enrollment Period around when you turn 65, you can enroll during the General Enrollment Period. This happens from January 1 to March 31 of each year. You may also have to pay a penalty for late enrollment - but not always. It depends on factors like whether you or your spouse are still working and have qualifying employer health coverage when you turn 65. If you’re still working, check with your benefits coordinator to find out your options as you decide whether to enroll in Medicare at age 65 or delay. 

You can check the CMS website to learn when you can sign up for Medicare. 

Medicare Parts A, B, C, and D

Medicare is divided into different parts. 

• Medicare Part A
• Medicare Part B
• Medicare Part C
• Medicare Part D

Parts A and B are also called Original Medicare. Medicare Part C is an alternative known as Medicare Advantage. 

The Centers for Medicare and Medicaid Services (CMS) list what each part covers. 

Medicare Part A: Hospital and Inpatient Care

Medicare Part A helps cover: 

• Inpatient hospital stays
• Skilled nursing facility care in certain situations
• Hospice care
• Some home health care

Medicare Part B: Medical Insurance

Medicare Part B helps cover medically necessary outpatient care and services, such as these:

• Doctor visits
• Outpatient procedures and services
• Certain medical equipment
• Mental health services
• Many preventive services and screenings

Part B may cover “necessary” care, but that doesn’t limit it to “urgent” situations. Part B is the part of Medicare that also covers a range of preventive services such as:

• Healthcare that helps prevent health problems
• Screening that detect health problems early so they’re easier to treat or less impactful
• Treatment that helps manage chronic conditions to reduce the risk of complications 

Preventive care can be just as important, since it helps optimize your health.

Medicare Part C: Medicare Advantage

Medicare Part C is also called Medicare Advantage. You can choose a Medicare Advantage plan instead of choosing traditional Medicare Part A and Part B. It just means you won’t get your Part A and Part B benefits through Medicare. You’ll get them through a private health plan instead. 

Here’s what else to know about Medicare Advantage.

• The private health plan is Medicare-approved to offer Medicare Advantage. 
• Medicare Advantage plans must offer at least the same coverage as Medicare Part A and Part B.
• Medicare Advantage plans may offer additional benefits.
• Medicare Advantage plans may include prescription drug coverage. 
• Plans can also have different provider networks, costs, and rules for getting care.

The right choice of whether to go with Medicare Parts A and B or Medicare Advantage depends on things like your health needs, finances, preferences, and the plans available where you live.

Medicare Part D: Prescriptions

Medicare Part D includes coverage for some prescriptions. 

Preventive Care in Medicare and the Medicare Diabetes Prevention Program (MDPP)

Medicare covers many preventive services to help you stay as healthy as possible for as long as possible. Examples of types of preventive services can include:

• Screenings to help find health problems early, like screening for diabetes, depression, and some types of cancer
• Vaccines to lower the risk of certain diseases or make them less dangerous if you get them, such as vaccines for COVID-19 and the flu
• Counseling to help manage conditions, such as nutrition therapy for diabetes
• Wellness visits to give you a chance to connect with your provider

Medicare also covers certain programs that support healthy lifestyle changes. For example, the Medicare Diabetes Prevention Program (MDPP) is for eligible Medicare enrollees who are overweight and have prediabetes, or blood sugar or A1C that’s high, but lower than in diabetes. 

The program is a year-long program designed to help participants make changes to prevent or delay the onset of type 2 diabetes. 

The MDPP includes education, tips, and opportunities to interact with coaches. It’s a structured program that can be more effective than simply being told to “lose weight” or “be more active.” Lark MDPP is a smartphone-based program that you can access anytime, anywhere for personalized coaching and support. 

It’s a fully covered benefit for eligible beneficiaries. 

Medicare and Technology: Digital Health and Improved Health Outcomes

Medicare is making changes as technology develops. An example is the ACCESS Model, or the Advancing Chronic Care with Effective, Scalable Solutions Model. It’s a 10-year CMS Innovation Center program that began in 2026. Its purpose is to make care more accessible and higher quality outside of doctor’s offices using technology. 

The focus of ACCESS shifts to health outcomes - or how well patients do. Traditional healthcare often uses a fee-for-service model - doctors can be paid for the tests they run, not how their patients do. It’s different with ACCESS. Doctors can be paid if their patients’ health improves. 

These are the current areas of care in ACCESS. 

• Early Cardio-Kidney-Metabolic (eCKM) - high blood pressure, obesity, and prediabetes
• Cardio-Kidney-Metabolic (CKM) - diabetes, chronic kidney disease, and cardiovascular disease
• Musculoskeletal - chronic pain
• Behavioral Health - depression and anxiety.

Lark's digital health programs are designed to provide ongoing support through your smartphone. Depending on the program and a person's eligibility, Lark may offer personalized health guidance, educational resources, health tracking, coaching, and connected health devices to help people work toward healthier habits and better health outcomes.

Lark Can Help

Compassionate, personalized coaching can help you reach your weight loss and health goals - and you may be eligible for Lark’s digital coaching at no cost to you. Your Lark coach is available 24/7 for encouragement, nutrition and physical activity coaching, and habit tracking. Lark can help you make healthy choices and establish habits that fit into your lifestyle so you can lose weight and keep it off with or without GLP-1 medications. 

Click here to see if you may be eligible to join Lark today!

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