Exactly what is Medicare and how many people have it?

More than one million St. Louis-area residents - young and old - depend on Medicare for access to health care.

Medicare is health insurance for Americans age 65 and older, and for some younger people with a qualifying disability. 

Most of its 71 million enrollees qualify due to age, but some eight million of them receive benefits because of a qualifying disability. By 2050, an estimated 92 million Americans will receive Medicare benefits. 

In 2026, the U.S. government will pay a staggering $1.2 trillion on medical and prescription drug costs for people with Medicare. That number, which is increasing faster than inflation, already represents an incredible 21% of all health care spending in America.

There are four parts of Medicare:

Medicare Part A is hospital insurance. While it pays for care when you are admitted to the hospital, this is the part of Medicare that also pays for skilled nursing care, home health care and more.

Medicare Part B is medical insurance. This is the part of Medicare you’ll use for doctor visits, lab tests, ambulance transportation and more.

Someone who has Part A and Part B has what is sometimes called "Original Medicare". Original Medicare does not pay for most dental care, routine vision care or prescription medicines. 

Medicare Part C is also called Medicare Advantage. This is not Original Medicare. Advantage members get their hospital and medical benefits from a private company with a government contract. They typically get extra benefits, too.

Medicare Part D is prescription drug insurance. Most Medicare beneficiaries get Part D coverage through either a Medicare Advantage plan or a standalone Part D drug plan, both of which are offered by private insurance companies, although some veterans choose to get their medicine from a Veterans Affairs pharmacy.

Medicare prescription drug plans have a pharmacy network that their members must use. They also have an approved drug list, called a formulary, broken into tiers. Each tier has its own out of pocket amounts either in the form of a co-pay or co-insurance. 

About the Author

Andrew Shea is an independent insurance advisor who helps St. Louisans compare Medicare plans side by side. He may be reached by calling (636) 495-1180.