What is Medicare?
Medicare is the federal health insurance program for people 65 and older, as well as certain younger people with disabilities. Understanding its four parts is essential to making informed healthcare decisions.
Medicare Part A: Hospital Insurance
Part A covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health services.
Key Facts:
- Most people don’t pay a premium if they or a spouse paid Medicare taxes for at least 10 years
- 2026 deductible: $1,632 per benefit period
- Covers up to 60 days in the hospital with no coinsurance
- Standard 2026 monthly premium: $185.00
- Annual deductible: $240
- After deductible, Medicare typically pays 80% of approved costs
- You pay the remaining 20%
- Often includes dental, vision, and hearing coverage
- May have lower out-of-pocket costs
- Usually includes prescription drug coverage
- Coordinated care through a network of providers
- Must use plan’s network of doctors
- May require referrals to see specialists
- Benefits and costs vary by plan and location
- Premiums vary by plan (average ~$55/month in 2026)
- Plans have a formulary (list of covered drugs)
- Late enrollment penalty applies if you don’t enroll when first eligible
- Out-of-pocket cap of $2,000 in 2026 (new under Inflation Reduction Act)
- Original Medicare (Parts A + B) + Medigap supplement + Part D: Maximum flexibility, higher premiums
- Medicare Advantage (Part C): Lower premiums, network restrictions, often bundled benefits
- Medicare.gov: Compare plans in your area
- 1-800-MEDICARE: 24/7 helpline
- State Health Insurance Assistance Programs (SHIP): Free local counseling
- Medicare & You Handbook: Mailed annually to all Medicare beneficiaries
Medicare Part B: Medical Insurance
Part B covers medically necessary services like doctors’ visits, outpatient care, preventive services, and some home health services.
Key Facts:
Medicare Part C: Medicare Advantage
Part C (Medicare Advantage) plans are offered by private insurers approved by Medicare. These plans must provide all Part A and B benefits and usually include prescription drug coverage.
Benefits of Part C:
Considerations:
Medicare Part D: Prescription Drug Coverage
Part D adds prescription drug coverage to Original Medicare. Plans are offered by private insurers and vary in what drugs they cover and at what cost.
Key Facts:
When to Enroll
Your Initial Enrollment Period (IEP) begins 3 months before your 65th birthday month and ends 3 months after. Missing this window can result in permanent premium penalties.
Special Enrollment Periods exist if you’re covered by employer insurance when you turn 65.