Medicare Basics for 2026

Medicare, a government-run health insurance program, is designed to provide health coverage to people aged 65 and older, as well as some younger individuals with disabilities or specific medical conditions. Understanding the process of enrolling in Medicare and knowing what insurance options are available once you’re enrolled can be confusing, but it’s essential for securing the right health coverage. This guide will walk you through the steps of signing up for Medicare and the various Medicare insurance options available to you.

Understand When You Can Sign Up for Medicare

Before you sign up for Medicare, it’s important to understand the timing of your enrollment. There are several windows during which you can enroll, and failing to sign up during these periods can result in penalties or delays in coverage.

Initial Enrollment Period (IEP)
Your Initial Enrollment Period (IEP) is the seven-month window surrounding your 65th birthday. This includes:

Three months before the month you turn 65.
The month of your 65th birthday.
Three months after the month you turn 65.
If you sign up during your IEP, your coverage will generally begin the first day of the month in which you turn 65. If your birthday falls on the 1st of the month, your coverage will begin the month before.

General Enrollment Period (GEP)
If you miss your IEP, you can enroll during the General Enrollment Period, which runs from January 1 to March 31 each year. However, if you enroll during the GEP, your coverage won’t start until July 1 of that year, and you may face a late enrollment penalty.

Special Enrollment Period (SEP)
If you are still working at age 65 and have health insurance through your employer, you may qualify for a Special Enrollment Period (SEP). The SEP allows you to sign up for Medicare without penalties when you retire or lose your employer-based coverage. This period generally lasts for eight months after your employer health coverage ends.

How to SIgn Up for Medicare Parts A & B

To sign up for Medicare Parts A and B, you can begin by visiting the official Medicare website at www.medicare.gov. If you’re eligible due to Social Security or Railroad Retirement Board (RRB) benefits, you’ll be automatically enrolled in Parts A and B when you turn 65, if you have been receiving them for at least 4 months. If you’re not automatically enrolled, you can sign up during your Initial Enrollment Period, which starts three months before your 65th birthday and lasts for seven months. To sign up, you will need to visit the social security website at www.ssa.gov and apply online. You can visit your local Social Security office to sign up as well. To find a location near you, visit https://secure.ssa.gov/ICON/main.jsp.

A, B, C’s of Medicare Coverage

Once you understand your enrollment windows, you need to decide which Medicare coverage options are right for you. Medicare consists of different parts, each covering different aspects of healthcare.

Medicare Part A: Hospital Insurance
Medicare Part A covers inpatient hospital stays, skilled nursing care, hospice care, and some home health services. Most people don’t have to pay a monthly premium for Part A if they or their spouse paid Medicare taxes while working for at least 10 years.

2026 Medicare Part A Costs

Enrollees age 65 and older who have fewer than 40 quarters of coverage, and certain persons with disabilities, pay a monthly premium in order to voluntarily enroll in Medicare Part A. Individuals who had at least 30 quarters of coverage, or were married to someone with at least 30 quarters of coverage, may buy into Part A at a reduced monthly premium rate, which will be $311 in 2026, a $26 increase from 2025. Certain uninsured aged individuals who have fewer than 30 quarters of coverage, and certain individuals with disabilities who have exhausted other entitlements, will pay the full premium, which will be $565 a month in 2026, a $47 increase from 2025.

Inpatient Hospital Deductible $1736

Daily hospital coinsurance for 61st-90th day $434

Daily hospital coinsurance for lifetime reserve days $868

Skilled nursing facility daily coinsurance (days 21-100) $217

Medicare Part B: Medical Insurance
Medicare Part B covers outpatient care, doctor’s services, preventative services, and some home health services. Part B is optional, but most people enroll in it. There is a monthly premium for Part B, which is based on your income. If you don’t sign up for Part B when you’re first eligible, you may face a late enrollment penalty.

2026 Medicare Part B Costs

$202.90 per month (could be more if you are affected by IRMAA)

$283 Part B Deductible

Medicare Part C: Medicare Advantage Plans
Medicare Part C, also known as Medicare Advantage, is a private health plan that combines coverage from Part A and Part B, and often includes additional benefits such as prescription drug coverage (Part D), dental, vision, and hearing coverage. These plans are offered by private insurance companies approved by Medicare and may have different costs and coverage options.

Medicare Part D: Prescription Drug Coverage
Medicare Part D helps cover the cost of prescription medications. Part D plans are offered by private insurance companies and are available to anyone enrolled in Medicare. You can either:

Enroll in a stand-alone Part D plan to add drug coverage to Original Medicare.
Choose a Medicare Advantage plan that includes Part D prescription drug coverage.
Like Part B, there is a monthly premium for Part D, and the amount you pay depends on your income. If you don’t enroll in Part D when you’re first eligible, you may face a late enrollment penalty. You can search for plans and enroll here.

Key Differences Between Medicare Advantage and Medigap

Coverage: Medicare Advantage plans replace Original Medicare and may offer additional benefits such as prescription drug coverage and extras like dental, vision, and wellness services. Medigap, on the other hand, supplements Original Medicare by covering its out-of-pocket costs but doesn’t provide extra benefits like vision or dental.

Costs: Medicare Advantage plans often have low or $0 premiums, but you’ll still need to pay the Part B premium and could face copayments and coinsurance for healthcare services. Medigap plans have higher premiums but generally lower out-of-pocket costs when you need care. You’ll also need a Part D plan for prescription coverage if you choose Medigap.

Provider Flexibility: With Medicare Advantage, you often have to use in-network providers, and you may need referrals for certain specialists. With Medigap, you can see any doctor who accepts Medicare without referrals, providing more flexibility in choosing healthcare providers.

Out-of-Pocket Costs: Medicare Advantage plans come with an annual out-of-pocket maximum, which caps how much you pay for covered services each year. Medigap plans help cover your out-of-pocket costs from Original Medicare, but there is no cap on your out-of-pocket spending with Original Medicare itself.

Which Option is Right for You?

Choosing between a Medicare Advantage plan and a Medicare Supplement plan depends on your health needs, budget, and preferences. If you want an all-in-one plan that combines your Medicare coverage with additional benefits like prescription drug coverage and extras such as dental or vision care, a Medicare Advantage plan might be a good fit for you.

On the other hand, if you prefer the flexibility of seeing any doctor who accepts Medicare and want to minimize out-of-pocket costs when you need care, a Medigap plan might be the better option. Keep in mind that if you choose Medigap, you will need to enroll in a separate Part D plan for prescription drug coverage, and you will have to pay the premiums for both Medigap and Part B.

Carefully assess your healthcare needs, budget, and how much flexibility you want in your coverage before making a decision. Both options have their advantages, so it’s important to review the plans available in your area and choose the one that best fits your lifestyle and medical needs.

Conclusion

Navigating the Medicare system can be overwhelming, but by understanding when to enroll and exploring your insurance options, you can make an informed decision about your healthcare coverage. Whether you choose Original Medicare with a Medigap plan or a Medicare Advantage plan, it’s important to review your options, costs, and coverage needs to ensure you have the right plan for your situation. With careful planning and knowledge, you can maximize your benefits and ensure you receive the healthcare you need during your retirement years. Book a call on our calendar so we can walk you through all of your options.