Medicare Basics
Understanding the fundamentals of Medicare is essential to making the right choices for your healthcare coverage.
Parts of Medicare
Hospital Insurance
Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.
Medical Insurance
Covers certain doctors' services, outpatient care, medical supplies, and preventive services.
Medicare Advantage
An alternative to Original Medicare offered by private companies. Combines Parts A, B, and usually D.
Prescription Drugs
Helps cover prescription drug costs. Run by Medicare-approved private insurance companies.
Medicare Supplements
Policies sold by private companies that help pay costs not covered by Original Medicare.
Medicare Eligibility
Age-Based Eligibility
U.S. citizens and permanent residents who are 65 years or older.
Disability-Based Eligibility
- Received Social Security Disability Insurance (SSDI) for 24 months
- Have Amyotrophic Lateral Sclerosis (ALS)
- Have End-Stage Renal Disease (ESRD)
Work Credits
Most people need 40 work credits (about 10 years of work) to qualify for premium-free Part A.
Enrollment Deadlines
Initial Enrollment Period (IEP)
The 7-month period around your 65th birthday
- 3 months before your 65th birthday
- The month of your 65th birthday
- 3 months after your 65th birthday
Annual Enrollment Period
October 15 – December 7 each year
Medicare Advantage Open Enrollment
January 1 – March 31 each year
Special Enrollment Periods
Based on certain life events
2026 Medicare Premium & Coverage Information
Up-to-date reference for Medicare costs, coverage details, and comparison information.
Medicare Premiums (2026)
| Individual | Joint | Part B Premium | Part D Premium |
|---|---|---|---|
| $109,000 or less | $218,000 or less | $202.90 | Plan Premium |
| $109,001 – $137,000 | $218,001 – $274,000 | $284.10 | $14.50 + Plan Premium |
| $137,001 – $171,000 | $274,001 – $342,000 | $405.80 | $37.50 + Plan Premium |
| $171,001 – $205,000 | $342,001 – $410,000 | $527.50 | $60.40 + Plan Premium |
| $205,001 – $500,000 | $410,001 – $750,000 | $649.20 | $83.30 + Plan Premium |
| $500,000+ | $750,000+ | $628.90 | $85.80 + Plan Premium |
Medicare Coverage (2026)
Medicare Part A
- •Inpatient hospital deductible: $1,716 (2026)
- •Days 61–90 coinsurance: $429/day
- •Lifetime reserve days: $858/day
- •Skilled Nursing days 21–100: $214.50/day
Medicare Part B
- •2026 Annual Deductible: $283
- •After deductible: 20% of Medicare-approved costs
- •No annual out-of-pocket maximum
- •Most outpatient services covered
Medicare Advantage (Part C)
- •2026 Out-of-Pocket Limit: $9,250 (in-network)
- •Combined in/out-of-network limit: $13,875
- •Bundles Parts A, B, and usually D
- •Network restrictions typically apply
Medigap (Plans G & N)
- •2026 Plan G High-Deductible: $2,870
- •Plan N copays: up to $20 office / $50 ER
- •Standardized federal benefits
- •No network — any provider accepting Medicare
Medigap Plan Coverage Comparison (2026)
Medigap benefits are standardized by the federal government. Every plan of the same letter offers identical benefits, no matter which company sells it.
| Benefit | Plan A | Plan B | Plan C | Plan D | Plan F | Plan G | Plan K | Plan L | Plan M | Plan N |
|---|---|---|---|---|---|---|---|---|---|---|
| Part A coinsurance & hospital costs (up to 365 extra days) | Covered | Covered | Covered | Covered | Covered | Covered | Covered | Covered | Covered | Covered |
| Part B coinsurance or copayment | Covered | Covered | Covered | Covered | Covered | Covered | 50% | 75% | Covered | Covered |
| Blood (first 3 pints) | Covered | Covered | Covered | Covered | Covered | Covered | 50% | 75% | Covered | Covered |
| Part A hospice care coinsurance or copayment | Covered | Covered | Covered | Covered | Covered | Covered | 50% | 75% | Covered | Covered |
| Skilled nursing facility care coinsurance | Not covered | Not covered | Covered | Covered | Covered | Covered | 50% | 75% | Covered | Covered |
| Part A deductible | Not covered | Covered | Covered | Covered | Covered | Covered | 50% | 75% | 50% | Covered |
| Part B deductible | Not covered | Not covered | Covered | Not covered | Covered | Not covered | Not covered | Not covered | Not covered | Not covered |
| Part B excess charges | Not covered | Not covered | Not covered | Not covered | Covered | Covered | Not covered | Not covered | Not covered | Not covered |
| Foreign travel emergency (up to plan limits) | Not covered | Not covered | 80% | 80% | 80% | 80% | Not covered | Not covered | 80% | 80% |
✓ = plan pays 100% of this benefit. A percentage means the plan pays that share of the cost.
Plans C and F are only available to those who became eligible for Medicare before January 1, 2020. Plans F and G also offer high-deductible versions.
Plan N pays 100% of the Part B coinsurance, except for copays of up to $20 for some office visits and up to $50 for emergency room visits that don't result in inpatient admission.
Plans K and L pay the shown percentages until you reach the annual out-of-pocket limit, after which they pay 100% of covered services for the rest of the year.
High-Deductible Plan G provides the same benefits as standard Plan G after you pay $2,950 in eligible out-of-pocket costs in 2026, excluding premiums.
Related Guides
Moving to Medicare
Transitioning from employer coverage, COBRA, or an ACA plan? Understand the timing rules that avoid lifetime penalties.
Enrollment Assistance
One-on-one help navigating Initial, Annual, and Special Enrollment Periods.
Medicare Resources
Free guides, checklists, and worksheets to help you apply what you've learned.
Need Help Understanding Medicare Enrollment?
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