Medicare Basics

Understanding the fundamentals of Medicare is essential to making the right choices for your healthcare coverage.

Parts of Medicare

Part A (Hospital Insurance)

Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.

Part B (Medical Insurance)

Covers certain doctors' services, outpatient care, medical supplies, and preventive services.

Part C (Medicare Advantage)

An alternative to Original Medicare offered by private companies. Combines Parts A, B, and usually D.

Part D (Prescription Drugs)

Helps cover prescription drug costs. Run by Medicare-approved private insurance companies.

Medicare Supplements (Medigap)

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

MEDICARE DATA

2026 Medicare Premium & Coverage Information

Up-to-date reference for Medicare costs, coverage details, and comparison information.

Medicare Premiums (2026)

Part B Deductible (2026): $283.00
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
*For individual tax return filers. For married filing jointly, the threshold is doubled.

Medicare Coverage (2026)

Medicare Part A
Coverage
Cost
Details & Notes
Hospital Inpatient Stay
Deductible: $1,736 per benefit period
First 60 Days Cost: You pay $0. Medicare pays
Days 61-100 Cost: You pay $434 a day. Medicare pays the rest.
Days 101-150 Cost: You pay $868 a day. Medicare pays the rest.
Skilled Nursing Facility Care
Only after a 3-day inpatient stay at a hospital.
Days 150+ Cost: You pay 100%
Nursing Care is a technical term and does not include solely custodial care.
First 20 days Cost: You pay $0. Medicare pays.
Days 21-100 Cost: You pay the first $217.00 a day. Medicare pays the rest.
Days 101+: You pay 100%
Inpatient Psychiatric Care
190 days lifetime benefit, Medicare pays 100%

Medigap Coverage

Benefits
Plan A
Plan B
Plan C
Plan D
Plan F
Plan G
Plan K
Plan L
Plan M
Plan N
Medicare Part A Coinsurance and hospital costs up to an additional 365 days after Medicare benefits are used up
Medicare Part B Coinsurance or Copayment
50%
75%
Blood (First 3 Pints)
50%
75%
Part A Hospice Care Coinsurance or Copayment
50%
75%
Skilled Nursing Facility Care Coinsurance
50%
75%
Medicare Part A Deductible
50%
75%
Medicare Part B Deductible
Medicare Part B Excess charges
2026 Out Of Pocket Limit $7,220
2026 Out Of Pocket Limit $3,610

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