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Services of 2026

What Is Medicare? Your Introductory Guide To Coverage

Medicare is a federal health insurance program primarily designed for people age 65 and older, though it also covers certain younger individuals with qualifying disabilities, End-Stage Renal Disease (ESRD), or Amyotrophic Lateral Sclerosis (ALS). The program helps eligible beneficiaries access hospital care, doctor visits, preventive services, prescription drug coverage, and other medically necessary healthcare services.

Medicare is different from Medicaid. Medicare is generally tied to age, disability, or certain medical conditions, while Medicaid is a joint federal and state program that helps people with limited income and resources pay for healthcare costs.

Understanding Medicare

Traditional Medicare includes two main components, commonly referred to as Original Medicare: Part A and Part B.

Part A – Hospital Insurance

Medicare Part A helps cover inpatient hospital care, skilled nursing facility care after a qualifying hospital stay, hospice care, inpatient rehabilitation, and some home health care services. In most cases, Part A applies when you are formally admitted to a hospital as an inpatient, rather than simply receiving emergency room care or being kept under observation.

Most Medicare beneficiaries do not pay a monthly premium for Part A because they or their spouse paid Medicare taxes for at least 40 quarters, or about 10 years, while working. If you do not qualify for premium-free Part A, you may be able to buy it. In 2026, the full Part A premium is $565 per month for people with fewer than 30 quarters of Medicare-covered employment. People with 30 to 39 quarters may pay a reduced premium of $311 per month.

Even if you qualify for premium-free Part A, you may still have out-of-pocket costs such as deductibles and coinsurance. In 2026, the Part A inpatient hospital deductible is $1,736 per benefit period. This deductible covers the beneficiary’s share of costs for the first 60 days of Medicare-covered inpatient hospital care during a benefit period.

For longer inpatient hospital stays, 2026 Part A coinsurance is $434 per day for days 61 through 90 and $868 per day for lifetime reserve days. For skilled nursing facility care, the daily coinsurance for days 21 through 100 is $217 in 2026.

Part B – Medical Insurance

Medicare Part B helps cover medical services and supplies needed to diagnose or treat health conditions. This includes doctors’ services, outpatient hospital services, emergency room visits, preventive services, certain home health services, durable medical equipment, and other medically necessary care that is not covered under Part A.

The standard monthly premium for Medicare Part B in 2026 is $202.90. Most beneficiaries pay this standard amount, but people with higher incomes pay more through an Income-Related Monthly Adjustment Amount, also known as IRMAA. For 2026, the standard premium applies to individuals with modified adjusted gross income of $109,000 or less, or married couples filing jointly with income of $218,000 or less.

The annual Part B deductible in 2026 is $283. After meeting this deductible, beneficiaries generally pay 20% of the Medicare-approved amount for most Part B-covered services.

It is important to remember that Original Medicare does not cover every healthcare cost. Beneficiaries are still responsible for premiums, deductibles, coinsurance, and copayments unless they have other coverage, such as Medicaid, employer coverage, or a Medicare Supplement Insurance policy.

Part C – Medicare Advantage

Beyond Original Medicare, private insurance companies offer Medicare Advantage plans, also known as Part C. These plans are approved by Medicare and are designed to replace Original Medicare as the way you receive your Medicare Part A and Part B benefits.

Medicare Advantage plans usually include all benefits covered by Part A and Part B, and many plans also include prescription drug coverage. Some plans may offer extra benefits such as dental, vision, hearing, fitness, transportation, or over-the-counter allowances, depending on the plan and location.

Most Medicare Advantage plans operate through managed care networks, such as HMOs or PPOs. This means you may need to use doctors, hospitals, and pharmacies within the plan’s network to receive the lowest costs. You may also need referrals or prior authorization for certain services.

Part D – Prescription Drugs

Medicare Part D helps cover the cost of prescription medications. This coverage is offered by private insurance companies approved by Medicare and is available to people who have Medicare Part A, Medicare Part B, or both.

You can get Part D coverage through a standalone Prescription Drug Plan that works with Original Medicare, or through a Medicare Advantage plan that includes prescription drug coverage, often called an MA-PD plan.

Part D costs vary by plan and may include a monthly premium, deductible, copayments, and coinsurance. In 2026, no Medicare drug plan can have a deductible higher than $615. Once a beneficiary’s out-of-pocket spending on covered Part D drugs reaches $2,100 in 2026, they enter catastrophic coverage and pay nothing out of pocket for covered Part D drugs for the rest of the calendar year.

Higher-income beneficiaries may pay an additional Part D income-related monthly adjustment amount. In 2026, Part D IRMAA ranges from $14.50 to $91.00 per month, depending on income and tax filing status, in addition to the plan’s premium.

Supplement Plans

Medigap, also called Medicare Supplement Insurance, is extra coverage sold by private insurance companies to help pay some of the costs Original Medicare does not fully cover. These costs can include deductibles, copayments, and coinsurance.

Medigap policies only work with Original Medicare. You cannot use a Medigap policy with a Medicare Advantage plan. If you choose Medicare Advantage, you generally cannot buy or use Medigap to pay your Medicare Advantage out-of-pocket costs.

There are 10 standardized Medigap plan types in most states. Plans with the same letter name offer the same basic benefits, regardless of which insurance company sells them. For example, a Plan G from one insurer must provide the same standardized benefits as a Plan G from another insurer, though premiums and customer service may vary.

Medicare Eligibility

To qualify for Medicare Part A and Part B at age 65, you generally must be a U.S. citizen or a lawful permanent resident who has lived in the United States continuously for at least five years.

Most people qualify for premium-free Part A if they or their spouse worked and paid Medicare taxes for at least 40 quarters. Part B requires a monthly premium for all beneficiaries. The premium amount is set each year, and higher-income beneficiaries pay more based on income reported to the IRS from two years prior.

For 2026, the standard monthly Part B premium is $202.90 for individuals with income of $109,000 or less, or married couples filing jointly with income of $218,000 or less. Beneficiaries above those income limits pay a higher total monthly premium.

No-Premium Part A

Most people receive Medicare Part A without a monthly premium. This usually applies if you or your spouse paid Medicare taxes for at least 10 years, or 40 quarters, while working.

If you do not meet the work-history requirement, you may still be able to buy Part A. In 2026, the reduced Part A premium is $311 per month for people with at least 30 quarters of coverage, or who were married to someone with at least 30 quarters. The full Part A premium is $565 per month for people with fewer than 30 quarters of coverage.

Even when Part A is premium-free, beneficiaries may still pay deductibles, copayments, and coinsurance. For 2026, the inpatient hospital deductible is $1,736 per benefit period.

Typically, Medicare premiums are deducted from Social Security benefits. If you are enrolled in Medicare but are not yet receiving Social Security benefits, you may receive a bill for your premiums instead.

Under 65

People younger than 65 may qualify for Medicare in certain situations.

Social Security Disability Insurance (SSDI) Recipients: People who have received SSDI benefits for at least 24 months are generally eligible for Medicare.

End-Stage Renal Disease (ESRD) Patients: People with permanent kidney failure requiring dialysis or a kidney transplant may qualify for Medicare, with coverage timing depending on their treatment situation.

Amyotrophic Lateral Sclerosis (ALS) Patients: People diagnosed with ALS generally qualify for Medicare as soon as they begin receiving SSDI benefits.

Automatic Medicare Enrollment

Depending on your situation, you may be enrolled in Medicare automatically.

If you are turning 65 and already receive Social Security or Railroad Retirement Board benefits, you are usually automatically enrolled in Medicare Part A and Part B. Coverage generally starts on the first day of the month you turn 65. If your birthday is on the first day of the month, coverage usually starts on the first day of the previous month.

If you are turning 65 and are not receiving Social Security or Railroad Retirement Board benefits, you usually need to sign up for Medicare yourself during your Initial Enrollment Period.

If you are under 65 and qualify due to disability, you are generally automatically enrolled in Medicare Part A and Part B after receiving SSDI benefits for 24 months, unless your qualifying condition is ALS or ESRD, which follow different rules.

How to Sign Up for Medicare

The Social Security Administration handles enrollment for Original Medicare, including Part A and Part B. You can sign up online through Social Security, by phone, or by visiting a local Social Security office.

If you already receive Social Security benefits before turning 65, enrollment may happen automatically. If you are not receiving Social Security benefits, you should take action during your Initial Enrollment Period to avoid delays or potential penalties.

Enrollment Periods

Initial Enrollment

Your Initial Enrollment Period is the seven-month window around your 65th birthday. It begins three months before the month you turn 65, includes your birthday month, and ends three months after your birthday month.

If you qualify for premium-free Part A, your Part A coverage generally starts the month you turn 65. If your birthday is on the first day of the month, coverage starts the month before.

For Part B and premium-Part A, coverage depends on when you sign up. If you sign up before the month you turn 65, coverage starts the month you turn 65. If you sign up during your birthday month or during the three months after, coverage starts the next month.

General Enrollment

If you miss your Initial Enrollment Period and do not qualify for a Special Enrollment Period, you can sign up during the General Enrollment Period. This period runs every year from January 1 through March 31.

If you enroll during the General Enrollment Period, coverage starts the month after you sign up. You may also have to pay a late enrollment penalty if you did not qualify for a penalty-free delay.

Other Enrollment Periods

After you have Medicare, there are other times when you can make changes to your coverage.

The Medicare Open Enrollment Period runs every year from October 15 through December 7. During this period, current Medicare beneficiaries can switch between Original Medicare and Medicare Advantage, change Medicare Advantage plans, join a Part D plan, switch Part D plans, or drop Part D coverage. Changes generally take effect January 1 of the following year.

Special Enrollment Periods may also be available after certain qualifying life events. Examples include losing employer-sponsored coverage, moving out of a plan’s service area, losing Medicaid coverage, or experiencing certain exceptional circumstances.

When Should You Sign Up for Medicare?

When approaching age 65, many people should sign up for both Medicare Part A and Part B during their Initial Enrollment Period. Signing up on time can help avoid gaps in coverage and late enrollment penalties.

You may need to enroll when you first become eligible if your current health insurance comes from an employer with fewer than 20 employees, COBRA, retiree coverage, an Affordable Care Act marketplace plan, short-term insurance, VA benefits, or retiree TRICARE coverage.

If you or your spouse are actively working and covered by an employer group health plan from an employer with 20 or more employees, you may be able to delay Part B without penalty. In that case, you can usually enroll later through a Special Enrollment Period when the employment or group health coverage ends.

COBRA and retiree coverage generally do not count as active employer coverage for delaying Medicare enrollment without penalty. To delay Medicare without penalty, the coverage usually must be based on current employment.

Penalties for Late Enrollment

If you do not enroll in Medicare when first eligible and do not qualify for a penalty-free delay, you may owe late enrollment penalties later.

Part A Penalties: If you are not eligible for premium-free Part A and do not buy it when first eligible, your monthly premium may increase by 10%. You will generally pay this higher premium for twice the number of years you could have had Part A but did not sign up.

Part B Penalties: If you do not enroll in Part B when first eligible and do not qualify for a Special Enrollment Period, your monthly premium may increase by 10% for each full 12-month period you could have had Part B but did not enroll. In most cases, this penalty lasts for as long as you have Part B.

Part D Penalties: If you go 63 or more days in a row without Medicare drug coverage or other creditable prescription drug coverage after your Initial Enrollment Period ends, you may owe a Part D late enrollment penalty. This penalty is generally added to your drug plan premium for as long as you have Medicare drug coverage.