Medicare covers more than 68 million Americans, yet its parts, deadlines, and choices confuse nearly everyone at first. This guide breaks it down in plain English so you can enroll with confidence.
What are the four parts of Medicare?
Medicare is split into four parts. Part A covers inpatient hospital stays, skilled nursing, hospice, and some home health, and is premium-free for most people. Part B covers doctor visits, outpatient care, preventive services, and durable medical equipment, with a standard 2026 premium of $202.90 per month (CMS). Together, Parts A and B are called Original Medicare. Part C, or Medicare Advantage, is a private bundled alternative. Part D covers prescription drugs through private plans. Many seniors add a Medicare Supplement (MEDIGAP) policy to Original Medicare to help pay deductibles and coinsurance. Understanding which parts you need is the first step, and 1-800-MEDIGAP can map it out for you.
Who is eligible for Medicare and when?
Most people qualify for Medicare at age 65. You are also eligible at any age if you have received Social Security Disability Insurance for 24 months, or if you have end-stage renal disease or ALS. You generally qualify for premium-free Part A if you or your spouse paid Medicare taxes for at least 10 years (40 quarters). If you already receive Social Security benefits, you are enrolled automatically. If not, you must sign up during your seven-month Initial Enrollment Period, which begins three months before the month you turn 65. Missing it can mean lifelong penalties, so call 1-800-MEDIGAP to confirm your dates.
How much does Medicare cost in 2026?
Medicare is not free. In 2026, the Part A inpatient hospital deductible is $1,736 per benefit period, and most people pay no Part A premium. The standard Part B premium is $202.90 per month with a $283 annual deductible, and higher earners pay more through IRMAA surcharges (CMS). After meeting the deductible, Original Medicare typically pays 80% of Part B costs, leaving you responsible for the other 20% with no out-of-pocket cap. That coverage gap is why many seniors buy a MEDIGAP supplement. Part C and Part D premiums vary by plan and location. A licensed agent at 1-800-MEDIGAP can estimate your total costs.
Original Medicare vs Medicare Advantage: which should you choose?
Original Medicare (Parts A and B) lets you see any doctor or hospital nationwide that accepts Medicare, with no networks and no referrals. You can add a standalone Part D drug plan and a MEDIGAP policy to limit out-of-pocket costs. Medicare Advantage (Part C) bundles A, B, and usually D into one private plan, often with extras like dental or vision, but it uses provider networks and prior authorization. Neither is universally better; the right choice depends on your doctors, prescriptions, travel, and budget. Switching later can be limited by medical underwriting on MEDIGAP, so the decision matters. Call 1-800-MEDIGAP to compare side by side.
What does Medicare not cover?
Original Medicare leaves notable gaps. It generally does not cover routine dental, vision, or hearing care, eyeglasses, hearing aids, most long-term custodial nursing home care, or care received outside the United States. It also has no annual out-of-pocket maximum, so a serious illness can produce unlimited 20% coinsurance. These gaps are exactly what Medicare Supplement (MEDIGAP) plans and, separately, Part D drug plans are designed to address. Knowing the holes before you enroll prevents costly surprises. The licensed agents at 1-800-MEDIGAP review your situation at no charge and explain how to fill each gap.