Medicare

Your Medicare path, explained clearly.

The biggest Medicare decisions involve timing, whether to use Original Medicare or Medicare Advantage, prescription coverage, provider access and whether Medigap fits your needs.

Start with the foundation

Medicare is not one single plan. Most people first need to understand Parts A and B, then decide how they want to receive coverage and how they will handle prescription drugs and cost sharing.

Part A — Hospital Insurance

Helps cover inpatient hospital care, skilled nursing facility care, hospice and certain home health services. Most beneficiaries qualify for premium-free Part A based on work history.

Part B — Medical Insurance

Helps cover physicians, outpatient care, durable medical equipment and many preventive and medically necessary services. Part B generally has a monthly premium.

Part D — Prescription Drugs

Private prescription drug coverage. Formularies, pharmacies, drug tiers and utilization rules vary by plan.

Part C — Medicare Advantage

Private plans that provide Part A and Part B benefits and often Part D. Plan networks, service areas, referrals, cost sharing and extra benefits vary.

The central decision

Original Medicare + optional Medigap vs. Medicare Advantage

Question	Original Medicare + Medigap route	Medicare Advantage route
How care is delivered	Original Medicare is federal coverage; a separate Medigap policy can help with eligible cost sharing.	A private Medicare Advantage plan provides Medicare-covered benefits and sets its plan rules.
Provider access	Generally broad access to providers who accept Medicare; Medigap does not create a provider network.	Often uses HMO/PPO or other plan networks. Out-of-network rules vary.
Prescription drugs	Usually add a separate Part D plan if drug coverage is needed.	Many Medicare Advantage plans include Part D, but not all.
Cost structure	Part B premium plus any Medigap and Part D premiums; Medigap can make medical cost sharing more predictable.	Plan premium may be low or $0 in some areas, but copays/coinsurance and a medical maximum out of pocket can apply.
Important tradeoff	Medigap has a one-time federal open enrollment protection when you are 65+ and first enrolled in Part B.	Changing later to Original Medicare does not always guarantee that you can buy the Medigap policy you want.

Plan availability and underwriting rights depend on federal and state rules and your circumstances. Review guaranteed-issue rights before switching coverage.

Enrollment timing

Medicare paths & common pitfalls

Turning 65 and retiring: Build your timeline before employer coverage ends. Confirm when Parts A and B should begin, then coordinate Medigap/Medicare Advantage and Part D.

Turning 65 and still working: Do not assume you can delay Part B simply because you have insurance. The employer size, whose employment the coverage is based on, and whether drug coverage is creditable can matter.

Already on Medicare: Review your coverage every year. Formularies, pharmacy contracts, provider networks, benefits and costs can change.

Leaving Medicare Advantage: Check Medigap eligibility before you disenroll. Outside protected periods, medical underwriting may apply in many situations.

Penalty alert

Medicare late-enrollment penalties can last years or, in many cases, as long as you have the coverage. They are different for Parts A, B and D.

Part A penalty

If you must buy Part A and delay when first eligible, the premium may increase by 10%. Medicare says the penalty is generally paid for twice the number of years you delayed.

Part B penalty

Generally, the premium increases by 10% for each full 12-month period you could have had Part B but did not, unless an exception or Special Enrollment Period applies. The penalty is generally paid for as long as you have Part B.

Part D penalty

If you go 63 days or more without Part D or other creditable prescription coverage after you are eligible, the penalty is generally 1% of the national base beneficiary premium for each full uncovered month and is typically added to your Part D premium for as long as you have Part D.

2026 reference points

Numbers that change each year

These figures are useful illustrations, but they should be updated annually.

Part B standard premium

$202.90/month in 2026 for the standard amount, with higher-income beneficiaries potentially paying more.

Part B annual deductible

$283 in 2026.

Part D maximum deductible

Medicare drug plans may not have a deductible above $615 in 2026; some plans have lower or no deductible.

2026 Part D penalty base

The national base beneficiary premium used to calculate Part D late-enrollment penalties is $38.99 in 2026.

Before you enroll, review five things.

Your doctors and hospitals, every prescription and dosage, preferred pharmacies, expected travel/residence patterns, and your tolerance for monthly premium versus out-of-pocket risk.

Request a Medicare Review