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Medicare, in plain English

Benefits for You publishes plain-language information about how Medicare works, what it costs, and the deadlines that are easy to miss.

This site does not sell insurance, does not quote plans, and does not collect your information. It is not affiliated with or endorsed by the U.S. government or the federal Medicare program.

The four parts

Part A — hospital insurance. Covers inpatient hospital stays, skilled nursing facility care after a qualifying hospital stay, hospice, and some home health care. Most people pay no premium for Part A because they or a spouse worked and paid Medicare taxes for at least 10 years. In 2026 the inpatient hospital deductible is $1,736 per benefit period.

Part B — medical insurance. Covers doctor visits, outpatient care, lab work, medical equipment, and preventive services. In 2026 the standard monthly premium is $202.90 and the annual deductible is $283. After the deductible you generally pay 20% of the Medicare-approved amount, and Original Medicare has no yearly cap on what you can pay.

Part C — Medicare Advantage. Private plans approved by Medicare that replace Parts A and B with a single plan, and usually include drug coverage. Most use a provider network. Every plan has a yearly limit on in-network out-of-pocket costs; in 2026 that limit can be no higher than $9,250, and many plans set it lower. You still pay your Part B premium even if the plan's own premium is $0.

Part D — prescription drug coverage. Sold by private plans, either on its own alongside Original Medicare or built into a Medicare Advantage plan. In 2026 the deductible can be no more than $615, and your out-of-pocket spending on covered drugs is capped at $2,100 for the year.

The big choice: Original Medicare with Medigap, or Medicare Advantage

Original Medicare plus a Medigap policy. You can see any doctor or hospital in the country that accepts Medicare, with no network and usually no referrals. A Medigap (Medicare Supplement) policy pays some or all of the costs Original Medicare leaves behind, such as the 20% coinsurance. You add a separate Part D plan for drugs. Premiums are higher, but costs are predictable.

Medicare Advantage. One plan in place of Parts A and B, often with drug coverage and extras such as dental, vision, or hearing. Premiums are often low, but you pay copays as you use care, you are usually limited to a network, and some services need prior approval. The out-of-pocket limit protects you from unlimited costs.

Two things people learn too late:

You cannot use a Medigap policy with Medicare Advantage. They do not work together.
Medigap policies are standardized by letter (for example, Plan G or Plan N). A Plan G from one company covers the same things as a Plan G from another; only the price and service differ. Plans C and F are not available to anyone who became eligible for Medicare on or after January 1, 2020.

Enrollment windows that matter

Initial Enrollment Period. Seven months around your 65th birthday: the three months before your birthday month, the month itself, and the three months after.
Medigap Open Enrollment. Six months that start the first month you are 65 or older and enrolled in Part B. During this window a company cannot refuse to sell you a Medigap policy or charge you more because of your health. After it ends, most states allow companies to use health questions.
Annual Open Enrollment (October 15 – December 7). Join, switch, or drop a Medicare Advantage or Part D plan. Changes take effect January 1.
Medicare Advantage Open Enrollment (January 1 – March 31). If you are in a Medicare Advantage plan, you can switch to another one or return to Original Medicare, once.
General Enrollment Period (January 1 – March 31). For people who missed their Initial Enrollment Period. Coverage starts the month after you sign up, and late penalties may apply.
Special Enrollment Periods. Certain events, such as losing employer coverage or moving, open a window outside the usual dates. If you or your spouse are still working and covered by an employer plan, you generally have eight months after that job or coverage ends to sign up for Part B without a penalty.

Late penalties that can last for life

Part B: 10% added to your premium for each full 12-month period you could have had Part B but did not, usually for as long as you have Part B.
Part D: if you go 63 days or more without Part D or other creditable drug coverage after you first become eligible, a penalty is added to your premium for as long as you have drug coverage.

Help paying for Medicare

Extra Help lowers Part D premiums, deductibles, and copays for people with limited income and resources. You apply through Social Security.
Medicare Savings Programs, run by each state's Medicaid office, can help pay Part B premiums and other costs.
Your State Health Insurance Assistance Program (SHIP) offers free, unbiased one-on-one Medicare counseling. Find yours at shiphelp.org.

Questions worth asking before you choose a plan

Are my doctors and hospitals in this plan's network?
Are my prescriptions on the plan's drug list, and at what tier and cost?
What is the most I could pay out of pocket in a bad year?
Do I need referrals or prior approval for specialists or procedures?
What happens if I travel, or spend part of the year in another state?
How many companies and plans does this agent represent in my area?
If I pick Medicare Advantage now, could I get a Medigap policy later without health questions in my state?

Where to get official information

Medicare.gov, or 1-800-MEDICARE (1-800-633-4227; TTY 1-877-486-2048), available 24 hours a day.
Social Security (ssa.gov) handles enrollment in Parts A and B for most people.
Your SHIP at shiphelp.org for free counseling.

The figures above are for 2026. Medicare announces the next year's premiums and deductibles each fall; plan changes for 2027 can be made during the Annual Open Enrollment Period from October 15 to December 7, 2026.

benefits-for-you.com is an information resource. Nothing on this page is an offer of insurance, a plan recommendation, or advice about your particular situation. It is not affiliated with or endorsed by the U.S. government or the federal Medicare program.

Individual sections of this domain are operated by independent licensed insurance agencies. Those pages identify the agency responsible for them, and any offer or request for your information comes from that agency rather than from this page.

Sources: Centers for Medicare & Medicaid Services, 2026 Medicare Parts A & B Premiums and Deductibles (November 2025); Medicare.gov, enrollment periods, Medigap, and late enrollment penalties; 2026 Part D and Medicare Advantage out-of-pocket limits as published by CMS.

Last reviewed September 2026.