Part A
Hospital Insurance
Inpatient hospital stays, limited skilled nursing facility care, hospice, and some home health services.
How Part A works
- Independent Agency
- Multiple Carriers
- Licensed Advisors
- Ongoing Support
The four parts
Medicare consists of several parts
Part B
Medical Insurance
Doctor visits, outpatient care, lab tests, preventive services, and durable medical equipment.
How Part B worksPart C & Medigap
Advantage and Supplement
Medicare Advantage is another way to get your Medicare benefits. Medicare Supplement (Medigap) works with Original Medicare to help pay cost sharing.
Medicare AdvantagePart D
Prescription Drug Coverage
Helps pay for covered prescription medications through a private, Medicare-approved plan.
How Part D worksEligibility & applying
Who qualifies, and how to apply
Who qualifies for Medicare?
You are eligible for Medicare if you are:
- Age 65 or older
- Under 65 with certain disabilities
- Any age with End-Stage Renal Disease (ESRD)
Tip: Being eligible does not always mean you are enrolled automatically. If you are not already receiving Social Security or Railroad Retirement Board benefits, you generally need to apply to start coverage.
How to apply for Medicare
You apply through the Social Security Administration, not Medicare directly. There are a few ways:
- Online: apply at ssa.gov. This is usually the fastest way to get your Medicare card.
- By phone: call Social Security at 1-800-772-1213 (TTY 1-800-325-0778) and schedule a telephone interview.
- In person: schedule an appointment at your local Social Security office.
Timing
Apply on time to avoid late enrollment penalties
Initial Enrollment Period (IEP)
Starts 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after.
Why apply during your IEP
- Avoid Part B and Part D late enrollment penalties
- Make sure your coverage starts on time, preventing gaps in healthcare and prescription coverage
Still working with employer coverage? Different rules may let you delay. See the Special Enrollment Period.
3 monthsbefore your birthday month
65your birthday month
3 monthsafter your birthday month
Part B
Part B late enrollment penalty
If you delay enrolling in Part B when first eligible, without a qualifying exception, your monthly premium increases by 10% for every full 12 months you were eligible but didn’t enroll. You generally pay it for as long as you have Part B.
Example: if you delay Part B by 2 years, your monthly premium could be 20% higher than the standard $202.90/month, or about $243.48/month.
Part D
Part D late enrollment penalty
If you go without creditable prescription coverage for 63 days or more in a row after your IEP, you may pay a Part D late enrollment penalty: 1% of the national base beneficiary premium for each full month you went without coverage, added for as long as you have Part D.
Example: delaying Part D by 12 months means paying an additional 12% of the national base premium each month.
Sources: Medicare penalty rules
Original Medicare (Parts A & B)
What it covers, and what it costs in 2026
Original Medicare is the traditional federal health insurance program for people who are eligible. For many Part B services you generally pay 20% of the Medicare-approved amount after the deductible; hospital stays follow Part A’s own deductible and coinsurance rules. There is no annual out-of-pocket limit.
| Coverage | Cost (2026) | What It Means |
|---|---|---|
| Part A Deductible | $1,736 Per Benefit Period | Paid at the start of a hospital stay. A benefit period ends after 60 days in a row without inpatient care, so it can apply more than once a year. |
| Part B Premium | $202.90/Month | Paid monthly for medical coverage. A late enrollment penalty or higher income can increase it. |
| Part B Deductible | $283 Per Year | Paid before Part B starts sharing the cost of most services. |
| Part B Coinsurance | 20% of the Medicare-Approved Amount | Example: after the deductible, ten specialist visits approved at $200 each means you pay $400. |
| Skilled Nursing Facility Coinsurance | $217/Day for Days 21–100 | Example: a 30-day Medicare-covered rehab stay means $2,170 for days 21–30. |
| Part A Premium | $0 for Most People | If you or a spouse didn’t pay Medicare taxes long enough, Part A can be purchased: $311 or $565/month in 2026. |
| Part D Premium | Varies by Plan | Each drug plan sets its own premium, deductible and copays. |
Sources: CMS 2026 Part A and Part B costs
Coverage gaps
Why the gaps matter
Original Medicare generally does not cover
- Most retail prescription drugs
- Routine dental, vision, or hearing
- Long-term custodial care
- Cosmetic procedures
Chronic conditions
Conditions such as diabetes, COPD, or heart disease often mean frequent specialist visits, lab work, equipment and medications. Your 20% share can add up over a year, and Original Medicare has no out-of-pocket maximum.
Caregiver insight
Adult children managing a parent’s care benefit from knowing which costs Medicare covers and which it leaves to the family. Unpredictable costs are where additional coverage, such as Medigap or Medicare Advantage, can help.
Summary
Key takeaways and next steps
Key takeaways
- Medicare provides essential coverage for hospital, medical, and preventive services.
- Apply through Social Security, not Medicare. Applying online is usually fastest.
- Apply during your Initial Enrollment Period to avoid lasting Part B and Part D penalties.
- Know your monthly costs and plan for them in advance.
Your next steps
- Understand Original Medicare coverage and its gaps.
- Compare your health needs, doctors and prescriptions against what’s covered.
- Plan for hospital, ambulance and prescription costs.
- Consider whether additional coverage, such as Medigap or Medicare Advantage, fits your situation.
Have questions about getting started?
We can help you understand enrollment timing, review coverage gaps, and prepare questions about your doctors and prescriptions.
Not affiliated with or endorsed by the federal government, Medicare, or the Social Security Administration. This page provides general Medicare education. Social Security or the Railroad Retirement Board handles enrollment in Parts A and B.