Question 1

When am I eligible for Medicare?

Accepted Answer

Most people become eligible for Medicare at age 65. You may also qualify before 65 if you have received Social Security Disability Insurance (SSDI) for 24 months, or if you have end-stage renal disease (ESRD) or ALS (Lou Gehrig's disease).

Question 2

When should I enroll in Medicare?

Accepted Answer

Your Initial Enrollment Period (IEP) is a 7-month window: 3 months before the month you turn 65, the month you turn 65, and 3 months after. Enrolling during the first 3 months of your IEP ensures your coverage starts on the first day of your birthday month. Enrolling late can result in permanent premium penalties.

Question 3

Do I have to enroll in Medicare at 65 if I am still working?

Accepted Answer

Not necessarily. If you or your spouse has employer-sponsored health coverage through a current employer with 20 or more employees, you can delay Medicare enrollment without penalty. However, you must enroll within 8 months of losing that coverage. If your employer has fewer than 20 employees, Medicare becomes your primary insurance at 65 and you should enroll.

Question 4

How do I enroll in Medicare if I am not collecting Social Security?

Accepted Answer

If you are not yet receiving Social Security benefits, Medicare will not automatically enroll you. You must sign up yourself through Social Security online at ssa.gov, by calling 1-800-772-1213, or by visiting your local Social Security office.

Question 5

What is the Annual Enrollment Period?

Accepted Answer

The Annual Enrollment Period (AEP) runs from October 15 through December 7 each year. During this period, you can switch between Original Medicare and Medicare Advantage, change Medicare Advantage plans, or change your Part D drug plan. Changes take effect January 1 of the following year.

Question 6

What is a Special Enrollment Period?

Accepted Answer

A Special Enrollment Period (SEP) allows you to enroll in or change Medicare coverage outside of standard enrollment windows due to a qualifying life event, such as losing employer coverage, moving out of a plan's service area, or gaining eligibility for Medicaid.

Question 7

What does Medicare Part A cover?

Accepted Answer

Medicare Part A covers inpatient hospital care, skilled nursing facility care (after a qualifying hospital stay), hospice care, and home health services. Most people pay no premium for Part A if they or their spouse paid Medicare taxes for at least 10 years.

Question 8

What does Medicare Part B cover?

Accepted Answer

Medicare Part B covers outpatient medical services including doctor visits, preventive care, lab tests, durable medical equipment, mental health services, and physical therapy. The standard Part B premium in 2026 is $202.90 per month.

Question 9

What is the Medicare Part B deductible in 2026?

Accepted Answer

The Medicare Part B deductible in 2026 is $283. After you meet this deductible, Medicare pays 80% of covered services and you pay the remaining 20% coinsurance.

Question 10

What is the Medicare Part A deductible in 2026?

Accepted Answer

The Medicare Part A inpatient hospital deductible in 2026 is $1,736 per benefit period. This covers your first 60 days of inpatient hospital care. Days 61 through 90 require a daily coinsurance of $422, and days 91 through 150 (lifetime reserve days) require $844 per day.

Question 11

What is IRMAA?

Accepted Answer

IRMAA stands for Income-Related Monthly Adjustment Amount. If your income exceeds certain thresholds, you pay a higher Part B and Part D premium. IRMAA is based on your income from 2 years prior. In 2026, the surcharge begins for individuals with income above $109,000 and couples above $218,000.

Question 12

What is Medicare Advantage?

Accepted Answer

Medicare Advantage (Part C) is an alternative to Original Medicare offered by private insurance companies approved by Medicare. Plans must cover everything Original Medicare covers, but most also include prescription drug coverage, dental, vision, and hearing benefits. You pay a monthly premium to the plan in addition to your Part B premium.

Question 13

What is the difference between an HMO and a PPO Medicare Advantage plan?

Accepted Answer

HMO plans require you to use in-network providers and typically require referrals to see specialists. PPO plans allow you to see out-of-network providers at a higher cost and generally do not require referrals. HMOs tend to have lower premiums; PPOs offer more flexibility.

Question 14

Can I switch from Medicare Advantage back to Original Medicare?

Accepted Answer

Yes. You can switch during the Annual Enrollment Period (October 15 to December 7) or the Medicare Advantage Open Enrollment Period (January 1 to March 31). Be aware that if you switch back to Original Medicare after your initial enrollment, you may not be able to get a Medigap plan without medical underwriting in most states.

Question 15

What is a Medicare Special Needs Plan (SNP)?

Accepted Answer

SNPs are a type of Medicare Advantage plan designed for people with specific chronic conditions (C-SNP), those who are dual-eligible for Medicare and Medicaid (D-SNP), or those living in certain institutions (I-SNP). They offer benefits tailored to the specific needs of their target population.

Question 16

What is a Medigap plan?

Accepted Answer

A Medigap plan (also called Medicare Supplement Insurance) is a private insurance policy that helps pay the cost-sharing gaps in Original Medicare, such as deductibles, coinsurance, and copayments. Medigap plans are standardized by letter (A, B, C, D, F, G, K, L, M, N) and sold by private insurers.

Question 17

What is the best Medigap plan?

Accepted Answer

Plan G is the most comprehensive Medigap plan available to new Medicare enrollees (Plan F is no longer available to those who became eligible after January 1, 2020). Plan G covers the Part A deductible, Part A coinsurance, Part B coinsurance, skilled nursing facility coinsurance, and foreign travel emergency care. You pay only the Part B deductible of $283 per year out of pocket.

Question 18

When is the best time to buy a Medigap plan?

Accepted Answer

The best time to buy a Medigap plan is during your 6-month Medigap Open Enrollment Period, which begins the month you are both 65 or older and enrolled in Part B. During this window, insurers cannot deny you coverage or charge you more due to pre-existing conditions. After this window, you may face medical underwriting.

Question 19

Can I have both Medicare Advantage and a Medigap plan?

Accepted Answer

No. It is illegal for an insurer to sell you a Medigap policy if you are enrolled in a Medicare Advantage plan. Medigap plans only work with Original Medicare (Parts A and B).

Question 20

What is Medicare Part D?

Accepted Answer

Medicare Part D provides prescription drug coverage. It is offered through private insurance companies approved by Medicare. You can get Part D as a standalone plan (if you have Original Medicare) or as part of a Medicare Advantage plan that includes drug coverage (MAPD).

Question 21

What is the Medicare Part D deductible in 2026?

Accepted Answer

The maximum Part D deductible in 2026 is $590. Not all plans charge the full deductible, and some plans waive it for certain drug tiers.

Question 22

What is the Medicare Part D out-of-pocket cap in 2026?

Accepted Answer

Starting in 2025 and continuing in 2026, there is a $2,100 annual out-of-pocket cap on Part D drug costs. Once you reach this cap, you pay $0 for covered drugs for the rest of the year. This is a significant improvement from prior years.

Question 23

What is a formulary?

Accepted Answer

A formulary is the list of prescription drugs covered by a Part D or Medicare Advantage plan. Drugs are organized into tiers, with lower tiers generally having lower copays. Always check that your medications are on a plan's formulary before enrolling.

Question 24

What is the Part D late enrollment penalty?

Accepted Answer

If you go 63 or more consecutive days without creditable prescription drug coverage after your Initial Enrollment Period ends, you may owe a late enrollment penalty. The penalty is 1% of the national base beneficiary premium for each month you went without coverage, added permanently to your monthly Part D premium.

Question 25

What are the Medicare costs in 2026?

Accepted Answer

Key 2026 Medicare figures: Part B premium $202.90/month, Part B deductible $283/year, Part A deductible $1,736/benefit period, Part D out-of-pocket cap $2,100/year, SNF coinsurance (days 21-100) $212/day.

Question 26

What is the Medicare Savings Program?

Accepted Answer

Medicare Savings Programs are state-administered programs that help people with limited income and resources pay Medicare premiums, deductibles, and coinsurance. There are four levels: Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), Qualifying Individual (QI), and Qualified Disabled and Working Individuals (QDWI).

Question 27

What is Extra Help for Part D?

Accepted Answer

Extra Help (also called the Low Income Subsidy or LIS) is a federal program that helps people with limited income pay Part D premiums, deductibles, and copayments. If you qualify, you may pay little or nothing for your prescription drugs.

Question 28

How can I reduce my Medicare costs?

Accepted Answer

Strategies to reduce Medicare costs include: enrolling during your Initial Enrollment Period to avoid late penalties, choosing a Medigap plan to cap your out-of-pocket exposure, comparing Part D plans annually during AEP, using generic drugs when available, and applying for Medicare Savings Programs or Extra Help if you have limited income.

Question 29

Does Medicare cover dental care?

Accepted Answer

Original Medicare does not cover routine dental care such as cleanings, fillings, or dentures. However, many Medicare Advantage plans include dental benefits. Some standalone dental plans are also available to Medicare beneficiaries.

Question 30

Does Medicare cover vision care?

Accepted Answer

Original Medicare does not cover routine eye exams or eyeglasses, except after cataract surgery. Medicare Advantage plans often include vision benefits. Medicare does cover treatment for eye diseases such as glaucoma and macular degeneration.

Question 31

Does Medicare cover hearing aids?

Accepted Answer

Original Medicare does not cover hearing aids or routine hearing exams. Some Medicare Advantage plans include hearing aid benefits with an annual allowance. Costs for hearing aids can range from $1,000 to $6,000 or more per pair.

Question 32

Does Medicare cover physical therapy?

Accepted Answer

Yes. Medicare Part B covers medically necessary physical therapy, occupational therapy, and speech-language pathology with no annual visit cap. You pay 20% coinsurance after the Part B deductible.

Question 33

Does Medicare cover skilled nursing facility care?

Accepted Answer

Yes, with conditions. Medicare Part A covers up to 100 days of SNF care per benefit period after a qualifying 3-day inpatient hospital stay. Days 1 through 20 are fully covered. Days 21 through 100 require a daily coinsurance of $212 in 2026.

Medicare FAQ Center

Eligibility and Enrollment

Medicare Parts A and B

Medicare Advantage (Part C)

Medigap (Medicare Supplement)

Prescription Drug Coverage (Part D)

Costs and Savings

Coverage Questions

Still Have Questions? Talk to a Local Expert.