Medicare Explained

Step 1

Understand Medicare

What each of the four parts covers, what it costs, and where the gaps are.

Step 2

Decide which option

A Medicare Supplement with a drug plan, or a Medicare Advantage plan.

Step 3

Decide how to proceed

Compare what’s actually available in your county, then enroll.

Step 1: Understanding Medicare

Medicare has four parts. You may not need all of them. Understanding what each part covers and costs is important so you can make an informed decision. Here’s how they break down for 2026.

Part A — hospital coverage

Hospital coverage, with some hospice care. For most people Part A costs nothing in premiums. It covers your room and board in the hospital for up to 60 days per benefit period with no daily copay once you’ve met the deductible; if you stay longer than 60 days, daily coinsurance applies. The 2026 Part A deductible is $1,736 per benefit period.

Part B — physician and outpatient coverage

Part B costs $202.90 per month in 2026 for most people. It can be higher if your income is above certain thresholds — an IRMAA surcharge — which for higher earners brings the total monthly premium to somewhere between $284.10 and $689.90, depending on income. In some cases help is available if you meet income guidelines.

The premium is typically deducted from Social Security, or billed directly if you’re not yet drawing benefits. Part B has a $283 annual deductible and covers 80% of approved costs after that, leaving you responsible for the remaining 20%. There’s a lifelong late-enrollment penalty if you don’t sign up when first eligible, unless you have qualifying group coverage through your own or your spouse’s current employer.

See Medicare Basics for the full detail on how Parts A and B pay.

Part C — Medicare Advantage

A combined plan that bundles Part A, Part B, and usually Part D into one plan, offered through private companies. Some people choose this route instead of a Medicare Supplement. More on this in Step 2 below.

Part D — prescription coverage

Available either as a standalone plan or built into a Part C Advantage plan. These plans tier your prescriptions — the higher the tier, the higher your copay. As of 2026 the benefit works in three phases: you pay full price up to your plan’s deductible (at most $615, though many plans set it lower or waive it for generics), then typically 25% coinsurance, and once your out-of-pocket spending reaches $2,100 you pay $0 for covered drugs for the rest of the year.

The old coverage gap, or “donut hole,” that used to hit people with expensive prescriptions has been eliminated — this annual cap replaced it. It is still very important to evaluate your specific prescription needs before choosing a plan, since formularies and tiering vary widely. I’m glad to help you with that.

There’s also a lifelong late-enrollment penalty for not carrying some form of Part D-equivalent coverage when you first become eligible, unless you have creditable coverage through an employer, a retirement plan, or VA benefits. See the full Part D page.

Where this leaves you

As you can see, there are gaps in Medicare that could leave you with significant financial responsibility. You do have options to help close those gaps, and there are subsidy programs available if you meet income guidelines. I’m glad to evaluate whether you’d qualify, and to help you apply if needed.

So the question becomes: what’s the best route for you? Medicare has rules every plan must follow, but that doesn’t mean every company and plan is the same — there can be big differences in cost, network, and coverage. Even more, the best plan for your spouse or your neighbor isn’t necessarily the best plan for you. You should weigh cost, prescriptions, medical needs, and provider networks, and these all vary by county.

Because of that, having a local independent agent in your corner is valuable. There’s no extra cost to you, and it means having someone who understands your specific situation and knows you by name. I’m an independent agent appointed with most major Medicare coverage companies — because of that independence, I have no allegiance to any one company, only to you and what’s best for your situation.

Step 2: Deciding Which Option

You essentially have two options for addressing the gaps in Original Medicare.

Option 1: Medicare Supplements (Medigap policies)

These pay secondary to Medicare, covering most or all of the remaining balance after Medicare pays its share. Plan G is now the most popular option for new enrollees. Plan F is no longer available to anyone who became Medicare-eligible on or after January 1, 2020 — if you already have Plan F you can keep it, but new enrollees choose Plan G or another option instead.

With Plan G you pay the Part B deductible ($283 in 2026) but little else out of pocket — you could be hospitalized for months and owe very little. Supplements also let you see any doctor or hospital in the country that accepts Medicare; regardless of the company name on your card, providers accept these plans widely.

Supplement premiums vary by plan, age, location, and carrier, generally running somewhere in the range of $100–$250+ per month depending on the plan and your area — I can pull current quotes for your specific situation. You’ll also need to add a standalone Part D prescription plan, which typically runs $10–$60+ per month depending on the plan, plus your prescription copays.

Option 2: Medicare Advantage plans

These are replacement plans that bundle hospital, doctor, and prescription drug benefits into one plan. You’d use the Advantage company’s card instead of your red, white and blue Medicare card. The federal government pays the insurance company a subsidy, and the company manages your care and billing.

You’ll have copays for office visits, procedures, and hospital stays. These plans typically have lower — sometimes $0 — monthly premiums than Supplements, but more cost-sharing at the point of care. Most operate as PPO or HMO networks, encouraging or requiring you to use in-network providers; out-of-network care may cost more or not be covered at all, and some providers don’t participate. As long as you’re in good health these plans often work well, but the cost-sharing structure matters more if you develop significant health needs. Premiums are often $0–$75+ per month, varying widely by county and plan.

Compare the two options side by side →

Step 3: Deciding How to Proceed

You probably still have questions — I’m glad to answer them. You can reach me any of these ways:

I would welcome the opportunity to serve as your agent and help you evaluate and compare the plans available from the carriers I represent in your county. There’s no extra fee for signing up through me — just personal service. You’ll have me as your dedicated agent, and I’ll follow up to make sure you’re actually enrolled. With one phone line, you won’t be routed through a call center or left speaking with a stranger when you need help.

You’ll also find answers to the questions I hear most often from people coming onto Medicare on the Top 10 Medicare Questions page, and more in the FAQs.

Good luck in your journey — great service and answers to your questions are just a phone call away.

Figures reflect 2026 Medicare costs as published by the Centers for Medicare & Medicaid Services (CMS) and are subject to annual change. Plan premiums cited are general ranges and will vary by carrier, plan, and county — always confirm current rates for a specific plan before enrolling.

Last reviewed: August 2026