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Medicare is the federal health insurance program for people age 65 and older. It also covers some younger people with disabilities or End-Stage Renal Disease (ESRD). Medicare has four parts. Part A pays for hospital care. Part B pays for doctor visits. Part C is Medicare Advantage. Part D pays for prescription drugs. You can get Medicare from the government (called Original Medicare) or through a private plan. A licensed Avid Medicare broker can help you choose at no cost.
Medicare has four parts. Part A covers hospital stays, skilled nursing care, hospice, and some home health care. Part B covers doctor visits, outpatient care, lab tests, and preventive care. Part D covers prescription drugs through a private drug plan. Part C is Medicare Advantage. It bundles Part A, Part B, and usually Part D into one private plan.
Part A is the "hospital insurance" part of Medicare. It pays for hospital stays, skilled nursing care after a hospital stay, hospice, and limited home health care. Most people pay no monthly premium for Part A. You qualify if you or a spouse worked 10 years (40 quarters) and paid Medicare taxes. In 2026, the Part A hospital deductible is $1,736 per benefit period for the first 60 days of hospitalization. After that, other costs will occur.
Part B is the "medical insurance" part of Medicare. It covers doctor visits, outpatient care, medical equipment, mental health care, and preventive care like flu shots. In 2026, the standard Part B premium is $202.90 a month. People with higher incomes pay more. Part B also has a yearly deductible. After you meet it, you usually pay 20% of the approved cost, and there is no cap to this potential cost.
Medicare Part C is also called Medicare Advantage. It lets you get your Medicare benefits through a private insurance company. These plans must cover everything Original Medicare covers. Most also include drug coverage and extra perks like dental, vision, hearing, and fitness benefits. Medicare Advantage plans use networks of doctors and hospitals. Common types are HMO, PPO, PFFS, and Special Needs Plans (SNPs).
Part D is Medicare's prescription drug coverage. Private drug plans approved by Medicare offer Part D. You can add a stand-alone Part D plan to Original Medicare. Or you can get drug coverage built into a Medicare Advantage plan. In 2026, no Part D plan can have a deductible higher than $615. Your yearly out-of-pocket drug costs are capped at $2,100.
Medigap is private insurance that helps pay the costs Original Medicare leaves behind. That includes copays, coinsurance, and deductibles. There are up to 10 Medigap plans. They are named with letters: Plan A, B, C, D, F, G, K, L, M, and N. Each letter plan has the same basic benefits, no matter which company sells it. So the main difference between companies is price. Medigap only works with Original Medicare. You cannot use it with a Medicare Advantage plan.
Medicare Advantage (Part C) replaces Original Medicare with a private plan. It bundles your coverage and often adds extra perks. Upfront costs are usually lower, but you must use a network of doctors. Medigap works with Original Medicare to pay the cost gaps. It gives you more freedom to see any doctor that takes Medicare. You can have one or the other, but not both. The right choice depends on your budget, your health, your doctors, and your travel needs. A licensed Avid broker can compare both for you, for free.
Most people enroll during their Initial Enrollment Period (IEP). This window lasts 7 months. It starts 3 months before the month you turn 65. It also includes your birthday month and the 3 months after. If you miss your IEP, you can sign up from January 1 to March 31 each year. This is called the General Enrollment Period. You may also qualify for a Special Enrollment Period if you delay Medicare due to employer coverage.
Signing up for Medicare requires several steps that can be confusing to navigate. It’s a good idea to speak with a licensed medicare advisor to get an overview of the process and talk through the specifics of your financial situation and healthcare needs. Our team is available to provide a free consultation so you can feel confident in the steps you need to take to enroll.
The Medicare Annual Enrollment Period runs from October 15 to December 7 each year. This is when you can join, switch, or drop a Medicare Advantage plan or Part D drug plan. Any changes you make start on January 1 of the next year. AEP is a good time to review your coverage. Plan benefits, drug lists, and costs can change each year.
The Medicare Advantage Open Enrollment Period runs from January 1 to March 31 each year. If you are already in a Medicare Advantage plan, you can switch to a different one. You can also drop it and go back to Original Medicare. If you go back to Original Medicare, you can add a Part D plan. You only get one change during this period. It is not the same as the fall Annual Enrollment Period.
Your Medigap Open Enrollment Period is a one-time, 6-month window. It starts the first month you are 65 or older and have Part B. During this time, insurance companies must sell you any Medigap plan they offer at the best rate. They cannot turn you down for health problems. Once this window closes, insurers can ask health questions. They can charge more or deny you based on your health. This is the best time to buy a Medigap policy.
A Special Enrollment Period (SEP) lets you sign up for Medicare or change plans outside the normal windows. You can qualify after a life event. Common reasons include losing employer coverage, moving out of your plan's area, or getting Medicaid or Extra Help. You also qualify if your plan ends its contract with Medicare. SEPs have time limits, so you need to act quickly. An Avid broker can check if you qualify and help you enroll on time.
If you skip Medicare when you are first eligible, you may owe a late penalty. This applies if you do not have other qualifying coverage. The Part B penalty is 10% of the standard premium for each full year you waited. The Part D penalty is 1% of the base premium for each month you went without drug coverage. These penalties are added to your monthly premium for life. So it pays to enroll on time.
Medicare is not free. Most people get Part A with no monthly premium. You qualify for free Part A if you or a spouse worked 10 years and paid Medicare taxes. Part B has a standard monthly premium of $202.90 in 2026. People with higher incomes pay more. Part D and Medicare Advantage plans have their own premiums, copays, and deductibles. These vary by plan.
In 2026, the standard Part B premium is $202.90 a month. The Part B deductible is $257 a year. The Part A hospital deductible is $1,736 per benefit period. Part D premiums vary by plan. No Part D plan can have a deductible higher than $615. Your out-of-pocket drug costs are capped at $2,100 a year. Medicare Advantage plan costs vary too. Some plans have $0 premiums.
IRMAA is an extra amount added to your Part B and Part D premiums. It applies if your income is above a set level. Social Security uses your tax return from two years ago to decide. Most people do not owe IRMAA. If a life event lowered your income, you can ask Social Security to recalculate. Retiring or losing a spouse can qualify you for a lower premium.
No, your employer should not pay your Medicare premiums directly. The best way is for you to pay your own premiums. Your employer can raise your salary to help cover the cost. Also, your employer cannot force you off the group health plan when you turn 65. You can stay on it while you are still working. An Avid broker can help you compare your employer plan to Medicare.
Insurance companies pay Avid Health directly. Our services are free to you. You never pay more for a plan by working with us. The carriers set their rates with the government. So the price is the same whether you buy from us, online, or from the carrier. Working with an Avid broker just gives you free, personal help comparing plans.
No, Original Medicare does not cover routine dental care. That means no cleanings, fillings, dentures, or pulled teeth. It only covers dental work tied to a covered medical procedure, like jaw surgery after an accident. Many Medicare Advantage plans do include dental benefits. Some even add it with no extra premium. If dental matters to you, an Avid broker can help you find plans that include it.
Original Medicare covers eye care for medical conditions. That includes cataracts, glaucoma, and diabetic eye disease. It does not cover routine eye exams for glasses or contacts. Most Medicare Advantage plans do include routine vision benefits. These often cover exams, frames, and lenses. Compare Medicare Advantage plans to find vision coverage that fits your needs.
Yes, but only after cataract surgery. Original Medicare pays for one standard pair of glasses or contacts after the surgery. It does not cover routine glasses. Many Medicare Advantage plans give you a yearly allowance for glasses or contacts. Talk to an Avid broker about plans with vision benefits.
No, Original Medicare does not cover hearing aids or routine hearing exams. It does cover hearing tests ordered by your doctor to find a medical problem. Many Medicare Advantage plans include hearing benefits. These often cover exams and give you an allowance for hearing aids. If you need hearing coverage, ask about Medicare Advantage plans that have it.
Yes, Part B covers chiropractic spine adjustments. This is called manual manipulation of the spine to correct a subluxation. A subluxation is when bones in your spine are out of place. Part B does not cover other chiropractor services like X-rays, massage, or acupuncture. You pay 20% of the approved amount after you meet your Part B deductible. Some Medicare Advantage plans offer wider chiropractic benefits.
Yes. Part D covers the shingles vaccine (Shingrix) at no cost to you. Thanks to the Inflation Reduction Act, all adult vaccines that the CDC recommends are free under Part D. There is no copay and no deductible for these shots. You must have Part D coverage to get the shot for free. This can be a stand-alone Part D plan or a Medicare Advantage plan with drugs. The same rule applies to other shots like Tdap and RSV.
Original Medicare does not cover most of the drugs you take at home. To get drug coverage, you need a Part D plan or a Medicare Advantage plan with drugs. In 2026, your yearly out-of-pocket cost for covered drugs is capped at $2,100. After you hit that cap, you pay $0 for covered drugs the rest of the year.
The donut hole, also called the coverage gap, is gone. It was removed starting in 2025. Now Part D has three simple stages: deductible, initial coverage, and catastrophic coverage. Once your drug spending hits $2,100 in 2026, you pay $0 for covered drugs the rest of the year. This $2,100 cap is one of the biggest Medicare changes in decades.
Plan F is the most complete Medigap plan. It covers almost all the costs Original Medicare leaves behind. It pays your Part A and Part B deductibles, copays, coinsurance, and excess charges. It also pays skilled nursing coinsurance. Plan F is only for people who became eligible for Medicare before January 1, 2020. If you turned 65 in 2020 or later, you cannot buy Plan F. But Plan G is very similar.
Plan G covers almost everything Plan F covers. The only thing it does not cover is the Part B deductible ($257 in 2026). After you pay that deductible once a year, Plan G picks up the rest. It pays hospital coinsurance, skilled nursing coinsurance, Part B excess charges, and emergency care abroad. Plan G is the most popular Medigap plan for new enrollees. It gives nearly full coverage at a lower premium than Plan F. Many people save money over time by choosing Plan G.
Plan N covers most of the same things as Plan G, but with two trade-offs. You pay a copay of up to $20 for some office visits. You also pay up to $50 for ER visits that do not lead to an admission. Plan N also does not cover Part B excess charges, which are additional charges over and above what Medicare Part B pays. These excess charges are capped at 15%. Those are the extra amounts some doctors charge above the Medicare-approved rate. Plan N premiums are usually lower than Plan G. It is a good fit if you do not mind small copays.
No. Medigap does not have a yearly enrollment period like Medicare Advantage and Part D do. You can apply to change your Medigap policy any time of year. But in most states, you will have to answer health questions. The new insurer can charge you more or turn you down based on your health. Always wait for the new policy to be approved before you cancel your old one.
You can apply to change your Medigap plan any time of year. Outside of your Medigap Open Enrollment Period, the new insurer will likely use medical underwriting. That means they ask health questions. They can deny you or charge a higher rate based on your health. A few states protect you from this. New York, Connecticut, and Massachusetts let you change plans without underwriting.
Attained-age is one of three ways companies price Medigap plans. With an attained-age policy, your premium starts low when you are younger. But it goes up every year as you get older. The other two methods are issue-age and community-rated. Issue-age is based on your age when you bought the plan. It does not go up just because you get older. Community-rated means everyone pays the same, no matter their age. All three rating methods still have yearly increases for inflation. Avid brokers can show you which method each company uses in your state.
A Medicare SELECT policy is a type of Medigap plan that uses a network. You must use the network doctors and hospitals for full benefits on non-emergency care. This works like an HMO. In return, SELECT policies usually have lower premiums than standard Medigap plans. You have 12 months to switch from a SELECT policy to a standard Medigap policy.
No. You cannot use both at the same time. Medigap only works with Original Medicare. Once you join a Medicare Advantage plan, your Medigap policy will not pay any benefits. It is also illegal for an agent to sell you a Medigap policy if you have Medicare Advantage. You can choose one or the other based on what you need.
It depends on how big your employer is. If you work for a company with 20 or more workers, your employer plan is usually your primary insurance. You can delay Part B without a penalty. If your employer has fewer than 20 workers, Medicare is usually primary. In that case, you should enroll in Part B at 65. Some people enroll in free Part A even when they have employer coverage. An Avid broker can review your case and pick the best path.
Many people work past age 65. That means you have a choice to make. The right path depends on a few things. How big is your employer? How much do you pay for your employer plan? What are the deductibles and out-of-pocket costs? Is your spouse on the plan? Some people keep employer coverage and add just Part A. Others drop the employer plan and pick Medicare with a Medigap or Medicare Advantage plan. There is no one-size-fits-all answer. Get a free comparison from an Avid broker to see what saves you the most.
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