Medicare Resources

Everything you need to know about Medicare coverage options, eligibility, and enrollment periods to make informed healthcare decisions.

Medicare Advantage Plans

Medicare Advantage (Part C) plans are offered by private insurance companies approved by Medicare. These plans provide all of your Part A and Part B coverage and often include additional benefits like prescription drug coverage, vision, dental, and more.

Key Benefits:

  • All-in-one coverage (combines Parts A & B)
  • Many plans include prescription drug coverage
  • Additional benefits like dental, vision, and hearing coverage
  • Annual out-of-pocket maximum for covered services
  • Often include fitness benefits and wellness programs

Types of Medicare Advantage Plans

Health Maintenance Organization (HMO)

Requires you to use network providers and get referrals from your primary care doctor.

Preferred Provider Organization (PPO)

Allows you to see any doctor but offers lower costs for using network providers.

Special Needs Plans (SNP)

Tailored benefits for people with specific diseases or characteristics.

Popular Medicare Supplement Plans

F

Plan F

Comprehensive coverage that pays for virtually all out-of-pocket costs.

G

Plan G

Similar to Plan F but doesn't cover the Medicare Part B deductible.

N

Plan N

Lower premium option with some cost-sharing for doctor visits.

Medicare Supplement Plans

Medicare Supplement Insurance (Medigap) helps pay for some of the health care costs that Original Medicare doesn't cover, like copayments, coinsurance, and deductibles. These policies are sold by private companies and can help reduce your out-of-pocket expenses.

Benefits of Medicare Supplements:

  • Freedom to see any doctor that accepts Medicare
  • No network restrictions or referrals needed
  • Standardized benefits - each plan letter offers the same benefits
  • Predictable out-of-pocket costs
  • Coverage when traveling within the U.S. and sometimes abroad

Medicare Part D

Medicare Part D provides prescription drug coverage to Medicare beneficiaries. These plans are offered by insurance companies and other private companies approved by Medicare. Each plan has its own list of covered drugs (formulary) and network of pharmacies.

Key 2026 Features:

  • $2,100 annual out-of-pocket cap – After you have paid $2,100 in deductibles, copays, and coinsurance for covered Part D drugs, you pay $0 for the rest of the calendar year. (The cap is indexed for inflation.)
  • Standard deductible – No higher than $615; many plans offer a lower or $0 deductible.
  • Flat up to 25% cost-sharing – After you meet the deductible, your share for covered drugs can be no more than 25% of the cost, but most plans replace this with lower, fixed copays for many medications; 25% is simply the ceiling until you reach the $2,100 annual out-of-pocket cap.
  • No more "donut hole" math – The coverage-gap phase is eliminated.
  • Catastrophic stage simplified – Hitting the $2,100 cap automatically drops your cost-share to $0.
  • Payment-smoothing option – Beneficiaries may elect to spread their out-of-pocket costs evenly over the year instead of paying large amounts up front.
  • Extra Help (Low-Income Subsidy) – Continues to offer very low premiums and small copays to those who qualify based on income and resources.

2026 Coverage Stages

1. Deductible Stage

You pay 100% of drug costs until your plan's deductible (up to $615) is met.

2. Post-Deductible Coverage

Your share for covered drugs can be no more than 25% of the cost, but most plans replace this with lower, fixed copays for many medications; 25% is simply the ceiling until you reach the $2,100 annual out-of-pocket cap.

3. Out-of-Pocket Cap Reached (Catastrophic)

You pay $0 for covered Part D prescriptions for the remainder of the calendar year.

Note: Plan premiums and the cost of drugs not on your plan's formulary do not count toward the $2,100 cap.

Medicare Enrollment Periods

Understanding when you can enroll in Medicare is crucial for avoiding late enrollment penalties and ensuring you have the coverage you need when you need it.

Initial Enrollment Period (IEP)

Your first opportunity to sign up for Medicare. This 7-month period includes:

  • 3 months before your 65th birthday
  • The month of your 65th birthday
  • 3 months after your 65th birthday
Note: Enrolling before your birth month ensures coverage starts when you turn 65.

Annual Enrollment Period (AEP)

Every year from October 15 to December 7, you can:

  • Join a Medicare Advantage Plan
  • Join a Medicare Part D Plan
  • Switch Medicare Advantage Plans
  • Switch from Medicare Advantage to Original Medicare (or vice versa)
  • Switch Part D prescription drug plans
Note: Changes take effect on January 1.

Special Enrollment Periods (SEP)

You may qualify for a Special Enrollment Period if you experience certain life events, such as:

  • Moving to a new address
  • Losing employer coverage
  • Being eligible for both Medicare and Medicaid
  • Moving into or out of a skilled nursing facility
  • Other qualifying life events

Medicare Advantage Open Enrollment Period

January 1 to March 31 each year. If you're enrolled in a Medicare Advantage plan, you can:

  • Switch to a different Medicare Advantage Plan
  • Drop your Medicare Advantage Plan and return to Original Medicare
  • Sign up for a standalone Medicare Part D plan (if returning to Original Medicare)
Note: You cannot switch from Original Medicare to a Medicare Advantage Plan during this period.

Eligibility Checklist

1

Age Qualification

Are you 65 or older?

2

Disability Status

Have you been receiving Social Security Disability benefits for 24 months?

3

Specific Conditions

Do you have ALS (Lou Gehrig's disease) or End-Stage Renal Disease?

4

U.S. Citizenship/Residency

Are you a U.S. citizen or permanent legal resident of at least 5 years?

Medicare Eligibility

Understanding if you qualify for Medicare is the first step in your healthcare journey. Most people become eligible for Medicare when they turn 65, but there are other qualifying circumstances as well.

You're eligible for Medicare if:

  • You're 65 or older
  • You're under 65 but have been receiving Social Security Disability Insurance (SSDI) for 24 months
  • You have Amyotrophic Lateral Sclerosis (ALS) at any age
  • You have End-Stage Renal Disease (ESRD) requiring dialysis or a kidney transplant

Most people qualify for premium-free Medicare Part A if they've worked and paid Medicare taxes for at least 10 years (40 quarters). If you don't qualify for premium-free Part A, you may still be able to purchase it.