Everything you need to understand Medicare enrollment, costs, and your coverage options — in plain language, not insurance jargon.
Medicare is divided into four parts — each covering a different aspect of your healthcare. Understanding what each part does is the foundation of every Medicare decision you'll make.
Missing Medicare enrollment windows can cost you permanently higher premiums for the rest of your life. These dates matter.
Unlike most penalties, Medicare's late enrollment penalties don't go away — they follow you for life. A 2-year delay in Part B means a 20% premium surcharge forever. Don't miss your windows.
Your first opportunity to enroll in Medicare. It runs for 7 months — starting 3 months before your 65th birthday month, including your birthday month, and ending 3 months after.
IEP opens — you can enroll in Parts A and B immediately. Coverage starts the first day of your birthday month.
Still within IEP. If you enroll now, coverage starts the first day of the following month.
IEP closes. Coverage is delayed by 1–3 months depending on when you enroll. Don't wait if you need immediate coverage.
If you or your spouse are still working and covered by an employer group health plan, you qualify for a Special Enrollment Period. You have 8 months after employment or employer coverage ends to enroll in Part B without penalty.
Important for COBRA and marketplace plan holders: COBRA coverage and ACA marketplace plans do NOT qualify as creditable coverage for purposes of avoiding the Part B late penalty. Only active employer group coverage counts. If you're on COBRA, enroll in Medicare during your IEP.
If you missed your IEP and don't qualify for a SEP, you can enroll during the General Enrollment Period: January 1 – March 31 each year, with coverage starting July 1. Late enrollment penalties apply.
Runs October 15 – December 7 every year. This is when you can switch Medicare Advantage plans, change Part D drug plans, or move between Original Medicare and Medicare Advantage. Changes take effect January 1.
Medicare costs change slightly each year. Here are the 2026 figures for standard beneficiaries — those not subject to IRMAA surcharges.
| Coverage | Premium | Deductible | Your Share |
|---|---|---|---|
| Part A | $0 (most people) | $1,736/benefit period | $0 days 1–60; $434/day days 61–90 |
| Part B | $185/month | $283/year | 20% of approved costs (no cap) |
| Part C (MA) | Varies ($0–$100+/mo) | Varies by plan | Varies — plans have out-of-pocket maximums |
| Part D | ~$39–$60/month avg | Up to $590/year | Copays/coinsurance per tier |
| Medigap | $100–$300+/month | None (most plans) | Little to none after deductible |
This is the most important Medicare decision most retirees face. Both fill gaps in Original Medicare — but they work very differently.
| Factor | Medigap (Supplement) | Medicare Advantage (Part C) |
|---|---|---|
| How it works | Supplements Original Medicare (A+B) — pays costs Medicare doesn't | Replaces Original Medicare — you use the plan instead |
| Monthly cost | Higher premium ($100–$300+/mo) | Lower or $0 premium (often) |
| Provider access | Any doctor/hospital that accepts Medicare — nationwide | Network-based — must use in-network providers |
| Out-of-pocket max | Essentially $0 (most plans cover 20% gap) | Set by plan — typically $3,000–$8,000/year |
| Referrals needed | No | Often yes (HMO plans) |
| Drug coverage | Need separate Part D plan | Usually included |
| Best for | Those who travel, want any doctor, or have serious health conditions | Those who are healthy, stay local, and want low premiums |
The key tradeoff: Medigap costs more monthly but gives you predictable, near-zero out-of-pocket costs. Medicare Advantage costs less monthly but can expose you to thousands in out-of-pocket costs if you become seriously ill. Your health status, travel habits, and financial situation should drive this decision.
Compare Medicare Advantage and Medigap plans from top insurers side by side. Free to use — licensed agents available.
Get personalized Medicare plan recommendations matched to your doctors, drugs, and budget. No cost to you.
State Health Insurance Assistance Program — free, unbiased Medicare counseling from trained volunteers. No sales pitch.
⚖️ RetireCalm™ may receive a referral fee when you use partner links — at no cost to you. We always include free options.
Part D covers prescription drugs. If you're on Original Medicare, you need a standalone Part D plan. Most Medicare Advantage plans include drug coverage.
Each Part D plan has a formulary — a list of covered drugs organized into tiers, with different copays at each tier. Generic drugs are cheapest; specialty drugs are most expensive.
The most important step: enter your specific medications into Medicare's Plan Finder tool before choosing a plan. Formularies vary significantly — the cheapest premium is rarely the cheapest total cost.
🏛️Medicare Plan Finder — Compare Part D Plans with Your Drugs→If your income exceeds certain thresholds, you'll pay more for Parts B and D. This surcharge is called IRMAA — Income-Related Monthly Adjustment Amount.
IRMAA is based on your income from 2 years prior. In 2025, your IRMAA is based on your 2023 tax return.
| 2024 Individual Income | 2024 Joint Income | 2026 Part B Premium |
|---|---|---|
| ≤ $109,000 | ≤ $218,000 | $202.90/mo (standard) |
| $109,001–$137,000 | $218,001–$274,000 | $284.10/mo |
| $137,001–$171,000 | $274,001–$342,000 | $405.80/mo |
| $171,001–$206,000 | $342,001–$412,000 | $527.50/mo |
| $206,001–$500,000 | $412,001–$750,000 | $649.20/mo |
| Above $500,000 | Above $750,000 | $689.90/mo |
Had a major life event? If your income dropped significantly due to retirement, divorce, death of a spouse, or loss of income-producing property, you can appeal your IRMAA using Form SSA-44. You don't have to wait 2 years for your income change to be reflected.
If you or your spouse are still working and covered by an employer group health plan with 20+ employees, you have options.
Always verify Medicare information with official government sources. Here are the most useful:
🏛️Medicare.gov — Official Medicare Website→ 🔍Medicare Plan Finder — Compare All Plans in Your Area→ 📞SHIP — Free State Medicare Counseling (No Sales Pitch)→ 🏛️Social Security Administration — Medicare Enrollment→ 💰Medicare.gov — 2025 Costs at a Glance→ 💊GoodRx — Free Prescription Discount Card (Works with Medicare Part D)→