Your Free Turning 65 Medicare Guide

A Closer Look at Medicare, in Plain English

Prefer to read online instead of waiting on an email? Here's an in-depth walkthrough of everything covered in the free guide above — what Medicare is, how it's structured, what it costs in 2026, when to enroll, and how to avoid the most common mistakes.

What Is Medicare, and Who Qualifies?

Medicare is the federal health insurance program run by the Centers for Medicare & Medicaid Services (CMS). It primarily serves people age 65 and older, but it also covers certain younger people with qualifying disabilities and people with End-Stage Renal Disease (ESRD). Eligibility generally comes down to work history: most people (or their spouse) qualify for premium-free Part A after paying Medicare payroll taxes for at least 10 years (40 quarters) of covered employment. You can confirm your own eligibility and work history through the Social Security Administration.

The Four Parts of Medicare

Medicare is broken into four parts, and understanding each one is the foundation for every decision that follows.

Part A — Hospital Insurance. Part A generally helps cover inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. Most people don't pay a monthly premium for Part A because of their work history.

Part B — Medical Insurance. Part B generally helps cover doctor visits, outpatient care, preventive services like screenings and vaccines, and durable medical equipment. Nearly everyone pays a monthly premium for Part B.

Part C — Medicare Advantage. Part C is an alternative way to receive your Part A and Part B benefits (and often Part D) through a private insurance company approved by Medicare. These plans often bundle in extra benefits like dental or vision, but typically require you to use an in-network list of providers.

Part D — Prescription Drug Coverage. Part D helps cover the cost of prescription medications. It's offered through private insurance companies, either as a stand-alone plan alongside Original Medicare or bundled into a Medicare Advantage plan. Going without creditable drug coverage can lead to a lasting late enrollment penalty.

2026 Medicare Costs

Medicare costs are set annually and change every year, so it's worth checking current figures at Medicare.govbefore making decisions. For 2026, the standard Medicare Part B monthly premium is$202.90, with an annual Part B deductible of $283. On the prescription drug side, Medicare Part D now includes a hard annual out-of-pocket cap — for 2026, once your out-of-pocket drug costs reach $2,100, your Part D plan covers your remaining covered drug costs for the rest of the year. Actual premiums for Part C and Part D plans vary by plan and location, since those are sold through private insurance companies.

Enrollment Periods Explained

When you enroll matters just as much as whether you enroll. Medicare uses several distinct windows:

IEP (Initial Enrollment Period) is a 7-month window centered on your 65th birthday — the 3 months before, your birthday month, and the 3 months after. This is typically your first opportunity to enroll.

GEP (General Enrollment Period) runs January 1 through March 31 each year, for people who missed their IEP and don't qualify for a Special Enrollment Period.

SEP (Special Enrollment Period) is triggered by qualifying life events, most commonly losing employer group health coverage or moving to a new service area. SEPs let you enroll or change coverage outside the usual windows.

AEP (Annual Enrollment Period) runs October 15 through December 7 every year. If you're already enrolled in Medicare, this is your annual opportunity to switch Medicare Advantage or Part D plans for the following year.

OEP (Medicare Advantage Open Enrollment Period) runs January 1 through March 31 for people already enrolled in a Medicare Advantage plan. It allows a one-time switch to a different Medicare Advantage plan or back to Original Medicare.

Missing a deadline in any of these windows is one of the most common — and most preventable — Medicare mistakes. Marking these dates on a calendar well before you turn 65, or before each fall's AEP, is a simple step that can save you from a permanent penalty or a gap in coverage.

Medigap: Filling the Gaps in Original Medicare

Original Medicare doesn't cover everything, and it doesn't cap what you could pay out-of-pocket in a given year on its own. Medicare Supplement insurance, commonly called Medigap, is a separate type of private policy designed to help pay some of the costs that Original Medicare leaves behind, such as coinsurance, copayments, and deductibles. Medigap policies are standardized into lettered plans (like Plan G or Plan N), so a given plan letter generally offers the same core benefits no matter which insurance company sells it — though premiums for the same lettered plan can still vary significantly by company and location. Medigap policies work alongside Original Medicare, not Medicare Advantage, and they typically don't include prescription drug coverage, so most people who choose Medigap also enroll in a stand-alone Part D plan.

Medicare Advantage vs. Original Medicare

Original Medicare (Parts A and B) lets you see any provider nationwide who accepts Medicare, with no network restrictions, but it doesn't cap your annual out-of-pocket costs on its own — many people pair it with a Medigap policy and a stand-alone Part D plan. Medicare Advantage (Part C) plans are offered by private insurers, often bundle in Part D and extra benefits like dental or vision, and include an annual out-of-pocket maximum, but typically require you to use an HMO or PPO provider network and may require referrals or prior authorization for certain services. Neither approach is universally better — the right fit depends on your health needs, budget, and which providers you want to keep seeing. See our Medicare Advantage vs. Medigap comparison for more detail.

How to Choose the Right Plan

There's no single "right" Medicare plan — the right choice depends on your own circumstances. Some starting questions worth asking: Do you want to keep seeing specific doctors or specialists, and are they in-network for the plans you're considering? What prescription drugs do you take, and are they on the plan's drug formulary? How much are you comfortable paying monthly in premiums versus paying out-of-pocket if you need care? Do you travel often, which may favor a plan with nationwide coverage? Comparing a small number of specific plans against your own answers to these questions tends to be more useful than looking for a generically "best" plan, since the right plan varies significantly from person to person.

Common Medicare Mistakes to Avoid

A few mistakes show up often enough to be worth calling out. Missing your Initial Enrollment Period without other creditable coverage can lead to permanent late enrollment penalties for Part B and/or Part D. Assuming employer coverage always lets you delay Medicare penalty-free — this generally depends on your employer's size (20+ employees is a common threshold) and whether the coverage is creditable, so it's worth confirming rather than assuming. Not reviewing your coverage annually during AEP — plan costs, drug formularies, and provider networks can all change year to year, so a plan that fit well last year may not be the best fit for next year. And enrolling in a plan based on a single feature (like a low premium) without checking the drug formulary or provider network first.

How a Licensed Insurance Agent Can Help

Medicare's rules, deadlines, and plan options can be a lot to sort through on your own. A licensed insurance agent can walk through your specific situation, help you compare plan options available in your area, and explain how enrollment timing affects you personally — without any obligation to enroll. Kayla Price is a licensed insurance agent (NPN 18530055) with Price Services Group, LLC, who offers free, no-pressure Medicare reviews. This educational guide does not recommend any specific insurance plan or company.

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

Additional Resources

For official, up-to-date Medicare information, visitMedicare.gov, the official U.S. government site for Medicare. For questions about eligibility, enrollment through Social Security, or your work history, visitssa.gov, the official Social Security Administration site.