Things You Should Know About Medicare
Medicare programs and policies can change each year, which means you’ll need to review all of your options before you enroll. If you’re new to Medicare, the health insurance landscape can seem even more complex. Let’s break down the essential points to help you make wise health care decisions when choosing a plan.
[READ: How Do You Apply for Medicare?]
1. The Differences Among the Parts of Medicare
Medicare can be broken down into four parts — A, B, C and D — and Medigap.
— Part A is hospital insurance. It covers a portion of the cost of inpatient hospital, skilled nursing facility, hospice and home health care.
— Part B is medical insurance. It usually covers 80% of the costs for visits to the doctor, mental health care, durable medical equipment (such as walkers or wheelchairs) and some outpatient services.
— Part C, also known as Medicare Advantage, refers to plans offered through private insurance companies and approved by the federal government. These plans are comparable to Medicare parts A and B (together known as “original” or “traditional” Medicare) but also offer extra benefits (more on that below).
— Part D is prescription drug coverage. Part D plans are available to original Medicare beneficiaries for an additional monthly plan premium. (Many Medicare Advantage plans include prescription drug coverage; these plans are often referred to as “MAPD”).
— Medigap is supplemental insurance. You can purchase a Medigap plan to cover expenses such as copayments, coinsurance and deductibles. A Medigap plan can only be paired with original Medicare, which doesn’t have a cap on costs. Medicare Advantage, on the other hand, does have an out-of-pocket maximum ($9,250 in 2026), which is why you can’t couple it with a Medigap plan. If you don’t sign up for a Medigap policy as soon as you become eligible for Medicare, you may have difficulty getting it later.
| Part of Medicare | Monthly Premium | Deductible |
| Part A | $0 for most beneficiaries | $1,736 per benefit period |
| Part B | $202.90 | $283 annually |
| Part C (Medicare Advantage) | $14 on average | Varies by plan |
| Part D | $38.99 (base beneficiary premium) | $615 annually |
[READ: Medicare IRMAA: What You Should Know]
2. Medicare Part B Covers Preventive Services
Medicare Part B health coverage provides a wide range of preventive health care benefits at no cost. These include:
— An annual wellness visit
— Cardiovascular disease screenings
— Colorectal cancer screenings
— Certain vaccinations and boosters
It is essential to understand the small print here. For example, Medicare Part B covers wellness visits but not annual physical exams, says Jason Mackey, an insurance advisor for Medicare Blueprint Advisors LLC and an advisor and managing partner for M & A Prime Benefits LLC. Mackey is also the author of “Medicare Blueprint.”
If you’re wondering what the difference between the two is, think of a physical exam as problem-based — trying to find the cause of illness or discomfort — while a wellness exam helps your doctor determine what support you need to remain healthy.
[READ What Is the “Welcome to Medicare” Preventive Visit?]
3. Medicare Advantage Plans Cover Additional Services
Medicare Advantage plans often cover services not provided to original Medicare plan beneficiaries. These perks may include:
— Prescription drug coverage
— An over-the-counter drug allowance
— A fitness benefit, such as a SilverSneakers membership
— Transportation to medical appointments
— Meal delivery services
As attractive as these perks are, it is important to review the entire plan, including all costs and coverage options, before signing up. The network for a Medicare Advantage plan is generally tighter, and you might need prior authorization or a referral to see a specialist. Conversely, many plans come with a $0 premium.
“People get attracted to the fact that many of these (Medicare Advantage) HMOs have no premium, and I think that people get sometimes surprised by the fact that there are copays associated with that,” notes Joel Mekler, a health benefits professional, Medicare expert and writer of the “Medicare Moments” weekly column in the New Castle (Pennsylvania) News. “It is not like they pay $0. They still have to pay their Part B premium plus the copays and coinsurance that are part of an HMO.”
[READ: What to Do When Medicare Advantage Plans Deny Coverage]
4. A Medicare Advantage Plan Might Be Right for You
A Medicare Advantage plan can be the right choice for some individuals, though — and these plans are becoming increasingly popular. According to KFF, more than half of all Medicare beneficiaries were enrolled in a Medicare Advantage plan in 2025.
Mackey recommends a three-step process when reviewing Medicare Advantage plans.
“First and foremost is the cost of my prescriptions,” he says. “The cost can vary widely between plans, so make sure you compare that first. The next is to check the provider networks to make sure the providers you want to see are in the network. Once you have narrowed down your list, then you can compare the benefits, such as copays for services, and the additional benefits, such as dental, vision and hearing coverage.”
5. Some People Should Apply for Medicare If They’re Still Working
In general, if you or your spouse work for a company that insures you and employs more than 20 people, you may be able to delay signing up for Medicare when you turn 65. If your company employs fewer than 20 people, however, you should sign up for Medicare when you become eligible to do so.
You’ll also need to check that the insurance coverage you do have is creditable, meaning it must be likely to pay at least as much as Medicare.
If you’re insured through a retirement or COBRA policy, you should enroll in Medicare when you first become eligible to avoid late enrollment penalties or risk not getting certain kinds of coverage, such as a Medigap policy.
6. You May Qualify for a Medicare Savings Program
Individuals with low incomes may qualify for financial assistance from Medicare Savings Programs to help pay for health care. Unfortunately, it is estimated that only half of the people eligible for one of these programs — which help pay Medicare plan premiums, deductibles, coinsurance and copayments — are enrolled in one.
Many people also don’t take advantage of Medicare Savings Programs because they are complicated and have an expiration date, says Shub Debgupta, founder and CEO at Predict Health, a health care analytics company.
“So, if you don’t refile in time, you lose it,” Debgupta explains, referring to the Medicare Savings Programs. “You’re going along fine, and all of a sudden, your drug subsidy runs out. That’s a huge problem, and it is the number one driver of people dropping out of a plan; it becomes too unaffordable then.”
7. You Can Change Your Medicare Plan
Once you’ve joined a plan during your initial enrollment period, you’ll have the chance to switch plans annually during the fall open enrollment period from October 15 to December 7. You can also switch from original Medicare to a Medicare Advantage plan or join, switch or drop your Medicare prescription drug plan during this time.
The Medicare Advantage open enrollment period runs from January 1 to March 31 each year. During this time, you can either switch from one Medicare Advantage plan to another or from a Medicare Advantage plan to original Medicare with a separate Medicare prescription drug plan.
8. Medicare Changes in 2026
There are a few changes you might see to your plan in 2026.
— Your prescription drug prices may change. The 2026 Medicare Part D design includes a $615 deductible and requires members pay 25% of drug costs after meeting the deductible until they reach the $2,100 annual cap. The 2022 Inflation Reduction Act is part of the reason why seniors may see lowered prices of some prescription medications if they’re enrolled in Medicare Part D. In addition, the new Medicare Prescription Payment Plan offered by insurance carriers allows beneficiaries to spread the costs of expensive drugs out over time.
— You may see decreases in other benefits. As insurers have to cover the cost of more expensive prescription drugs, other benefits may be reduced and other costs may increase. For example, copays and coinsurance may increase, and extra benefits (like dental and eyeglass coverage or gym membership benefits) with Medicare Advantage plans may be reduced, says Barbara Hopkins, a self-employed Medicare educator with nearly 30 years of experience in health payer operations.
— Access to telehealth coverage may change. Those using telehealth services may see changes to their options, especially those who do not live in rural areas. After January 31, 2026, most telehealth services are not offered from home, except for some behavioral and mental health services, as well as stroke and end-stage renal disease care. It’s important to consult your health provider for the most-up-to-date information about using telehealth services.
— You or your family may be able to use GUIDE. Guiding an Improved Dementia Experience Model, or GUIDE, is a pilot program designed to help those with dementia and their caregivers by providing training and support. You can talk with your health care provider about whether they’re participating in this program.
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Things You Should Know About Medicare originally appeared on usnews.com
Update 02/03/26: This story was published at an earlier date and has been updated with new information.