The four parts of Medicare at a glance
Part A — Hospital Insurance
Free for most people
Covers inpatient hospital stays, skilled nursing facility care, hospice, and some home health care.
Part B — Medical Insurance
$185/month premium (2026)
Covers doctor visits, outpatient care, preventive services, medical equipment, and mental health services.
Part C — Medicare Advantage
Varies by plan
A private plan alternative that bundles Parts A and B, often including Part D and extras like dental and vision.
Part D — Drug Coverage
Varies by plan (~$35–$60/mo avg)
Covers prescription medications. Offered through private insurers approved by Medicare.
Who qualifies for Medicare?
You qualify for Medicare if you are:
- 65 or older and a U.S. citizen or permanent resident who has lived in the U.S. for at least 5 years
- Under 65 with a disability — you automatically get Medicare after receiving SSDI benefits for 24 months
- Any age with End-Stage Renal Disease (ESRD) — permanent kidney failure requiring dialysis or a transplant
- Any age with ALS (Lou Gehrig's disease) — Medicare begins the same month your SSDI starts
Medicare costs in 2026
| What you pay | Part A | Part B |
|---|---|---|
| Monthly premium | $0 for most people* | $185/month |
| Annual deductible | $1,676 per benefit period | $257/year |
| Coinsurance (days 1–60) | $0/day | 20% of approved amount |
| Coinsurance (days 61–90) | $419/day | 20% of approved amount |
*Part A is free if you or your spouse worked and paid Medicare taxes for at least 10 years (40 quarters). If not, you pay up to $518/month in 2026.
When to enroll in Medicare
Missing your enrollment window can result in permanent late penalties, so timing matters:
- Initial Enrollment Period: 7 months surrounding your 65th birthday — 3 months before, the month of, and 3 months after. This is your main window.
- General Enrollment Period: January 1 – March 31 each year, if you missed your initial window. Coverage starts July 1. A late enrollment penalty applies.
- Special Enrollment Period: If you or your spouse were covered by employer insurance when you turned 65, you can enroll without penalty within 8 months of that coverage ending.
Original Medicare vs Medicare Advantage
When you become eligible for Medicare, you choose between two main options:
- Original Medicare (Parts A + B) — the traditional government program. You can see any doctor or hospital that accepts Medicare nationwide. You pay deductibles and 20% of costs. Most people add a Medigap (supplemental) policy and Part D drug plan.
- Medicare Advantage (Part C) — a private insurance plan that replaces Original Medicare. Plans often have lower out-of-pocket costs and include drug coverage and extras like dental and vision. But you are usually limited to the plan's network of providers.
How to enroll in Medicare
Check if you are enrolled automatically
If you are already receiving Social Security benefits when you turn 65, you will be automatically enrolled in Parts A and B. You will receive your red, white, and blue Medicare card in the mail 3 months before your 65th birthday.
If not automatic, sign up online
Go to ssa.gov/medicare to apply online in about 10 minutes. You can also call 1-800-772-1213 or visit your local Social Security office.
Choose your drug coverage (Part D)
If you choose Original Medicare, you should also enroll in a standalone Part D plan to cover prescriptions. Go to medicare.gov/plan-compare to compare plans in your area.
Consider Extra Help for drug costs
If you have limited income and resources, you may qualify for Extra Help — a program that reduces Part D costs to near zero. Apply at SSA.gov or through your state's Medicaid office.
Frequently asked questions
Does Medicare cover dental, vision, and hearing?
Original Medicare does not cover routine dental, vision, or hearing services. Medicare Advantage plans often include these as extra benefits. You can also purchase separate standalone dental or vision insurance.
Can I get Medicare if I never worked?
You may still qualify for premium-free Part A through a spouse's work record. If neither you nor your spouse worked long enough, you can still enroll in Medicare but will pay a monthly premium for Part A (up to $518/month in 2026).
What is Medigap?
Medigap (Medicare Supplement Insurance) is private insurance that fills the gaps in Original Medicare — covering deductibles, coinsurance, and copayments. It is sold by private companies but standardized by the federal government. You cannot have both Medigap and Medicare Advantage.