Medicare Basics — Simple Guide for Seniors Turning 65
What Medicare Is
Medicare is the U.S. federal health insurance program for:
- People 65 and older
- Younger people with certain disabilities
It helps pay for healthcare, but it isn’t free and doesn’t cover everything.
The 3 Main Parts of Medicare
Original Medicare
This is the core program and has two parts:
Part A — Hospital Insurance
Covers:
- Hospital stays
- Skilled nursing care
- Hospice care
- Some home health services
Most people get Part A premium-free if they (or their spouse) worked and paid Medicare taxes for about 10 years. If not, they may pay a monthly premium.
2026 cost highlights:
- Part A premium: $0 for most people
(If you don’t qualify for free Part A, it can be $311 or $565 per month, depending on work history. - Part A inpatient deductible (before Medicare pays): $1,736 per benefit period.
Part B — Medical Insurance
Covers:
- Doctor visits
- Outpatient care
- Lab tests
- Preventive care
- Medical equipment
2026 costs:
- Standard monthly premium: $202.90 (most people pay this)
(Higher-income individuals may pay more due to income-related adjustments.) - Annual deductible: $283
After the deductible, you generally pay 20% of the cost for many services.
Part D — Prescription Drug Coverage
2026 typical costs:
- Average Part D plan premium: around $34.50 per month
- Annual deductible and out-of-pocket limits also apply.
Extra Coverage Options
Since Original Medicare doesn’t cover everything, many people add:
Medicare Supplement (Medigap)
Helps pay deductibles, copays, and coinsurance.
Lets you go to any doctor that accepts Medicare.
You still need a Part D plan for prescriptions.
Medicare Advantage (Part C)
A “bundled” alternative from private companies.
Includes Part A, Part B, and often Part D in one plan.
May include extras like dental, vision, or fitness benefits.
Has a maximum out-of-pocket limit, unlike Original Medicare.
Step-by-Step: How Medicare Works When You Turn 65
Know When You’re Eligible
- You’re eligible for Medicare when you turn 65.
- Your initial enrollment period starts 3 months before your 65th birthday month, includes your birthday month, and ends 3 months after — a total of 7 months to sign up.
Sign Up for Part A and Part B
You can enroll:
- Automatically (if you already get Social Security benefits)
- Manually (through the SSA website or office)
- If you delay Part B without a good reason (like employer coverage), you could pay a late enrollment penalty later.
Understand Your Costs
- At age 65, you typically begin paying:
- Part A: $0 if you qualify (or a monthly premium if not)
Part B: $202.90 monthly in 2026 for most people
You also pay deductibles, coinsurance, and other out-of-pocket costs.
Choose Optional Coverage
Think about whether you want:
- Prescription drug coverage (Part D)
- A Medicare Advantage plan (Part C)
- Medicare Supplement insurance (Medigap)
Each choice affects how much you’ll pay and which doctors you can see.
Review Costs Every Year
Medicare costs often change each year (premiums, deductibles, maximum out-of-pocket limits), so review them during open enrollment.
Is Your Current Plan Still the Best Fit?
We’ll help you compare your current coverage and uncover better options at no cost.
