Frequently Asked Questions

Frequently Asked Questions About Medicare – 2026

WHO CAN GO ON MEDICARE?

If you are turning 65, you are eligible for Medicare. A person under 65 can also be eligible if they have been receiving Social Security Disability Insurance (SSDI) for more than 24 months.

HOW DO YOU APPLY FOR MEDICARE?

There are 3 ways:
1) Call Social Security at their toll-free number (800) 772-1213. This is the most complicated way;
2) Apply online at www.SocialSecurity.gov/medicareonly;
3) In person at your local Social Security Office.

HOW MUCH IS MEDICARE? IS THERE A COST?

If you or your spouse worked for at least 10 years and paid Medicare taxes, you won’t pay a monthly fee, called a premium, for Part A. Now, for Part B your standard premium is $202.90 a month in 2026, unless your Modified Adjusted Gross Income is greater than $109K Single/$218K Married, then you will also pay an Income Related Monthly Adjustment Amount (IRMAA).

WHAT IS MEDICARE PART A?

Part A is coverage for inpatient hospital care, skilled nursing facility care, Hospice, and Nursing home care, depending on the circumstance.

WHAT IS MEDICARE PART B?

Part B is for Ambulance services, Clinical research, Lab work, Tests, Durable Medical Equipment, getting a second opinion before surgery and some limited Outpatient prescription drugs. Also, this part covers Mental Health – Inpatient, Outpatient and Partial Hospitalization.

WHAT IS MEDICARE PART C?

Medicare Advantage Plans are sometimes called Part C or MA Plans. These are offered by private insurance companies approved by Medicare. If you enroll in a Medicare Advantage Plan, you will get your Medicare Part A and Part B coverage from the Medicare Advantage Plan (the private insurance company approved by Medicare) and not Original Medicare. Note: If you go on a Part C plan for more than a year, you may have to go through underwriting in order to return to a Medicare Supplement plan.

WHAT IS MEDICARE PART D?

Part “D” is for Drugs. To avoid future penalties, everyone should enroll in a Part D Plan, or a prescription plan which is the same thing. Unless, you have a current prescription plan that is considered credible coverage, such as Veteran Benefits or credible Employer Group coverage or IHS. The benefits for 2026 changed due to the Inflation Reduction Act of 2025. Enrollees may pay the full cost of their prescriptions until they meet the $615.00 deductible. (Some plans may have no deductible). In the Initial Coverage Phase: Enrollees pay 25% of their drug costs, and the plan pays the rest, until their out-of-pocket spending reaches $2,100.00. After reaching the out-of-pocket limit, then you will automatically get”catastrophic coverage” for the remainder of the calendar year on covered Part D Drugs.

WHAT IS THE DIFFERENCE BETWEEN ORIGINAL MEDICARE AND MEDICARE ADVANTAGE PLANS?

When you have Medicare Part A and Part B you are on original Medicare, which is the government or the traditional Medicare plan. Original Medicare usually doesn’t have a maximum out of pocket cost. Therefore, if you stay on original Medicare, you should also get a Medigap Plan for your financial protection. Medicare Advantage Plans can be chosen in place of Original Medicare. A Medicare Advantage Plan is regulated by the federal government (CMS), but administered and run by private insurers or insurance companies. Even if you chose to enroll on a MA Plan you are still in the Medicare Program and you still have the same Medicare Rights and Protections, but your benefits are paid through a private plan. These plans must have an Out-of-Pocket Maximum for your protection.

WHAT IS A MEDIGAP PLAN?

A Medigap Plan is the same as a Secondary Plan and a Medicare Supplement. All three are the same, just different names. If you stay on Original Medicare, then you should get a Medigap Plan to protect you from expensive Medical Bills. There are different Plans available. The plans that are considered Cadillac plans are the Plan G and F. These are the most popular. The plan F does not have a deductible, co-insurance or co-pay as long it’s a Medicare approved service offered by a Medicare assigned provider.

WHAT IS A DRUG FORMULARY?

A drug formulary is a list of Drugs provided by Plan D – Drugs. Each plan has its own formulary. It is very important to check your prescriptions against the formulary of the plan that you intend to enroll in.