FREE MEDICARE INFORMATION GUIDE
Everything You Need to Know About
Medicare — Before You Enroll
Timelines, deadlines, coverage options, official contacts, and a step-by-step roadmap — all in one place.
👋 If you know someone turning 65, this is the most important thing you can share with them right now.
65M+
Americans on Medicare
4 Parts
A, B, C & D explained
7 Months
Initial Enrollment Window
Free
Advisor consultation
Medicare: Your Complete 2026 Guide
Medicare is a federal health insurance program primarily for people 65 and older, as well as certain younger people who qualify due to a disability or specific medical condition.
$202.90/mo
Part B Premium
2026 standard
$283/yr
Part B Deductible
2026 annual
$1,736
Part A Deductible
Per benefit period
$2,100
Part D OOP Cap
2026 max out-of-pocket
Part A - Hospital Insurance (Most people pay $0 premium)
Part A covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care. Most people don't pay a premium for Part A if they (or their spouse) worked and paid Medicare taxes for at least 10 years (40 quarters).
Inpatient deductible (per benefit period) — $1,736 (2026)
Hospital days 1–60 — $0 coinsurance
Hospital days 61–90 — $434/day (2026)
Skilled nursing facility days 21–100 — $217/day (2026)
Part B - Medical Insurance ($202.90/month standard premium in 2026)
Part B covers doctor visits, outpatient care, preventive services, durable medical equipment, and some home health care. The standard premium in 2026 is $202.90/month (up from $185 in 2025). Higher-income beneficiaries pay more through IRMAA surcharges.
Standard monthly premium — $202.90 (2026)
Annual deductible — $283 (2026)
Coinsurance after deductible — 20% of approved amount
Important: Part B has no out-of-pocket maximum on its own. A Medigap supplement or Medicare Advantage plan can cap your costs.
Part C - Medicare Advantage (All-in-one Alternative)
Medicare Advantage (Part C) plans are offered by private insurance companies approved by Medicare. They must cover everything Original Medicare covers, and most include prescription drug coverage (Part D) and extra benefits like dental, vision, and hearing.
Original Medicare
• Pay monthly Part B premium
• No out-of-pocket cap
• Needs separate drug plan
• No dental/vision
• Full provider freedom
Medicare Advantage
• Often $0 additional premium
• Has out-of-pocket limit
• Drugs usually included
• May include additional dental/vision benefits
• Network restrictions
Part D - Prescription Drug Coverage (2026: $2,100 OOP Cap)
Part D plans cover prescription drugs. In 2026, the out-of-pocket cap is $2,100 — meaning once you've paid $2,100 in covered drug costs, you pay nothing for the rest of the year. This is a major improvement from prior years.
2026 out-of-pocket cap — $2,100 (down from $3,300)
Initial deductible (max) — $590 (2026)
Late enrollment penalty — 1% per month without coverage
Tip: If you don’t have other creditable prescription drug coverage, going 63 days or more without Part D or other creditable drug coverage after you’re eligible can result in a late-enrollment penalty.
Medigap / Medicare Supplement Insurance
Medigap policies (Plans A, B, C, D, F, G, K, L, M, N) are sold by private insurers to fill the "gaps" in Original Medicare — covering deductibles, coinsurance, and copays. Plan G is the most popular for new enrollees (Plan F is no longer available to new enrollees after Jan 1, 2020).
✔ No network restrictions — see any Medicare provider nationwide
✔ Predictable monthly premium instead of surprise bills
⚠ Does NOT include prescription drug coverage (need separate Part D)
⚠ Medical underwriting may apply if you miss your Open Enrollment Period
Medicare Supplement Plan Comparison
Medigap policies can help pay certain out-of-pocket costs in Original Medicare, such as coinsurance, copayments and, depending on the plan, certain deductibles.
Critical Enrollment Periods
Initial Enrollment Period (IEP)
Your 7-month window to enroll in Medicare when you first become eligible. Starts 3 months before your 65th birthday month and ends 3 months after. Missing this window may result in coverage gaps and late-enrollment penalties, depending on your circumstances.
Annual Enrollment Period (AEP)
October 15–December 7: The Annual Enrollment Period is when you can generally join, switch, or drop a Medicare Advantage or Part D plan. Changes made during this period generally take effect January 1.
Special Enrollment Period (SEP)
If you or your spouse are still employed and covered by a qualifying large employer group health plan (20+ employees), you may be eligible to delay Medicare without penalty. But you must verify this — not all employer plans qualify. COBRA and retiree coverage do NOT count
General Enrollment Period (GEP)
January 1–March 31: The General Enrollment Period is for people who missed their Initial Enrollment Period and don't qualify for a Special Enrollment Period. You can enroll in Medicare Part A and/or Part B during this period. Coverage generally begins the month after you enroll.
IEP Enrollment Calculator
Enter your birth month and year to see your exact 7-month Initial Enrollment Period window.
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Most people learn these results after it's too late to avoid coverage gaps or late-enrollment penalties.
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Watch & Learn
Medicare Explainer Video Library
Short, clear videos from official and trusted sources — covering every Medicare topic. Filter by subject and watch at your own pace.
All Videos
MEDICARE BASICS
Medicare 101. Understanding the parts of Medicare.
MEDICARE BASICS
Original Medicare Explained . Understanding Parts A and B.
ENROLLMENT
Your Two Medicare Coverage Paths.
ENROLLMENT
Medicare Enrollment Period Explained.
ENROLLMENT
Your Medicare Decision Checklist.
Want even more Medicare education videos?
Medicare Enrollment Timeline
Missing a Medicare deadline can mean coverage gaps and, in some cases, late-enrollment penalties.
Six Months Before Your 65th Birthday — Start Preparing
Begin researching plan options in your area. Compare Medicare Advantage vs. Original Medicare + Supplement. Review your current employer/retiree coverage to understand how it coordinates. Contact Social Security to confirm your enrollment status if already receiving SS benefits — you may be enrolled automatically.
Initial Enrollment Period (IEP) — Your Most Important Window
A 7-month window: 3 months BEFORE the month you turn 65 + your birthday month + 3 months AFTER. Enroll in Parts A and B here for the most seamless start. Enrollment during the birthday month or the 3 months after generally starts coverage the first day of the following month.
Missing this window may = permanent late penalties
Missing this window may = permanent late penalties
Special Enrollment Period (SEP) — If You Have Employer Coverage
If you or your spouse are still working and have employer group health coverage, you qualify for an 8-month SEP after employment or coverage ends (whichever comes first). This lets you delay Part B without penalty. Important: COBRA and retiree insurance do NOT qualify you for a SEP.
Annual Enrollment Period (AEP) — October 15 to December 7
Anyone on Medicare can switch, join, or drop Medicare Advantage and Part D plans each year. Changes take effect January 1. This is your annual chance to review your plan for formulary changes, premium increases, or new benefits. Review every year — plans change!
Medicare Advantage Open Enrollment — January 1 to March 31
If you're enrolled in a Medicare Advantage plan, you can switch to a different MA plan or return to Original Medicare (and then enroll in a standalone Part D plan). You can only make one change during this period.
5-Star Special Enrollment Period — Available Year-Round
If a 5-star rated Medicare Advantage or Part D plan is available in your area, you can switch to it at any time during the year. This is CMS's highest rating and reflects outstanding member satisfaction and outcomes.
If you know someone turning 65, send them this page right now.
If a Part B late-enrollment penalty applies, the premium generally increases 10% for each full 12-month period the person could have had Part B but didn’t sign up. The penalty generally lasts for as long as the person has Part B.
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Official Resources & Contact Numbers
These are the official government agencies and resources you'll need to enroll, ask questions, compare plans, and get assistance. Save these numbers.
Social Security Administration
1-800-722-1213
Enroll in Medicare Parts A & B here. If you're already receiving Social Security benefits at 65, you may be enrolled automatically. TTY: 1-800-325-0778
Medicare.gov (CMS)
1-800-633-4227
Compare plans, find providers, check coverage, and get help with Medicare questions 24/7. TTY: 1-877-486-2048. Use the Plan Finder tool to compare Part D and Advantage plans.
SHIP — Free Local Counseling
State Health Insurance Assistance Program offers free, unbiased counseling from trained volunteers. No sales pitch — just expert guidance on your Medicare options.
Extra Help / Part D Assistance
1-800-772-1213
Apply for the Low-Income Subsidy (LIS/Extra Help) through Social Security. This can save you thousands per year on prescription drug costs.
Eldercare Locator
1-800-677-1116
Connects older adults and caregivers to local services including benefits enrollment assistance, transportation, legal services, and more. Mon–Fri 9am–8pm ET.
Carolyn Simon
+18046215959
State Health Insurance Assistance Program offers free, unbiased counseling from trained volunteers. No sales pitch — just expert guidance on your Medicare options.
How to Start Your Medicare Enrollment — In Order
Check your automatic enrollment status
If you’re receiving Social Security or Railroad Retirement Board benefits at least 4 months before you turn 65, you’ll generally be automatically enrolled in Medicare Part A and Part B when you turn 65.
Decide: Original Medicare or Medicare Advantage?
Original Medicare (Parts A + B) gives maximum flexibility with any Medicare-accepting provider. Medicare Advantage bundles everything through a private insurer with lower out-of-pocket costs but a more limited network. This is one of the most consequential decisions you'll make — a licensed advisor can help you compare options in your specific zip code.
Enroll in Parts A & B through Social Security
Apply online at SSA.gov/medicare/sign-up, call 1-800-772-1213, or visit your local Social Security office. You'll need your Social Security number, birth certificate or proof of age, and proof of citizenship or legal residency.
Choose a Part D prescription drug plan (or Medicare Advantage with drug coverage)
Even if you take no medications now, enroll in a Part D plan to avoid the late enrollment penalty. Use the Medicare Plan Finder at Medicare.gov to enter your specific medications and find the most cost-effective plan.
Consider a Medigap Supplement policy (if choosing Original Medicare)
Your 6-month Medigap Open Enrollment Period generally begins the first month you have Medicare Part B and you’re 65 or older. During this period, you have federal protections that generally allow you to buy any Medigap policy sold in your state regardless of health problems. Plan G is the most popular for new enrollees. Contact a licensed insurance broker to compare carriers in your area.
Set up your MyMedicare.gov account & review annually
Create an account at MyMedicare.gov to track claims, view coverage, and manage your plan. Every fall during AEP (Oct 15 – Dec 7), review your plan for changes to premiums, formularies, and networks — then switch if you can do better.
Not Receiving Social Security Yet?
You Are NOT Automatically Enrolled in Medicare.
Millions of Americans miss this. If you haven't started Social Security benefits, the government will NOT sign you up for Medicare automatically — even when you turn 65. Take action yourself to avoid coverage gaps and possible late-enrollment penalties.
This is the #1 most common and costly Medicare mistake.
If you delay Part B enrollment and do not qualify for a Special Enrollment Period, you may have to pay a late-enrollment penalty. The penalty generally adds 10% for each full 12-month period you could have had Part B but didn’t sign up, and generally lasts for as long as you have Part B.
Still Working at 65
If you or your spouse are still employed and covered by a qualifying large employer group health plan (20+ employees), you may be eligible to delay Medicare without penalty. But you must verify this — not all employer plans qualify. COBRA and retiree coverage do NOT count
Retired But Delaying Social Security
Many people delay Social Security to maximize their benefit (waiting until 70), but this means Medicare does NOT auto-enroll you. You must proactively sign up for Medicare Part A and Part B during your Initial Enrollment Period — the 7-month window around your 65th birthday.
Self-Employed or Business Owner
Self-employed individuals often have their own health insurance and haven't started Social Security. You are not enrolled automatically. You need to proactively contact Social Security and apply for Medicare during your enrollment window — even if you plan to keep your business coverage temporarily.
Covered By a Spouse's Employer Plan
If you're covered under your spouse's employer group plan, you may qualify for a Special Enrollment Period when that coverage ends. However, when your spouse retires or loses coverage, you have only 8 months to enroll in Medicare before late penalties apply permanently.
What To Do If You're NOT on Social Security — In Order
Follow these steps carefully. Missing a step or a deadline can be costly.
Mark your 65th birthday on the calendar — RIGHT NOW
Your Initial Enrollment Period (IEP) opens 3 months before the month you turn 65. For the smoothest start date, enroll in the 3 months BEFORE your birthday month. If you enroll during the month you turn 65 or during the three months afterward, your coverage generally begins the first day of the following month.
Confirm whether your current coverage qualifies for a delay
Only active employer group health coverage from an employer with 20+ employees qualifies you to delay Medicare without penalty. Call your HR department and ask: "Is our group health plan primary to Medicare for employees aged 65+?" Get the answer in writing if possible. COBRA, marketplace, retiree, and individual plans do NOT qualify.
Apply online at SSA.gov — do NOT wait for the mail
Go to ssa.gov/medicare/sign-up and apply for Part A and/or Part B. You can apply up to 3 months before your 65th birthday. You do NOT have to apply for Social Security income at the same time — you can apply for Medicare only. Alternatively, call SSA at 1-800-772-1213 or visit your local Social Security office.
Set up your Medicare premium payment — it won't come out of SS automatically
Since you're not receiving Social Security benefits, Medicare will NOT automatically deduct your Part B premium from a Social Security check. You'll receive a quarterly bill from Medicare. You can set up automatic bank payments through your MyMedicare.gov account or pay by check. Failing to pay your premium can result in loss of coverage.
What you'll need to apply
Have the following ready: your Social Security number, date and place of birth, proof of U.S. citizenship or legal residency, current health insurance information (if you have other coverage), and your employer's name and address if you're still working. If you're applying during a Special Enrollment Period (leaving employer coverage), you'll also need CMS Form L564 completed by your employer confirming your group coverage dates.
Work with a licensed Medicare advisor — this is where mistakes happen
The rules for non-Social Security enrollees are more complex — especially around SEP qualification, employer size rules, and premium billing. A licensed Medicare advisor can walk through your specific situation at no cost. This is exactly the kind of situation where one conversation can help you avoid unnecessary costs and late-enrollment penalties.
Quick Fact — You Can Have Medicare Without Social Security
Applying for Medicare does NOT mean you have to start collecting Social Security income. These are two completely separate programs. You can — and often should — enroll in Medicare at 65 while choosing to delay Social Security until age 70 to maximize your monthly benefit. Don't let confusion between the two programs cause you to miss your Medicare window.
Medicare Readiness Checklist
Click each item as you complete it. Use this as your personal Medicare to-do list.
Have Questions? Get a Free Consultation
Medicare decisions are personal. Get 1-on-1 guidance from a licensed advisor who can review your specific situation at no cost — and no obligation.
The Best Gift You Can Give Someone Turning 65 — Or Anyone With Medicare Questions Is This Information
Most people don't learn about Medicare enrollment windows, late penalties, or the Social Security trap until after they've already paid for the mistake. One share could save a family member from costly Medicare mistakes.
Copy your personal referral link below and share it anywhere.
Carolyn Simon | Licensed Life & Medicare Advisor
Hope Insurance Solutions | Medicare Benefits Advisor Licensed in VA,NC
© Copyright 2026 Hope Insurance Solutions. All Rights Reserved.
This guide is for informational purposes only and does not constitute legal or financial advice. Medicare information is current as of 2026 and is subject to change. We are not affiliated with or endorsed by Medicare, Medicaid, the Social Security Administration, or any government agency. Always verify current costs and coverage details at Medicare.gov.