Medicare FAQ

You are eligible for Medicare at age 65 if you are a U.S. citizen or permanent legal resident who has lived in the U.S. for at least 5 consecutive years. You may also qualify before 65 if you have received Social Security Disability Insurance (SSDI) for 24 months, or if you have End-Stage Renal Disease (ESRD) or ALS.

You do not have to enroll at 65 if you have qualifying coverage through a current employer (yours or a spouse's). If you don't have employer coverage, you should enroll during your Initial Enrollment Period (7-month window around your 65th birthday) to avoid late enrollment penalties.

You can enroll online at ssa.gov, by calling Social Security at 1-800-772-1213, or by visiting your local Social Security office. Many people are automatically enrolled if they are already receiving Social Security benefits.

Missing your Initial Enrollment Period without qualifying coverage results in permanent late enrollment penalties. Part B penalties are 10% per 12-month period you were eligible but didn't enroll — added to your premium for as long as you have Part B. Part D penalties are 1% of the national base beneficiary premium per month without creditable coverage.

Part A is free for most people who paid Medicare taxes for at least 40 quarters (10 years). Part B requires a monthly premium — $202.90/month in 2026 (standard). Higher earners pay more through IRMAA. Medicare Advantage and Part D plan costs vary.

The standard Part B monthly premium is $202.90 in 2026. The annual deductible is $283. After the deductible, you pay 20% of Medicare-approved costs. Higher-income beneficiaries pay more via IRMAA surcharges.

Original Medicare (Parts A and B) has no annual out-of-pocket cap — you could theoretically pay 20% indefinitely. Medicare Advantage plans are required to have a cap (up to $9,350 for in-network care in 2026). Medicare Supplement (Medigap) plans can also protect against uncapped costs.

Thanks to the Inflation Reduction Act, Part D out-of-pocket costs are capped at $2,000 per year in 2026 for covered drugs. Once you reach $2,000, you pay $0 for covered medications for the rest of the year.

Original Medicare (Parts A and B) does not cover routine dental care — cleanings, fillings, extractions, or dentures. However, most Medicare Advantage plans include some dental coverage. You can also purchase a standalone dental plan.

Original Medicare covers medically necessary eye exams (for conditions like glaucoma or diabetic retinopathy) but not routine vision exams or eyeglasses. Many Medicare Advantage plans include routine vision coverage.

Original Medicare does not cover hearing aids or routine hearing exams. Many Medicare Advantage plans now include hearing benefits. Coverage varies significantly by plan.

Original Medicare Parts A and B have very limited drug coverage. Part D provides prescription drug coverage through standalone plans or Medicare Advantage plans (MAPD). You should enroll in Part D when first eligible to avoid late penalties.

Medicare Part A covers up to 100 days in a skilled nursing facility following a qualifying hospital stay — but only for skilled care, not custodial care. Medicare does not pay for long-term nursing home care. Medicaid covers long-term care for those who qualify.

Original Medicare (Parts A and B) is administered by the federal government and is accepted by nearly all U.S. doctors. Medicare Advantage (Part C) is offered by private insurers approved by Medicare — it replaces Original Medicare and usually includes additional benefits like dental and drug coverage, but restricts you to a provider network.

Yes. You can switch during the Annual Enrollment Period (Oct 15–Dec 7) or the Medicare Advantage Open Enrollment Period (Jan 1–Mar 31). If you switch back to Original Medicare, you may then apply for a Medigap plan — though in most states you will be subject to medical underwriting outside your guaranteed issue window.

Medigap (Medicare Supplement) is supplemental insurance sold by private companies to fill the gaps in Original Medicare — covering deductibles, copayments, and the 20% coinsurance. Plan G is the most popular for new enrollees.

No. Medigap policies only work with Original Medicare. If you enroll in Medicare Advantage, you cannot use a Medigap policy.