Medicare
Medicare is the federal health coverage that begins at 65, and it has more forks in the road than most people expect. Below, Geoff breaks down every part of it: what each piece does, where the gaps are, and the deadlines that can cost you for the rest of your life if you miss them.
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THE TEN PARTS OF MEDICARE
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The 10 Medicare Essentials
Medicare Parts A and B
When people say “Medicare,” they are usually referring to Original Medicare, which is Medicare Part A and Part B. Part A covers hospital stays, and Part B covers doctor visits and outpatient care. Between them they handle a large share of the medical bills retirees face.
Most people pay nothing for Part A, because they already paid for it through years of payroll taxes. Part B is different. It comes with a monthly premium, and higher earners pay a higher Part B premium (see IRMAA).
Original Medicare also comes with deductibles, copays, and uncapped coinsurance, which could quickly drain a senior’s savings if they needed a major surgery, say a heart valve replacement. Original Medicare also has limits on certain services. Skilled nursing care, for example, is only covered for a set number of days, and only under specific conditions.
To cover the gaps, people often add a Medigap plan or Medicare Advantage.
Medicare Part D
Part D is the part of Medicare that helps pay for the prescriptions you pick up at the pharmacy.
Part D is not automatic. It is sold by private insurance companies approved by Medicare, which means there are many plans to choose from, and they are not all the same. Two plans can charge very different amounts for the exact same drug, depending on how each one builds its list of covered medications and its pricing tiers.
The other thing that surprises people is how their costs can change across a single year. What you pay for a drug in January is not always what you pay later on, because of how the coverage is structured in stages. Knowing how those stages work, and choosing the plan that fits the specific drugs you take, can make a big difference in what you spend.
Medigap (Medicare Supplement)
Original Medicare leaves real gaps: the deductibles, copays, and that uncapped 20% coinsurance with no ceiling on what you could owe in a bad year. A Medigap plan, also called a Medicare Supplement, is designed to fill those gaps. It “supplements” your Parts A and B and picks up much of what they leave behind.
All Medigap plans are standardized and sold by letter, so a Plan G from one insurance company covers the exact same things as a Plan G from another. The benefits do not change from company to company. What changes is the price, and the same lettered plan can cost meaningfully more from one insurer than another for identical coverage.
Choosing a plan means weighing the level of coverage against the monthly premium, and understanding how the pricing tends to change as you age. There are 10 standardized plans, each identified by a letter, and they offer different levels of coverage. For most people newly eligible today, Plan G is the most comprehensive option available, and it’s premium reflects that.
Medicare Advantage (Part C)
Medicare Advantage, also called Part C, is a way to get your Medicare coverage through a private insurance company instead of directly from the government. You still have Medicare, but the plan delivers your Part A and Part B benefits, and usually bundles in drug coverage and extras Original Medicare does not offer.
Many plans offer a $0 premium and add dental, vision, and hearing, although coverage in those areas is often quite limited. For a lot of people, having medical, drug, and extra coverage in one plan is simpler than piecing it together on their own.
Advantage plans use networks, so the doctors and hospitals you can use may be limited, and you may need approval before certain care is covered. Costs are structured differently too, often built around copays as you go. A plan that works well while you are healthy can feel very different in a year when you are not.
Switching back to Original Medicare with a Medigap plan later is not always guaranteed, because your health can be reviewed when you try. The choice you make at the start can be harder to undo than it looks.
Enrollment Periods
Medicare has six enrollment windows, including special ones for life events. Each has its own rules, and missing one can cost you for the rest of your life.
Your first is the Initial Enrollment Period, the seven months around your 65th birthday. Skip it without other qualifying coverage, and you can face a late-enrollment penalty added to your Part B premium permanently, not just for a year. The same kind of penalty exists for Part D drug coverage.
Miss that window and the General Enrollment Period lets you sign up later, though it can come with a coverage delay and that lingering penalty. Special Enrollment Periods, triggered by life events like leaving a job with employer coverage, let you enroll without penalty if you qualify.
Once you are in, the Annual Enrollment Period (Oct 15–Dec 7) each fall is your yearly chance to change Part D or Medicare Advantage plans. If you are already in an Advantage plan, the Medicare Advantage Open Enrollment Period (Jan 1–Mar 31) in the first months of the year gives you one more chance to switch plans or move back to Original Medicare. And one window matters more than people realize: your Medigap open enrollment, the one-time period when an insurer must sell you a supplement plan regardless of your health. Let it pass, and that coverage can get harder or more expensive to buy later.
Switching Between Plans
If you want to switch plans, you might not be locked into your current choice. Most changes are only allowed during set windows, like the Annual Enrollment Period each fall. Miss the window, and you may be stuck with your current plan until the next one comes around.
Not every switch is open to everyone, and one move in particular can backfire. If you leave a Medicare Advantage plan to go back to Original Medicare with a Medigap policy, the insurer can review your health first. If that review does not go your way, you could pay much more, or be turned down entirely. The plan you picked years ago can become a plan you are stuck with.
That is why a switch you have not thought through can cost you. Before you change anything, it is worth knowing exactly which windows apply to you and which moves are hard to undo.
If you are not sure, talk to a Medicare advisor first. A good one can tell you which switches are simple, which ones carry a risk, and which doors close behind you once you walk through them.
IRMAA (Income-Related Monthly Adjustment Amount)
Most people pay the standard Part B premium. In 2026, that is $202.90 per month. Higher earners pay more, and the extra amount is called an IRMAA surcharge, the income-related monthly adjustment amount. It is added to both your Part B and your Part D premiums.
Two things about IRMAA surprise people. The first is the timing. The income Medicare uses to determine your surcharge is not your current income. It is your income from two years earlier, taken from your tax return. So a good year two years ago can raise your premium today, after the money is long spent.
The second is how the thresholds work. IRMAA is not a gradual slope. It steps up in tiers, and going even one dollar over a line can push you into the next tier and a higher premium for the whole year. A small difference in income can mean a real difference in what you pay.
What Medicare Does Not Cover
Medicare covers a lot, but not everything, and the gaps catch people off guard. Planning for them is easier when you know they are there.
The biggest one is long-term care. If you need help with daily living, like bathing, dressing, or eating, over an extended period, Medicare generally does not pay for it. It covers short-term skilled care after a hospital stay, but not the ongoing custodial care many people end up needing. That cost falls to you, or to Medicaid once your savings are spent.
Routine dental, vision, and hearing are your responsibility too. So are most routine foot care and cosmetic procedures. Some Medicare Advantage plans add limited dental, vision, and hearing coverage, but it is often capped.
Care outside the United States is generally not covered, with only limited exceptions, so a long trip abroad is something to plan for separately.
Medicare vs. Medicaid
Medicare is the federal health program you qualify for mainly by age, at 65, or by disability. What you earned does not decide whether you get it. Almost everyone who paid in is eligible.
Medicaid is a joint federal and state program for people with limited income and assets, and it covers people of all ages, not just retirees. Because the states run it, the rules and benefits vary depending on where you live.
Long-term care is where the difference between them shows up. Medicare generally does not pay for it, but Medicaid does, only after your income and savings are low enough to qualify. That is why many people who start out on Medicare end up on Medicaid later, once the cost of long-term care has drawn down what they had.
Does It Cost More to Use a Medicare Advisor
No. Working with a Medicare advisor does not add to the cost.
Licensed Medicare advisors are paid directly by the insurance companies, not by you. The premium you pay is the same whether you sign up on your own or with help – that’s the law. An advisor cannot charge you more for it or give you a discount on it. So the plan costs what it costs, with help or without.
What changes is the information you receive. A good advisor compares plans against your specific drugs, your doctors, and your budget, and explains the trade-offs in plain terms before you commit. They can also point out which moves are hard to undo later, like switching rules so you do not get stuck.
One thing worth knowing. Not every advisor works with every plan. Some, like Chapter, review and recommend every plan nationwide, but most do not – so the options one person shows you may not be the full picture. It is fair to ask which plans an advisor can offer and how they are paid. A good one will answer both without hesitating.
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