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Medicare basics

Medicare, explained in plain English

Medicare has four parts. Most people choose one of two paths: Original Medicare (often with a Medigap plan and a drug plan) or a Medicare Advantage plan that bundles everything. Here is what each part covers and how the two paths differ.

Written by PlanScout teamReviewed by PlanScout teamLast reviewed Oct 8, 20268 sourcesHow we make money

The four parts of Medicare

Part A: Hospital

Hospital stays, a short skilled-nursing stay after a hospital stay, hospice, and some home health.

Most people pay no premium for Part A.

Part B: Medical

Doctor visits, outpatient care, tests, preventive care, and medical equipment like CPAP or glucose monitors.

Has a monthly premium. Usually pays 80% after the yearly deductible.

Part C: Medicare Advantage

Not separate coverage. A private plan that takes the place of A and B, and usually adds drug coverage and extras like dental or vision.

You still pay your Part B premium.

Part D: Prescriptions

Drug coverage from private plans. It comes inside most Advantage plans, or as a separate plan with Original Medicare.

Has a yearly limit on what you pay for covered drugs.

Part A + Part B = Original Medicare Part C = a private plan that includes A + B (and usually D)

Original Medicare vs Medicare Advantage

The biggest differences. Neither path is right for everyone.
TopicOriginal Medicare (with optional Medigap and Part D)Medicare Advantage (Part C)
Doctors and hospitalsAny provider in the U.S. that takes Medicare. No referrals.Usually a network (HMO or PPO). Referrals may be needed.
Monthly costPart B premium, plus a Medigap premium and a drug plan premium if you add them.Part B premium, plus the plan's premium (many plans are $0).
Cost when you get careWith Medigap, little or nothing. Without it, usually 20% with no yearly limit.Copays and coinsurance, up to the plan's yearly out-of-pocket limit.
Drug coverageSeparate Part D plan.Usually built in.
Dental, vision, hearingNot covered by Original Medicare.Often included, with limits.
TravelWorks anywhere in the U.S.Mostly limited to the plan's area, except emergencies.
Switching laterIn most states, Medigap can be hard to get later because of health questions.You can change plans each fall during Open Enrollment.
Where does Medigap fit?

Medigap (Medicare Supplement) is extra insurance that works only with Original Medicare. It pays some or all of the 20% and the deductibles Original Medicare leaves you. You can’t use Medigap with a Medicare Advantage plan.

Key costs

$202.90Part B monthly premium (standard) (2026)
$283Part B yearly deductible (2026)
$1,736Part A hospital deductible, per benefit period (2026)
$2,100Most you pay for covered drugs in a year (Part D) (2026)
$615Highest yearly drug deductible a Part D plan can set (2026)
See Medicare.govHighest in-network out-of-pocket limit an Advantage plan can set (2026)
$0Part A premium for most people (2026)
Where these numbers come from

Next year’s figures show “Not announced yet” until CMS publishes them. Your own costs can be higher, for example if your income is high.

When you can sign up or switch

  1. Oct 15 – Dec 7Annual Open Enrollment. Anyone with Medicare can join, switch or drop a Medicare Advantage or drug plan, or go back to Original Medicare. Changes start Jan 1. Source for Annual Open Enrollment
  2. Jan 1 – Mar 31Medicare Advantage Open Enrollment. Only if you are already in a Medicare Advantage plan. You can switch to another Advantage plan or go back to Original Medicare. Source for Medicare Advantage Open Enrollment
  3. Around your 65th birthdayInitial Enrollment. Lasts 7 months: 3 months before the month you turn 65, that month, and 3 months after. Source for Initial Enrollment
  4. First 6 months of Part B at 65 or olderMedigap open enrollment. You can buy any Medigap policy, and the company can't turn you down for health problems. It happens once and does not repeat each year. Source for Medigap open enrollment
  5. After certain life eventsSpecial Enrollment. Only for situations like moving to a new address, losing or changing your coverage, getting Medicaid, or getting Extra Help with drug costs. Source for Special Enrollment
    A federally declared disaster can also open one if it kept you from making a change you could have made (42 CFR 422.62(b)(18)). Check your ZIP.

Helping a parent or loved one decide

  1. Gather their Medicare card, current plan name, and a list of medications and pharmacies.
  2. List the doctors they want to keep.
  3. Ask what matters most to them: low monthly cost, freedom to see any doctor, or extras like dental.
  4. Compare plans together, then call the plan or a free SHIP counselor (find yours below) before enrolling.

Next steps

Compare plans near youFree, about 2 minutesNot sure which path fits?Take the coverage guide questionnaireWhat changes for 2027 in your stateMedicare Advantage plans, 2026 vs 2027

Free Medicare counseling in your state

Every state has a State Health Insurance Assistance Program (SHIP) with trained counselors who explain Medicare for free and don’t sell plans.

Official SHIP directory (shiphelp.org)

Reviewed & sourced

Reviewer
PlanScout team. Checks facts and plain-English accuracy; has no say in how results are ordered.
What was checked
Every 2026 cost figure against its CMS or Medicare.gov source; enrollment windows against Medicare.gov; plain-English wording.
Last reviewed
Oct 8, 2026
Next review
Before Jan 1, 2027 (new plan year), or sooner if CMS changes a rule.
Corrections
See something wrong? Tell us. We fix confirmed errors within 2 business days and note the change in the page's change log.
Change log
  • Oct 8, 2026: First published, with 2026 costs checked against CMS and Medicare.gov.
Sources
  1. CMS fact sheet: 2026 Medicare Parts A & B Premiums and Deductibles (retrieved Oct 8, 2026)
  2. CMS CY 2026 Rate Announcement (retrieved Oct 8, 2026)
  3. Medicare.gov: Medicare Advantage plans (retrieved Oct 8, 2026)
  4. Medicare.gov: Costs (retrieved Oct 8, 2026)
  5. CMS CY 2027 Rate Announcement (retrieved Oct 9, 2026)
  6. Medicare.gov: Annual Open Enrollment
  7. Medicare.gov: Initial Enrollment
  8. Medicare.gov: Medigap open enrollment