Medicare is the federal health insurance program run by the U.S. government.

Most people qualify at age 65 — regardless of income — but you may also qualify younger if you've received Social Security disability benefits for 24 months, or if you have ALS (Lou Gehrig's disease) or end-stage renal disease (ESRD).

To be eligible, you'll need to be a U.S. citizen or a lawful permanent resident who has lived in the country for at least five continuous years.

Part A is your hospital coverage. It covers inpatient hospital stays, skilled nursing care (up to 100 days after a qualifying hospital stay), hospice, and some home health services.

Part B is your medical coverage. It covers doctor visits, outpatient care, lab work, durable medical equipment, preventive services like vaccines and mammograms, and more.

Together, Parts A and B make up what's called "Original Medicare." Most people get Part A without paying a monthly premium if they or their spouse worked and paid Medicare taxes for at least 10 years.

Not necessarily. If you have health coverage through your own current job (or your spouse's current job) at a company with 20 or more employees, you can generally delay Part B enrollment without a late penalty.

You'll have an 8-month special enrollment window after that coverage ends.

If your employer has fewer than 20 employees, Medicare would typically pay first — so it's usually smart to sign up for Part B when you first become eligible. Every situation is a little different, so it's worth talking through the timing with an agent before you decide.

The standard Part B premium in 2026 is $202.90 per month. Most people pay this amount.

However, if your income reported to the IRS two years prior was above $106,000 (or $212,000 for joint filers), you may pay a higher amount — this is called the Income-Related Monthly Adjustment Amount, or IRMAA.

Part B also has a $283 annual deductible in 2026. After you meet that deductible, you typically pay 20% of the Medicare-approved cost for most services. There's no cap on that 20% under Original Medicare alone, which is one reason many people consider supplemental coverage.

Missing your initial enrollment window can result in permanent late enrollment penalties. For Part B, the penalty is an extra 10% added to your premium for each 12-month period you could have enrolled but didn't — and it lasts as long as you have Part B.

For Part A (if you'd have to pay a premium for it), a similar 10% penalty applies for twice the number of years you delayed.

There are exceptions — for instance, if you had qualifying employer group coverage. But the rules can get complicated quickly, so if you're unsure about your situation, it's worth sorting it out sooner rather than later.

Yes, and more people qualify than you might expect. There are several programs designed to help with Medicare costs if your income or resources are limited.

The Medicare Savings Program can help pay your Part A and Part B premiums, and in some cases, your deductibles and cost-sharing, too. The Part D Extra Help program (sometimes called the Low-Income Subsidy) can significantly reduce what you pay for prescription drugs each month.

You can apply through your state Medicaid office, call Social Security at 1-800-772-1213, or visit Medicare.gov to see what you might qualify for. Some states also have their own Pharmaceutical Assistance Programs for people who don't meet the federal thresholds but still need a hand.

If you're not sure where to start or want someone to walk you through it, that's exactly what I'm here for. Reach out, and we'll figure out together what you may be eligible for — no pressure, no obligation.

Original Medicare (Parts A and B) is run directly by the federal government. You can see any doctor or hospital in the country that accepts Medicare — no referrals needed. It does have significant out-of-pocket costs — a $1,736 deductible per benefit period for hospital stays and no annual cap on your 20% coinsurance under Part B — so many people add a Medigap supplement plan and a separate Part D drug plan.

Medicare Advantage (Part C) is offered by private insurance companies approved by Medicare. These plans must cover everything Original Medicare covers (except hospice), often include prescription drug coverage, and many offer extra benefits. They typically have provider networks and may require referrals, depending on the plan type.

Neither option is right for everyone — the better choice depends on your health needs, budget, preferred doctors, and where you live. That's exactly the kind of conversation we're here to help with.

Medigap (also called Medicare Supplement insurance) is sold by private companies to cover the cost gaps in Original Medicare — things like the $1,736 Part A deductible, the $283 Part B deductible, and the 20% coinsurance with no out-of-pocket cap. Some plans also cover limited benefits, such as emergency care when traveling abroad.

You can only use Medigap with Original Medicare, not with a Medicare Advantage plan. The best time to enroll is during your 6-month open enrollment window that begins when you turn 65 and enroll in Part B — during that window, insurers can't turn you down based on health conditions.

There are standardized plan letters (A through N) that mean the same benefits no matter which company sells them, though premiums can vary. If you became eligible for Medicare on or after January 1, 2020, some plan types are no longer available to you.

Special Needs Plans are a type of Medicare Advantage plan designed for people with specific health situations.

The three main types are:

Dual-Eligible SNPs (D-SNPs) for people with both Medicare and Medicaid,

Chronic Condition SNPs (C-SNPs) for people with certain serious conditions, such as diabetes or heart failure

Institutional SNPs (I-SNPs) for people living in long-term care facilities.

These plans are built around the specific needs of those populations and may offer more tailored benefits. Eligibility requirements vary by plan type.

It depends on how you get your Medicare. If you're in Original Medicare, you'll need to add a stand-alone Part D Prescription Drug Plan (PDP) if you want drug coverage — Original Medicare alone doesn't cover most prescriptions.

If you're in a Medicare Advantage plan, many of those plans already include drug coverage (called MA-PD plans). You'd want to confirm before enrolling.

If you skip Part D and don't have other creditable drug coverage, you may face a late enrollment penalty when you do sign up later — so it's worth thinking through even if you don't take many medications right now.

The Inflation Reduction Act brought significant changes to Part D. Starting in 2025, the coverage gap (commonly known as the "donut hole") was eliminated, and out-of-pocket drug costs for Medicare beneficiaries are now capped at $2,000 per year. That's a major shift for people who take expensive medications.

For 2026, Medicare can also directly negotiate prices for certain high-cost drugs without generic alternatives. The first round of negotiated prices applies to ten drugs selected by CMS and takes effect in 2026.

The bottom line: if you take expensive medications, 2025 and 2026 brought some of the biggest changes to drug coverage in years — and it's worth reviewing whether your current plan still makes sense.

No — agents and brokers are not allowed to charge you a fee for helping you with Medicare plan selection or enrollment.

If you enroll in a plan through an agent, the plan pays the agent's compensation.

Your costs are the same whether you enroll through an agent or on your own.

What you do get by working with an agent is someone who can walk through your specific situation — your doctors, your prescriptions, your budget — and help you compare options in a way that's actually useful.

That's the value, not a shortcut to any particular plan.

The main window to make changes is the Annual Election Period (AEP), which runs from October 15 through December 7 each year.

Changes made during AEP take effect January 1.

If you're in a Medicare Advantage plan, you also have the Medicare Advantage Open Enrollment Period from January 1 through March 31, during which you can switch to a different MA plan or go back to Original Medicare — once.

There are also Special Enrollment Periods for life changes like moving, losing other coverage, or qualifying for extra help.

The rules around when and how you can change plans are specific, so it's worth checking your situation with an agent before making a move.