Medicare FAQ 2026 — 14 Common Questions Answered

Medicare is the federal health insurance program for people aged 65 and older, and certain younger people with disabilities or End-Stage Renal Disease (ESRD). Most U.S. citizens and permanent residents who have lived in the U.S. for at least 5 years are eligible at age 65.

Part A is premium-free for most people (with 40+ quarters of work). Part B costs $185.00/month standard. Part D averages ~$46.50/month. Higher-income beneficiaries pay more through IRMAA surcharges.

Original Medicare (Parts A + B) lets you see any Medicare-accepting provider with no network restrictions. Medicare Advantage (Part C) is offered by private insurers, typically has networks, but often includes extra benefits like dental, vision, and drug coverage, plus an out-of-pocket maximum.

Under the Inflation Reduction Act, the old "donut hole" has been largely reformed. In 2026, your annual out-of-pocket drug costs are capped at $2,000. Once you reach this cap, you pay $0 for the rest of the year. This eliminates the previously unlimited catastrophic costs.

IRMAA (Income-Related Monthly Adjustment Amount) is an extra charge on Part B and Part D premiums for higher-income beneficiaries. It is based on your MAGI from 2 years ago. For 2026, IRMAA begins at income above $106,000 (single) or $212,000 (joint).

Your Initial Enrollment Period (IEP) is 7 months around your 65th birthday: 3 months before, your birthday month, and 3 months after. If you miss it, the General Enrollment Period runs January 1 through March 31 each year, but late penalties may apply.

If you are still working and have employer group coverage, you can delay Part B without penalty. Once employment or coverage ends, you get an 8-month Special Enrollment Period. If your employer has fewer than 20 employees, Medicare becomes the primary payer at 65.

Medigap (Medicare Supplement) plans help pay costs that Original Medicare does not cover, like copayments, coinsurance, and deductibles. If you choose Original Medicare over Medicare Advantage, Medigap can significantly reduce your out-of-pocket costs. You cannot have both Medigap and Medicare Advantage.

Key changes include: $2,000 annual out-of-pocket cap on Part D drug costs, $35/month insulin cap, free recommended vaccines, Medicare drug price negotiation, and the Medicare Prescription Payment Plan for spreading costs monthly.

Late enrollment penalties apply: Part B has a permanent 10% premium surcharge for each year you delayed. Part D has a permanent 1% surcharge per month delayed. These penalties apply for as long as you have Medicare, so enrolling on time is important.

Yes. During the Annual Enrollment Period (October 15 – December 7), you can switch Medicare Advantage plans, switch from Original Medicare to MA (or vice versa), and join/switch/drop Part D plans. The Open Enrollment Period (January 1 – March 31) allows MA-to-MA switches or dropping MA for Original Medicare.

Original Medicare generally does not cover routine dental, vision, or hearing services. However, many Medicare Advantage plans include these benefits. You can also purchase standalone dental, vision, and hearing insurance to supplement Original Medicare.

The 2026 Part A deductible is $1,676 per benefit period. This is the amount you pay before Part A begins covering your inpatient hospital stay. A benefit period starts when you are admitted and ends when you have been out of the hospital for 60 consecutive days.

If your income has decreased due to a life-changing event (retirement, divorce, death of spouse, work stoppage, etc.), you can request a new determination by filing form SSA-44 with the Social Security Administration. You can appeal online, by phone (1-800-772-1213), or at your local SSA office.