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Medicare Options
Medicare can be quite confusing and complex. Let's break down the four basic parts.
4 Parts
original Medicare
Original Medicare is broken into two parts, Part A and Part B.
Medicare Part A:
Medicare Part A (Hospital Insurance): Helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and some home health care. Most people don’t need to pay a monthly premium for Part A coverage if you or your spouse paid Medicare taxes while working for a certain amount of time. This is sometimes called premium-free Part A. If you aren’t eligible for premium-free Part A, you may be able to buy it.
There are costs associated with Part A, particularly for Inpatient Hospital stays which is measured in benefit periods. In 2026, the Part A deductible per benefit period is $1,736. In addition to this deductible, you may incur further costs for hospital stays longer than 60 days, as well as for skilled nursing facility care.
Original Medicare
Medicare Part B:
Medicare Part B (Medical Insurance): Helps cover services from doctors and other health care providers, outpatient care, durable medical equipment, and many preventive services. You must pay a monthly premium if you want Part B coverage. In 2026, the standard Part B premium is $202.90. You’ll pay more if you have a higher income.
There are additional costs with Part B, including an annual deductible. In 2026, the Part B deductible is $283. You are responsible for paying all Part B costs up to this deductible. After it’s met, Medicare generally covers 80% of the Medicare-approved amount for covered services, and you are responsible for the remaining 20%.
Part C
Medicare Advantage (also called Part C) plans are Medicare-approved plans offered by private insurance companies as an alternative to Original Medicare. These plans combine your Part A, Part B, and usually prescription drug coverage (Part D) into one plan. Plans may offer extra benefits that Original Medicare doesn’t cover.
Each Medicare Advantage plan can have its own rules for how you receive care—such as using doctors within the plan’s network, needing referrals for specialists, or prior approval for certain services or prescriptions. All plans must cover emergency and urgent care, along with nearly all medically necessary services covered by Original Medicare. Some plans may also offer added benefits for specific health conditions.
Out-of-pocket costs under Medicare Advantage plans differ from Original Medicare and include an annual maximum limit on what you pay. Premiums, benefits, and costs vary depending on the plan you choose.
You must have both Part A and Part B to join a Medicare Advantage Plan.
Part D
Medicare drug coverage (Part D) plans are Medicare-approved plans offered by private insurance companies to helps pay for your prescription drugs. It’s optional and offered to everyone with Medicare.
There are 2 ways to get Medicare drug coverage (Part D):
Even if you don’t take prescription drugs now, consider getting Medicare drug coverage. If you decide not to get it when you’re first eligible for Medicare Part A and/or B, and you don’t have other creditable prescription drug coverage (like drug coverage from an employer or union) or get Extra Help, you’ll likely pay a late enrollment penalty that’s added to your monthly premium if you join a plan later.
Medicare FAQ's
You are eligible to apply for Medicare during your initial enrollment period which is a 7 month window. 3 months before turning 65, the month you turn 65 and 3 months after turning 65.
The easiest way to sign up for Medicare is online through SSA.gov or by Calling Social Security at 1-800-772-1213. You can also visit your local Social Security Office.
If you are already receiving Social Security Benefits you will be automatically enrolled into Original Medicare, otherwise you will be eligible to enroll during your initial enrollment period that starts 3 months before your 65th birthday.
If you miss your Initial Enrollment Period you can sign up during the General Enrollment period that occurs every year January 1st through March 31st. Coverage becomes effective the month following your enrollment date.
Yes, there are penalties for not signing up for Part B of Medicare and will be added to your premium.
If you need a new Medicare card you can order a replacement card by phone at 1-800-772-1213, or online at the Social Security Administration web site. Make sure you have your Medicare number ready when you call.
Guidepoint Insurance Advisors is not affiliated with or endorsed by the government or the federal Medicare program. Medicare has neither reviewed nor endorsed this information. We do not offer every plan available in your area. Currently we represent 1-10 organizations which offer 1-50 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options. © Copyright 2026 Guidepoint Insurance Advisors | All rights reserved.Website created by MedicarePRO|Marketing