Direct answer: Medicare decisions happen in two stages. First, determine which enrollment period applies to Part A and Part B. Then decide how to receive coverage: Original Medicare, which can be paired with Part D and, when appropriate, Medicare Supplement insurance, or a Medicare Advantage plan. Compare providers, prescriptions, total cost exposure, travel needs, and plan rules before choosing.
Medicare is easier to evaluate when the letters are separated from the coverage decision. The parts describe different benefits. Original Medicare and Medicare Advantage describe two different ways to receive those benefits.
This guide uses 2026 national Medicare amounts and current federal enrollment rules. Plan premiums, networks, formularies, pharmacies, benefits, and service areas can vary and can change each year.
The four parts of Medicare
Parts A and B make up Original Medicare. Part C is another name for Medicare Advantage. Part D covers outpatient prescription drugs.
Hospital insurance
Helps cover inpatient hospital care, skilled nursing facility care, hospice, and certain home health services.
Original MedicareMedical insurance
Helps cover doctors, outpatient care, preventive services, durable medical equipment, and other covered medical services.
Original MedicareMedicare Advantage
A Medicare-approved private-plan alternative for receiving Part A and Part B benefits. Most plans include Part D.
Coverage pathDrug coverage
Helps cover outpatient prescription drugs through a standalone plan or as part of many Medicare Advantage plans.
Private plan coverageMedigap is not another part of Medicare. Medicare Supplement insurance is private coverage that can help pay certain out-of-pocket costs left by Original Medicare. It cannot be used with Medicare Advantage.
What Medicare costs in 2026
These are national Medicare amounts for 2026. They are a starting point, not a complete estimate of what one person will spend.
| Coverage | 2026 amount | What to remember |
|---|---|---|
| Part A | Most people pay a $0 monthly premium. The inpatient hospital deductible is $1,736 per benefit period. | A benefit period is not the same as a calendar year, so the deductible can apply more than once. |
| Part B | The standard monthly premium is $202.90. The annual deductible is $283. | Higher-income beneficiaries may pay more. After the deductible, Original Medicare commonly pays 80% of the approved amount for covered Part B services. |
| Part D | Premiums, deductibles, and cost sharing vary by plan. Annual out-of-pocket spending on covered Part D drugs is capped at $2,100. | Premiums and non-covered drugs do not count toward the $2,100 amount. Formularies and pharmacy pricing still vary. |
| Medicare Advantage | Premiums and cost sharing vary by plan. | Each plan has an annual maximum for covered Part A and Part B out-of-pocket costs. The exact amount and plan rules vary. |
Late-enrollment penalties, income-related adjustments, Medicare Supplement premiums, and costs for services Medicare does not cover are not included above. Verify current amounts with Medicare and the applicable plan documents.
Original Medicare and Medicare Advantage
Both paths begin with Medicare eligibility and enrollment in Part A and Part B. The differences involve how benefits are administered, how providers are accessed, how drug coverage is added, and how out-of-pocket risk is structured.
| Compare | Original Medicare | Medicare Advantage |
|---|---|---|
| Who administers coverage | The federal Medicare program administers Part A and Part B. | A Medicare-approved private plan administers Part A and Part B benefits. |
| Provider access | You may use any doctor or hospital that takes Medicare and accepts you as a patient. | Provider networks, service areas, referrals, and prior-authorization rules depend on the plan. |
| Prescription coverage | You can enroll in a separate Part D plan. | Most plans include Part D. Confirm every medication, dosage, form, tier, and pharmacy. |
| Medical out-of-pocket limit | Original Medicare alone has no annual out-of-pocket limit for covered Part A and Part B services. | The plan has an annual maximum for covered Part A and Part B out-of-pocket costs. |
| Supplemental coverage | You may be able to purchase Medicare Supplement insurance, subject to enrollment and eligibility rules. | Medicare Supplement insurance cannot be used to pay Medicare Advantage cost sharing. |
| Annual review | Review Part D premiums, formulary, pharmacy network, and cost sharing each year. | Review the plan's benefits, network, formulary, pharmacy access, costs, and rules each year. |
Medicare enrollment periods
Each enrollment period has a specific purpose. The period that lets one person sign up for Part B may not allow another person to change a Medicare Advantage or Part D plan.
Initial Enrollment Period
Generally begins three months before the month you turn 65, includes your birthday month, and ends three months after it. If your birthday is on the first day of a month, Medicare bases this enrollment period on the previous month.
Part B Special Enrollment Period
If you delayed Part B because of qualifying coverage from current employment, you generally have eight months after the employment or group coverage ends, whichever happens first.
General Enrollment Period
For people who missed earlier Part A or Part B enrollment. Coverage generally starts the month after enrollment. Late penalties may apply.
Annual Enrollment Period
Used to join, switch, or leave Medicare Advantage and Part D coverage for January 1. Medicare makes next-year plan information available beginning October 1.
Medicare Advantage Open Enrollment
Only for people already enrolled in Medicare Advantage. It allows one change to another Medicare Advantage plan or a return to Original Medicare, with the option to join Part D.
Special Enrollment Periods
Moving, losing certain coverage, Medicaid status changes, and other events may create a specific election period. Eligibility and deadlines depend on the event.
Working past 65? Do not assume every type of coverage lets you delay Medicare. Confirm how Medicare coordinates with the employer plan, whether the drug coverage is creditable, and whether Medicare enrollment affects Health Savings Account contributions. COBRA, retiree coverage, and Marketplace coverage do not follow the same rule as qualifying current-employment group coverage.
Medigap has its own enrollment period. Under federal rules, the one-time Medigap Open Enrollment Period lasts six months and begins the first month you are 65 or older and enrolled in Part B. It is not the October 15–December 7 Annual Enrollment Period. Outside open enrollment or a guaranteed-issue right, medical underwriting may apply.
What to verify before choosing coverage
- Enrollment period and start date: Confirm the deadline and coverage effective date that apply to your situation.
- Doctors and facilities: Check each provider against the exact plan and confirm participation with the provider when practical.
- Prescriptions: Check the exact drug name, dosage, form, formulary tier, restrictions, and preferred pharmacies.
- Total cost exposure: Compare premiums, deductibles, copays, coinsurance, and the maximum amount you could reasonably owe.
- Plan rules: Review networks, referrals, prior authorization, service area, travel, and out-of-area coverage.
- Other coverage: Understand what happens to employer, retiree, COBRA, Medicaid, Marketplace, HSA, or union coverage before changing it.
- Official documents: Read the plan's Summary of Benefits, Evidence of Coverage, formulary, and provider and pharmacy directories.
Common Medicare questions
Do I need all four parts of Medicare?
No. Original Medicare is Part A and Part B. Part C is Medicare Advantage, a private-plan alternative for receiving Part A and Part B benefits. Part D is prescription drug coverage and may be included in a Medicare Advantage plan or purchased as a standalone plan with Original Medicare.
Is Original Medicare or Medicare Advantage better?
Neither path is best for everyone. Compare provider access, prescriptions, premiums, cost sharing, travel needs, plan rules, and your ability to absorb out-of-pocket costs. The right fit depends on the person and the specific options available where they live.
Do I have to enroll in Medicare at 65 if I am still working?
Not always. If you or your spouse have qualifying group health coverage from current employment, you may be able to delay Part B without a late-enrollment penalty. Confirm with the employer benefits administrator and Medicare before delaying; COBRA, retiree coverage, and Marketplace coverage are not treated the same as current-employment group coverage.
When can I change Medicare coverage?
Medicare Annual Enrollment runs October 15 through December 7. Medicare Advantage Open Enrollment runs January 1 through March 31, but only for people already enrolled in a Medicare Advantage plan. Special Enrollment Periods are event-specific, so confirm the rule that applies before making a change.
Does Medigap have an annual open enrollment period?
No. Under federal rules, the one-time Medigap Open Enrollment Period lasts six months and begins the first month you are 65 or older and enrolled in Part B. Outside that period or another guaranteed-issue right, medical underwriting may apply.
Official sources
Reviewed August 21, 2026. Medicare costs and rules can change; use the current official source when making an enrollment decision.
- Medicare.gov: Parts of Medicare
- Medicare.gov: 2026 Medicare costs
- Medicare.gov: When Medicare coverage starts
- Medicare.gov: Joining a Medicare health or drug plan
- Medicare.gov: Working past 65
- Medicare.gov: When to buy Medigap
Want these details checked against your situation?
David can help you identify the Medicare enrollment period that applies, verify your doctors and prescriptions, and compare expected costs.
The first step asks for basic contact details and whether you have a deadline or coverage change. Detailed plan review follows through the appropriate secure workflow.
Related Medicare guides
This article is for general educational purposes and is not legal, tax, medical, or financial advice. Lakeland Health Insurance and David Huff are not connected with or endorsed by the U.S. government or the federal Medicare program.
We do not offer every plan available in your area. Currently we represent 10 organizations which offer 73 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program to get information on all of your options.
Company inventory note: HealthMarkets/Connecture displayed 10 organizations and 73 products for the selected 2026 Lakeland/Polk County service area on August 17, 2026. Those figures are not CMS counts or statewide Florida totals. Counts and available products vary by ZIP code, service area, plan year, and current company authorization. Confirm the ZIP code and current approved platform inventory before relying on these figures. Plan availability, benefits, networks, formularies, pharmacies, and costs are subject to the applicable plan documents and service area.