Getting ready for Medicare: What you need to know

With so many changes on tap for 2026, you should review all your plan options before selecting coverage. To see how plans compare, go to Medicare.gov for a side-by-side comparison of plan coverage, costs and quality ratings.

How Medicare works

Offered through the federal government, Medicare is health insurance available to those who meet at least one of the following requirements:

Medicare covers medical, hospital and drug costs through three components.

Part A: hospital coverage

Part A coverage applies to hospital stays, skilled nursing facility stays, hospice care and some home health care services. If you worked for at least 10 years and paid Medicare taxes, there is no premium for Part A. For those who do have to pay a premium, the maximum monthly premium for Part A in 2025 is $518. The estimated maximum premium for 2026 is $563; CMS is expected to publish that information this fall.

The Part A deductible is expected to increase from $1,676 in 2025 to $1,716 in 2026. This deductible applies to inpatient care for each benefit period (this period starts when inpatient care begins and ends once they have not received inpatient care for 60 days). It’s possible this deductible could be paid by supplemental coverage.

For all hospital stays beyond 20 days, you will have to pay a copayment. All stays beyond 20 days in a skilled nursery facility requires a copayment; however, if you remain in the facility for 100 or more days, you are responsible for all costs.

Part B: medical insurance

Part B coverage applies to qualifying doctors’ visits, preventive services, medical supplies, and outpatient treatment and services. Part B premiums are based on your income. For most enrollees, you will pay the standard Part B premium, which is $185 in 2025 (expected to increase as noted above). For those with a modified adjusted gross income of at least $103,000 for an individual or $206,000 filing jointly on your tax return two years before enrolling in Medicare, the monthly premium will be higher.

As noted above, the Part B deductible is expected to increase for 2026.

Part C: prescription drug plans

Part C covers prescription drugs and is purchased separately from Parts A and B (Original Medicare). All costs for this coverage, including premiums, deductibles, copayments and coinsurance, vary by plan. Some Medicare Advantage plans include prescription drug coverage.

When do I enroll?

Open enrollment is actually not the time to first enroll in Medicare; instead, it’s the period when you can review and make changes to your existing Medicare coverage for the following year. To actually enroll for Medicare coverage, you’ll need to sign up during one of three enrollment periods.

Initial enrollment period

This is when you first become eligible for Medicare coverage; it starts three months before the month you turn 65 and ends three months after the month you turn 65. If your birthday is the first of the month, your initial enrollment period starts four months before your 65th birthday and ends two months after you turn 65.

Special enrollment period

To avoid a penalty, you should sign up for Medicare Part A when you become eligible at age 65. But you can delay Part B enrollment if you are working and have insurance through your or your spouse’s employer. Once you or your spouse stop working and that insurance ends, you will have eight months to enroll in Part B coverage.

General enrollment period

If you missed your initial enrollment period or don’t qualify for a special enrollment period, you can enroll in the general enrollment period from Jan. 1 to March 31 of each year. Enrolling during general enrollment may result in higher premiums.

Under 65 and on disability

Anyone with a disability who receives monthly Social Security or Railroad Retirement Board (RRB) benefits automatically receives Medicare Part A and Part B after 24 months of receiving disability benefits. Anyone with Amyotrophic Lateral Sclerosis (ALS) (Lou Gehrig’s disease) who receives Social Security disability benefits will automatically get Medicare.

What is the difference between Medicare Advantage and a Medicare supplement plan?

Also known as Part C, Medicare Advantage plans include Part A and Part B coverage, and most include Part D drug coverage. These plans are offered by private companies, and must match the benefits of Original Medicare. However, the premiums, deductibles, copayments and coinsurance costs will vary by plan. Some could provide extra benefits like hearing, vision and dental coverage.

Available from private companies, Medigap is a Medicare supplement plan that helps pay expenses not covered by Original Medicare. This includes deductibles, coinsurance and copayments. Premiums will vary based on the plan. If you have Medicare Advantage, you cannot have a Medigap plan.

To find the best Medicare coverage for your needs, set up an account on Medicare.gov, where you can research coverage and drug plans and providers. If you have questions, talk with a Medicare representative or reach out to the Georgia State Health Insurance Assistance Program (SHIP) for free health insurance counseling.