Medicare 101: 2026 Guide to Parts, Costs, Enrollment, and Plan Compare

Direct answer: Medicare is federal health insurance for people 65 or older and for some younger people who qualify because of disability, End-Stage Renal Disease, or ALS. Original Medicare consists of Part A and Part B. You can add separate Part D drug coverage and, if eligible, a Medigap policy, or receive Part A and Part B benefits through a private Medicare Advantage plan. The right path depends on enrollment timing, county-level plan availability, doctors, prescriptions, travel, total costs, and whether you prefer Original Medicare’s broad provider access or a private plan’s rules and network.

This guide was reviewed August 10, 2026 and uses 2026 information from Medicare.gov, the Centers for Medicare & Medicaid Services (CMS), and the Maryland Department of Aging. Medicare rules and private-plan details can change. Verify current costs, eligibility, enrollment rights, provider participation, formularies, pharmacy networks, prior-authorization rules, and effective dates before acting.

What is Medicare?

Medicare is a federal health insurance program administered by CMS. Most people first become eligible around age 65, although some people qualify earlier because of a disability or certain conditions. Eligibility is not the same as automatic enrollment: whether you need to sign up, when you should sign up, and when coverage begins depend on your Social Security status and other coverage.

Medicare is different from Medicaid. Medicare eligibility is generally connected to age, disability, or a qualifying condition. Medicaid is a joint federal-state program with financial and other eligibility rules. Some people have both programs. Maryland residents who need an individual or family marketplace plan before Medicare eligibility should use the canonical Maryland health insurance guidance rather than applying marketplace rules to Medicare.

What do Medicare Parts A, B, C, and D mean?

The lettered parts describe different benefits or ways to receive them.

Part A: Hospital Insurance

Part A helps cover inpatient hospital care, skilled nursing facility care that meets Medicare’s requirements, hospice care, and some home health care. Part A is not unlimited nursing-home or long-term custodial-care coverage.

Most people do not pay a Part A premium because they or a spouse paid Medicare taxes long enough while working. Premium-free Part A is not free care: deductibles, coinsurance, coverage requirements, and benefit periods can still apply.

Part B: Medical Insurance

Part B helps cover medically necessary physician services, outpatient care, preventive services, durable medical equipment, and some home health care. Most people pay a monthly Part B premium. Under Original Medicare, a person commonly pays 20% of the Medicare-approved amount for many Part B services after the deductible when the provider accepts assignment, but exceptions and service-specific rules apply.

Part C: Medicare Advantage

Medicare Advantage is another way to receive Part A and Part B benefits through a Medicare-approved private plan. Most plans include Part D drug coverage, and some offer extra benefits. You must keep paying the Part B premium. Plan premiums, cost sharing, service areas, networks, referrals, prior authorization, drug coverage, and extra benefits vary.

An HMO generally requires network care except for specified situations such as emergency or urgent care. A PPO generally allows out-of-network care at a higher cost, subject to the plan’s terms. Those labels are only a starting point; verify the exact plan and network rather than relying on the carrier name or plan type alone. Medicare.gov’s comparison of Medicare Advantage plan types explains common network and referral differences.

Part D: Drug Coverage

Part D helps pay for covered prescription drugs. It may be included in a Medicare Advantage plan or purchased as a separate drug plan alongside Original Medicare. Each plan has a formulary, drug tiers, pharmacy network, and utilization rules. A drug covered this year may have different costs or restrictions next year, so review the plan’s current documents and run a fresh comparison.

Original Medicare and Medicare Advantage are two different paths

With Original Medicare, the federal program pays for covered Part A and Part B services. You can generally use any doctor or hospital that takes Medicare anywhere in the United States. Original Medicare has no annual out-of-pocket maximum for Part A and Part B services. A person may add a separate Part D plan and, if eligible, a private Medigap policy to help with certain cost sharing.

With Medicare Advantage, a private Medicare-approved plan administers Part A and Part B benefits. The plan has an annual limit on covered Part A and Part B out-of-pocket costs, but it may use provider networks, referrals, or prior authorization. Plan availability and details depend on the service area and can change each year.

Neither path is universally best. Compare at least these criteria:

• Total yearly cost, not premium alone
• Deductibles, copayments, coinsurance, and out-of-pocket limits
• Every doctor, hospital, facility, and pharmacy that matters to you
• Every prescription’s exact name, dose, form, tier, restrictions, and estimated annual cost
• Travel or time spent outside the plan’s service area
• Referrals and prior authorization
• Extra benefits and the limits attached to them
• The plan’s quality information, complaints, and current official documents
• Your ability to obtain Medigap now or later under applicable federal and state rules

For a deeper side-by-side discussion, read the canonical Medicare Advantage vs. Medigap guide for Carroll County. That comparison is educational; underwriting rights, prices, and available plans depend on the person, location, date, and policy.

What does Medicare cost in 2026?

The official Medicare cost page lists the amounts that apply in 2026. These figures are a baseline, not a personal estimate.

• Part A premium: $0 for most people. People who must buy Part A pay $311 or $565 per month in 2026, depending on Medicare-covered work history.
• Part A inpatient hospital deductible: $1,736 for each benefit period. A person can have more than one benefit period in a year.
• Part B standard premium: $202.90 per month. Some people pay more because of income, and penalties can apply in some late-enrollment situations.
• Part B deductible: $283 for 2026.
• Medicare Advantage costs: Premiums, deductibles, copayments, coinsurance, and the plan’s out-of-pocket limit vary by plan. A member must continue paying the Part B premium.
• Part D costs: Premiums and cost sharing vary. No Medicare drug plan may have a deductible above $615 in 2026. For covered Part D drugs, the 2026 annual out-of-pocket threshold is $2,100 under Medicare’s rules for counting qualifying spending.
• Medigap premium: Varies by insurer, policy, location, age or rating method, and other permitted factors.

CMS confirmed the 2026 Part A and Part B amounts in its November 14, 2025 fact sheet. Do not use old articles or last year’s premium as a quote. Also check whether an income-related adjustment, assistance program, employer benefit, retiree plan, union coverage, Medicaid, or other coverage changes the practical result for you.

When should you sign up for Medicare?

Enrollment calendars are easy to confuse because they serve different purposes.

Initial Enrollment Period

For most people who become eligible at 65, the Initial Enrollment Period lasts seven months: it starts three months before the month you turn 65, includes your birthday month, and ends three months after it. Special timing applies when a birthday falls on the first day of the month.

Coverage does not always start on the day you apply. Medicare.gov’s coverage-start guidance says Part B and premium-Part A generally start the month you turn 65 if you enroll before that month; enrollment during the birthday month or the three months after generally starts coverage the next month.

Special Enrollment Period related to current employment

Some people can delay Part B without a late-enrollment penalty while covered by a group health plan based on their or a spouse’s current employment. The rules depend on the employment and plan. COBRA, retiree coverage, VA coverage, TRICARE, and marketplace coverage do not all create the same Part B rights.

Do not assume COBRA extends the Part B enrollment window. Medicare.gov says the common employment-based Special Enrollment Period generally ends eight months after employment or qualifying group coverage ends, whichever happens first. Confirm the rule that applies before delaying Part B or contributing to a Health Savings Account.

General Enrollment Period

The General Enrollment Period runs January 1 through March 31 each year for eligible people who did not enroll in Part B or premium-Part A when first able and do not have another enrollment right. Coverage generally begins the month after enrollment. A late-enrollment penalty may apply.

Medicare Open Enrollment

Medicare Open Enrollment runs October 15 through December 7 each year. During this period, people can make permitted changes involving Original Medicare, Medicare Advantage, and Part D. Changes generally take effect January 1 if the plan receives the request by December 7. The official Medicare Open Enrollment page lists the available changes.

Medicare Advantage Open Enrollment Period

From January 1 through March 31, a person already enrolled in a Medicare Advantage plan can generally switch to another Medicare Advantage plan or return to Original Medicare and, if desired, join a separate drug plan. This is not a general opportunity for someone with Original Medicare to join Medicare Advantage.

Special Enrollment Periods also exist for certain other events. Never assume an event qualifies or that the effective date is automatic; verify the current rule with Medicare or Social Security.

When can you buy Medigap?

Medigap is private supplemental insurance designed to help pay certain out-of-pocket costs in Original Medicare. It does not replace Part A or Part B, and it is not used with Medicare Advantage.

For many people, the best federal purchase window is the one-time six-month Medigap Open Enrollment Period that starts the first month they are 65 or older and enrolled in Part B. During that window, federal protections generally allow purchase of any Medigap policy sold in the state despite health problems. After the window, options may be limited, medical underwriting may be allowed, or a policy may cost more unless another guaranteed-issue right applies. Medicare.gov explains the federal timing on its Medigap purchase page.

Maryland rules and available policies may add context, especially for people under 65 or those changing coverage. Verify current rights with Medicare, the Maryland Insurance Administration, or Maryland SHIP before leaving coverage or assuming a Medigap policy will be issued.

How to use Medicare Plan Compare step by step

The official Medicare Plan Compare tool is the canonical starting point for comparing Medicare Advantage and Part D options. It is not a substitute for confirming final details with the plan.

1. Enter the correct ZIP code and coverage year. Plan availability is tied to the service area, so confirm the county when prompted.
2. Choose the coverage type you want to compare. Keep Original Medicare plus a separate Part D plan distinct from Medicare Advantage.
3. Add prescriptions precisely. Enter the drug name, dose, form, quantity, and frequency. Do not send a medication list through an ordinary contact form or unsecured email.
4. Add pharmacies you would realistically use. A preferred in-network pharmacy may produce a different estimated cost from another pharmacy in the same network.
5. Review estimated annual cost. Compare premium plus expected medical and drug costs. A $0 plan premium does not mean $0 total cost.
6. Check providers outside the tool. Search the plan’s current directory, then call the doctor’s office and the plan using the exact plan and network name. Ask whether the provider participates at the specific location and is accepting new patients.
7. Read official plan documents. Review the Summary of Benefits, Evidence of Coverage, formulary, provider directory, pharmacy directory, and Annual Notice of Change when applicable.
8. Confirm enrollment and effective date. Save the confirmation number and plan materials. Verify that the plan received the enrollment and confirm the effective date before relying on coverage.

Networks and formularies can change, and directory information can be wrong or outdated. For medical treatment questions, talk with an appropriate health professional. For coverage questions, contact the plan or Medicare.

Maryland Medicare help and local guidance

Maryland residents can get free, unbiased Medicare counseling through the Maryland Department of Aging’s State Health Insurance Assistance Program (SHIP). SHIP does not sell insurance and can help people understand Medicare and possible assistance programs.

A licensed insurance professional can also help organize comparisons and explain plan features within the professional’s current licensing and carrier appointments. No agent can guarantee eligibility, plan availability, provider participation, drug coverage, approval, savings, claims, or an effective date.

Kayla Pugh provides Medicare guidance in Westminster and broader Medicare services for consumers who want help comparing available options. Use the contact page to schedule a conversation, but do not send a Medicare number, Social Security number, medical records, insurance-card image, or detailed medication list through the website form.

Frequently asked questions

This article provides general insurance education, not individualized insurance, tax, legal, or medical advice. Verify current Medicare rules and costs, available plans, provider networks, formularies, pharmacies, plan documents, enrollment rights, and effective dates with the responsible official source before acting.