Medicare, explained in plain language
Turning 65 or retiring soon? Here's how Medicare works, what each part covers, and the dates you need to know so you can choose coverage with confidence.
Book a free consultationThe four parts of Medicare
Medicare is federal health insurance for people 65 and older, and for some younger people with certain disabilities or conditions. It's divided into parts, each covering different kinds of care.
Inpatient hospital stays, skilled nursing facility care, hospice, and some home health care. Most people pay no premium for Part A.
Doctor visits, outpatient care, lab work, preventive services, and medical equipment. Part B has a monthly premium.
Plans from private insurers approved by Medicare that combine Parts A and B, and often Part D and extra benefits like dental or vision.
Coverage for prescription medications, offered through private plans as a stand-alone plan or built into a Medicare Advantage plan.
Two main paths
Most people choose between Original Medicare (often with a Medicare Supplement) and a Medicare Advantage plan. Each works well for different needs.
| Original Medicare + Supplement | Medicare Advantage | |
|---|---|---|
| Doctors & hospitals | Any provider nationwide that accepts Medicare | Usually a plan network (HMO or PPO) |
| Drug coverage | Add a separate Part D plan | Often included |
| Out-of-pocket costs | A Supplement (Medigap) can cover most gaps; higher monthly premium | Copays and coinsurance with a yearly out-of-pocket maximum; premiums are often lower |
| Extra benefits | Generally not included | Many plans include dental, vision, hearing, or fitness benefits |
| Referrals | Not required | Some plans require them |
Key enrollment periods
- Around age 65
Initial Enrollment Period
A 7-month window: the 3 months before your 65th birthday month, your birthday month, and the 3 months after.
- Oct 15 – Dec 7
Annual Enrollment Period
Switch between Original Medicare and Medicare Advantage, change plans, or join or change a drug plan. Changes start January 1.
- Dec 8, 2026 – Feb 28, 2027
If your Medicare Advantage plan is ending
If your plan won't continue in 2027, you can choose a new Medicare Advantage plan, or return to Original Medicare and add a drug plan. You may also have a guaranteed right to buy certain Medicare Supplement plans.
- Jan 1 – Mar 31
Medicare Advantage Open Enrollment
If you're in a Medicare Advantage plan, you can switch to another one or return to Original Medicare once.
- Jan 1 – Mar 31
General Enrollment Period
If you missed your initial window, you can sign up for Part A or Part B. Late penalties may apply.
- Anytime, if eligible
Special Enrollment Periods
Life events such as retiring and losing employer coverage, moving, or qualifying for extra help can open a window to enroll or change plans.
What's changing next year
Annual cap on out-of-pocket costs for covered Part D drugs, up from $2,100 in 2026.
Maximum standard Part D deductible, up from $615.
Gain new Medicare-negotiated prices on January 1, including several diabetes medications.
Plans change their costs, networks, and benefits every year. Reviewing your coverage during the Annual Enrollment Period helps make sure it still fits your doctors, prescriptions, and budget.
What to have on hand
- Your red, white, and blue Medicare card (or Social Security information if you're new)
- A list of your doctors, hospitals, and pharmacies
- A list of your prescriptions with dosages
- Information about any current or retiree coverage from an employer
Have questions? Let's talk.
As a licensed local agent, I'll walk you through your options one-on-one, at no cost and with no obligation. I can help with first-time enrollment, plan reviews, and planning your coverage as you transition into retirement.
Phillip Dunson · Health Plan Superstore · 216-238-7266
Call 216-238-7266 to schedule