Learn Your Rights, Benefits & Entitlements With Medicare
If the Medicare maze has you turned around, it's time to call Insurance Benefits for Seniors. We help you understand the difference between a Medicare Supplement and a Medicare Advantage Plan — and find coverage built around you.
What Medicare Is — And Who's Eligible
Medicare is the national health insurance program that started in 1965 under the Social Security Administration and is now run by the Centers for Medicare & Medicaid Services (CMS). It primarily covers Americans age 65 and older, along with some younger people with qualifying disabilities, End-Stage Renal Disease, or ALS (Lou Gehrig's disease).
Part A — Hospital
Covers inpatient hospital stays (formal admission only), skilled nursing care after a qualifying 3-day hospital stay, and hospice services. Most people pay no premium for Part A.
Part B — Medical
Covers outpatient care, most doctor visits (even inside a hospital), outpatient hospital charges, and most professionally administered prescription drugs.
Part C — Medicare Advantage
A private-plan alternative to Original Medicare that must cover at least what Parts A & B cover — often bundling Part D and always including an annual out-of-pocket limit. You must have Parts A & B first.
Part D — Prescription Drugs
Voluntary drug coverage from private insurers, approved by Medicare. If you're eligible for Part A or B, you're generally eligible for Part D too.
Still not sure Advantage vs. Supplement is right for you?
See a full side-by-side comparison of Medicare Advantage and Medigap.
Your 2026 Medicare Cost Update
Every year CMS resets Medicare's premiums, deductibles and income brackets. Here's exactly what changed for 2026, in plain English.
2026 Medicare Costs at a Glance
EFFECTIVE JAN 1, 2026| Part B standard monthly premium | $202.90 up from $185.00 in 2025 |
| Part B annual deductible | $283 up from $257 in 2025 |
| Part A inpatient hospital deductible | $1,736 up from $1,676 in 2025 |
| Part A coinsurance, hospital days 61–90 | $434 / day skilled nursing days 21–100 also rise |
| IRMAA income threshold begins at | $109,000 individual · $218,000 joint filers |
| High-income Part B premium range | $284.10–$689.90 based on reported income (IRMAA tiers) |
| Part D out-of-pocket cap | $2,100 up from $2,000 in 2025 |
| Part D maximum deductible | $615 plans may charge less, or none |
CMS says the increase reflects projected price and utilization growth. It would have been roughly $11/month higher, but a 2026 Physician Fee Schedule change targeting "skin substitute" spending held costs down.
The first 10 drugs selected under the Inflation Reduction Act now have Medicare-negotiated prices, in effect since January 1, 2026 — lowering costs for beneficiaries who take them.
The Part D "donut hole" remains eliminated. Once you hit the $2,100 cap, you pay $0 for covered drugs for the rest of the year — no more phases to track.
Medicare Part D — Prescription Drug Plans
A Part D plan is voluntary prescription drug coverage offered by private insurers and approved by Medicare. It helps pay for your prescriptions and protects you from high drug costs. You can also get drug coverage bundled into a Medicare Advantage (Part C) plan.
$2,100 out-of-pocket cap in 2026. Once your deductible, copays and coinsurance for covered drugs reach this amount, your plan covers 100% of covered medications for the rest of the year.
No more coverage gap. The old "donut hole" stayed eliminated for 2026 — one continuous benefit from deductible to catastrophic coverage.
Premium stabilization continues. A CMS demonstration program is still limiting how sharply stand-alone Part D premiums can rise in 2026, though it's set to end in 2027.
Negotiated drug pricing is live. The first round of IRA-negotiated prices on 10 widely used drugs began January 1, 2026.
2026 Medicare Enrollment Periods
Missing an enrollment window can mean waiting a full year — or paying a lifelong late-enrollment penalty. Here's when each one opens.
Initial Enrollment
7-month window centered on your 65th birthday month — 3 months before, your birthday month, and 3 months after.
Annual Open Enrollment
Oct 15 – Dec 7, 2026. Switch between Original Medicare and Medicare Advantage, or change Part D plans.
Medicare Advantage Open Enrollment
Jan 1 – Mar 31, 2026. Already in a Medicare Advantage plan? You get one plan switch or a return to Original Medicare.
Special Enrollment
Triggered by life events — moving, losing employer coverage, or qualifying for Extra Help — available year-round.
Personalized Coverage, Designed Especially For You
Having trouble understanding the difference between a Medicare Supplement and a Medicare Advantage Plan? That's exactly what we're here for. No pressure, no jargon — just clear answers from a licensed local agent.