Medicare Plan Guide | Turning 65 & Becoming Medicare Eligible

If you’re approaching age 65, congratulations — you’re about to become eligible for Medicare, the federal health insurance program that covers tens of millions of Americans. Understanding how Medicare works before you enroll can save you money, prevent costly coverage gaps, and help you make decisions that fit your health needs and budget. This guide walks you through the key parts of Medicare and your options for additional coverage.

What Is Medicare?

Medicare is a federally administered health insurance program primarily for people age 65 and older, as well as certain individuals under 65 with qualifying disabilities. It is divided into several distinct parts, each covering different types of health care services.

Medicare Part A – Hospital Insurance

Medicare Part A covers inpatient hospital stays, skilled nursing facility care (following a qualifying hospital stay), some home health care, and hospice care.

No premium — if you (or your spouse) paid Medicare taxes for at least 10 years (40 quarters) while working.

Reduced premium: $311/month (2026) — if you had at least 30 quarters of Medicare-taxed employment.

Full premium: $565/month (2026) — if you have fewer than 30 quarters of coverage.

Key Cost-Sharing for 2026:

Service / Period	Your Cost
Inpatient hospital deductible	$1,736 per benefit period
Days 1–60	$0 coinsurance after deductible
Days 61–90	$434/day coinsurance
Days 91+ (lifetime reserve)	$868/day coinsurance
Skilled nursing facility days 21–100	$217/day coinsurance

Important: Part A uses a “benefit period” — not a calendar year — so costs can reset if you are readmitted after being out of a hospital or skilled nursing facility for 60 consecutive days.

Medicare Part B – Medical Insurance

Medicare Part B covers outpatient medical services, including doctor visits, preventive care, lab work, durable medical equipment, mental health services, and many outpatient procedures.

Cost Item	2026 Amount
Standard monthly premium	$202.90/month (higher-income individuals pay more via IRMAA)
Annual deductible	$283
After deductible	You pay 20% of Medicare-approved costs
Out-of-pocket maximum	None under Original Medicare (Parts A & B alone)

When to Enroll: Your Initial Enrollment Period (IEP) is a 7-month window — the 3 months before your 65th birthday month, your birthday month itself, and the 3 months after. Enrolling late without a qualifying Special Enrollment Period can result in a permanent late enrollment penalty added to your Part B premium.

If you are still working and covered by an employer group health plan (at an employer with 20 or more employees), you may be able to delay Part B without penalty until you retire or lose that coverage.

Medicare Part C – Medicare Advantage

Medicare Advantage (Part C) plans are an alternative to Original Medicare offered by private insurance companies that have contracted with Medicare. These plans must cover everything that Original Medicare covers, and most include additional benefits such as prescription drug coverage, dental, vision, and hearing.

Important Note: Term Insurance Brokers does not sell Medicare Advantage (Part C) plans. If you are interested in a Medicare Advantage plan, we recommend contacting Medicare directly at 1-800-MEDICARE (1-800-633-4227) or visiting Medicare.gov to compare plans in your area.

Medicare Part D – Prescription Drug Coverage

Medicare Part D provides coverage for prescription drugs. Part D plans are offered by private insurance companies approved by Medicare. Each plan has its own formulary (list of covered drugs), premiums, deductibles, and cost-sharing.

Important Note: Term Insurance Brokers does not sell Medicare Part D prescription drug plans. To compare and enroll in a Part D plan, please contact Medicare directly at 1-800-MEDICARE (1-800-633-4227) or visit Medicare.gov.

Late Enrollment Penalty: If you go without creditable prescription drug coverage for 63 or more consecutive days after your Part D Initial Enrollment Period, you may owe a permanent late enrollment penalty added to your monthly Part D premium.

Medicare Supplement Insurance (Medigap)

Original Medicare (Parts A and B) covers many healthcare costs, but it does not cover everything — and with no out-of-pocket maximum, costs can add up quickly. Medicare Supplement Insurance, also known as Medigap, is sold by private insurance companies to help cover some or all of the cost-sharing gaps left by Original Medicare, such as deductibles, coinsurance, and copayments.

Key facts about Medigap:

Standardized by federal law — A Plan G from one insurance company covers the same benefits as a Plan G from any other company. Only the price differs.

Works with Original Medicare only — Medigap does not work with Medicare Advantage (Part C) plans. You must have both Part A and Part B.

No prescription drug coverage — You would need to enroll in a separate Part D plan for drug coverage.

Nationwide access — Most Medigap plans allow you to see any doctor or specialist nationwide who accepts Medicare — no referrals or network restrictions.

Most Popular Medigap Plans

Plan	Best For	What It Covers	Key Gap
Plan G	Most comprehensive coverage for new enrollees (turning 65 on/after Jan 1, 2020)	Part A coinsurance & hospital costs, Part B coinsurance/copay (20%), Part A hospice care, SNF coinsurance, Part A deductible, foreign travel emergency	Part B annual deductible ($283 in 2026)
Plan N	Generally healthy people who want lower premiums with modest cost-sharing	Most Plan G benefits, but you pay up to $20/office visit and up to $50/ER visit (waived if admitted)	Part B excess charges not covered; office/ER copays apply
High-Deductible Plan G	People who want catastrophic protection at the lowest monthly cost	Same benefits as standard Plan G after meeting the annual deductible ($2,950 in 2026)	$2,950 annual deductible before coverage kicks in

When Is the Best Time to Enroll in Medigap?

The best time to enroll in a Medigap plan is during your Medigap Open Enrollment Period — a one-time, 6-month window that begins the first month you are both age 65 or older and enrolled in Medicare Part B.

During Open Enrollment — Insurance companies are required by federal law to sell you any Medigap plan they offer at the best available rate, regardless of your health history. They cannot deny coverage or charge more due to pre-existing conditions.

Outside Open Enrollment — In most states, insurance companies can use medical underwriting to deny coverage or charge higher premiums based on your health. This makes enrolling during your open enrollment period critical.

State Protections — Some states (currently California, Connecticut, Maine, Massachusetts, Missouri, New York, and Oregon) have additional protections that may allow you to switch Medigap plans with guaranteed issue rights at other times. Check the rules in your state.

How Do I Get Started?

Navigating Medicare and your supplemental coverage options doesn’t have to be confusing. At Term Insurance Brokers, we specialize in Medicare Supplement Insurance and can help you compare Medigap plans from multiple top-rated insurance carriers to find the right coverage at the best rate available to you.

Give us a call at 1-888-972-0024 to speak with one of our licensed agents, or send us a message here. We’re here to help you make the most informed decision about your Medicare coverage.

The information provided on this page is for educational purposes only and reflects 2026 Medicare guidelines as released by the Centers for Medicare & Medicaid Services (CMS). Medicare costs and plan details change annually. Always verify current figures at Medicare.gov or by calling 1-800-MEDICARE (1-800-633-4227).