6 key Medicare questions

To help you prepare for enrolling in Medicare with confidence, here are answers to some of the most common Medicare questions people ask.

1. What is Medicare?

The Centers for Medicare and Medicaid Services is the official federal organization responsible for Medicare. They describe Medicare as a federal health insurance program for:

• People age 65 and older
• Certain younger people with disabilities
• In some cases, people afflicted with amyotrophic lateral sclerosis (ALS), aka Lou Gehrig's Disease 
• People with End-Stage Renal Disease (ESRD), which is permanent kidney failure that requires dialysis or a kidney transplant

Getting started with a few Medicare basics

Medicare only offers individual coverage. Unlike health insurance plans before age 65, there is no family coverage plan with Medicare, which means your spouse or partner won't be covered by your Medicare coverage. They have to enroll on their own when they become eligible for Medicare.

The Initial Enrollment Period (IEP) is when an individual is allowed to sign up or enroll in Medicare; which is generally when an individual turns 65. Generally, the IEP lasts for 7 months, starting 3 months before they turn 65, and ending 3 months after the month they turn 65.  However, if an individual's birthday is on the first of the month, their IEP starts earlier. It starts 4 months before they turn 65 and ends 2 months after the month they turn 65.

Medicare offers a Special Enrollment window for people age 65 who are still working and/or have health insurance through their employer or spouse's employer, which is also available if certain events happen in your life, such as moving or losing other insurance coverage.

Missing your IEP without qualifying for a Special Enrollment Period comes with big risks. If you miss the opportunity to enroll, you may need to wait until the next General Enrollment Period (January 1–March 31). Your Medicare coverage won't start until the month after you sign up during the General Enrollment Period, so you could end up with a gap in coverage. You'll also risk having to pay a lifetime late enrollment penalty for Medicare. This penalty is tacked onto your monthly premium.

2. What are my options?

Before Medicare, picking health insurance coverage while working for your previous employers may have been fairly straightforward— you picked a single plan for your doctor visits, prescriptions, and medical needs.

Medicare is different. It's comprised of parts covering different things, with lots of different options. Let's take a look.

Medicare Part A: Hospital Insurance

Medicare Part A helps cover hospital visits, certain hospital treatments and procedures, skilled nursing facility care (not including long-term care), and hospice care.

Medicare Part B: Medical insurance

Medicare Part B helps cover certain health care costs not covered by Part A, such as doctor visits and services, outpatient hospital care, physical and speech therapy, lab tests, blood transfusions, durable medical equipment and supplies, and ambulance services.

Part A and Part B together are also known as Original Medicare.

Medicare Supplement (Medigap)

A Medicare Supplement is private health insurance that helps supplement Original Medicare, which means it helps pay some of the out-of-pocket costs that Original Medicare doesn't cover (such as copayments, coinsurance, and deductibles). These are "gaps" in Medicare coverage. If you have Original Medicare and Medicare Supplement insurance, Medicare will pay its share of the Medicare-approved amounts for covered health care costs, then your Medicare Supplement insurance pays its share.

While the federal government provides Medicare Parts A and B, private health insurance companies offer Medicare Supplement plans. There's a wide variety of Medicare Supplement plans to choose from that address services that you may need that Medicare Parts A and B don't cover.

Tip: You can find out which insurance companies sell Medicare Supplement policies in your area on Medicare.gov and read Viewpoints on Fidelity.com: Medicare Supplement plan (Medigap) 101: What you need to know.

Medicare Part D: Standalone Prescription drug coverage

Original Medicare and Medicare Supplement insurance does not provide prescription drug coverage, which means you may want to purchase a standalone Medicare Part D plan or a Medicare Advantage plan that includes prescription drug coverage. Enrolling in a Part D plan is not required. However, if you don't enroll in a Part D plan when you first become eligible, and you don't have other creditable prescription drug coverage, you may wind up getting penalized financially by paying a late enrollment penalty for the rest of the time you maintain Medicare drug coverage, should you enroll later.

Regardless of the coverage you choose for prescription drugs, it's important to consider which ones cover the medications you need, how often you need them, and where you purchase them.

Medicare Part C: Medicare Advantage (MA and MAPD)

This coverage is an alternative to Original Medicare and Medicare Supplement plans. Medicare Advantage (also called Medicare Part C) is an "all-in-one" managed care plan that provides the coverage you'd find under Original Medicare and Medicare Supplement, and may also include additional benefits such as prescription drug, dental, vision, or hearing coverage.

Medicare Advantage plans generally provide coverage for what's called "in-network services." Each Medicare Advantage plan works with a network of doctors and health care facilities. Most Medicare Advantage plans require a beneficiary to go through their network for services, but plans vary. For example, while HMOs provide only in-network services, PPOs have a network but may allow you to go out-of-network with higher cost sharing.

Tip: If you're considering a Medicare Advantage plan, think about which doctors you see, what your current medical needs are (such as prescription medications). Also, consider how your plan handles regular health care services outside your plans service area and the cost, and whether the doctors you now see are in-network for the Medicare plan you're considering.

3. How do I sign up?

Original Medicare (Parts A and B)

• Apply online at the website of the Social Security Administration (SSA). If you started your online application and have your re-entry number, you can go back to finish your application.
• Visit your local SSA office.
• Call the SSA at 800-772-1213 (TTY: 800-325-0778).

Medicare Part C: Medicare Advantage¹

There are several options for signing up for a Medicare Advantage plan. You may be able to enroll during:

• The Initial Enrollment Period for Original Medicare (generally the IEP lasts for a 7 month period when turning 65).
• The Annual Enrollment Period, which starts on October 15 and ends December 7. You can also switch or drop a Medicare Advantage plan during this time. To enroll in a Medicare Advantage plan, you must be enrolled in Medicare Part A and Medicare Part B.
• The Medicare Advantage Open Enrollment Period, which starts on January 1 and ends March 31 (This only if you're already in a Medicare Advantage Plan.²)
• The Special Enrollment Period, which depends on your personal situation. The Medicare website provides more details about this kind of period.

How you enroll (an online form, a paper application, over the phone) depends on whether you go through a health insurance company, an agent, or a health insurance marketplace website.

Medicare Supplement

When you first turn 65, there is a 6-month Medicare Supplement enrollment period that starts the first month you have Medicare Part B. During this period you'll have "guaranteed issue" rights, which means that insurance companies can't deny you or charge you more based on your health status. If you delay Medicare Part B coverage until after you turn 65, your 6-month Medigap enrollment period will also be deferred until the first month your Medicare Part B coverage takes effect. Outside of the 6-month Enrollment Period you may have a guaranteed issue right under certain situations. At this point, companies must sell you a Medicare Supplement policy, regardless of your health status. They cannot deny you coverage. Some states may have additional Medicare Supplement guaranteed issue rights. Check with your state's Department of Insurance to see if any special rules apply where you live.

Medicare Part D

If you're new to Medicare, you might consider enrolling in a prescription drug plan generally during the 7 month IEP. A person may owe a late enrollment penalty if they go without standalone Medicare Part D coverage or other creditable prescription drug coverage for any continuous period of 63 days. After you enroll, you may change to a different prescription drug plan during the Annual Enrollment Period from October 15 to December 7.

4. What do the plans cost?

Medicare plans are provided on an individual basis, so if you are married, you and your spouse will enroll in separate plans.

Medicare Part A¹

As long as you or your spouse paid Medicare taxes for at least 40 quarters (approximately 10 years), Medicare Part A coverage is premium-free. However, you are still responsible for paying a deductible per each benefit period ($1,736 in 2026), and a daily coinsurance for extended hospital stays.

Each quarter has to have sufficient earned income subject to Medicare to qualify. For example, a quarter with only $100 in earned income would not qualify.

Individuals who don't qualify for premium-free Part A because they didn't pay Medicare taxes long enough can purchase Part A coverage (in 2026, $565 monthly if you paid Medicare taxes for less than 30 quarters; and $311 monthly if you paid Medicare taxes 30–39 quarters).

Medicare Part B¹

Medicare sets the cost (premium) for Part B each year at a fixed rate for most individuals ($202.90 a month for 2026), but it increases for individuals with an annual income over $109,000 and married couples with an annual income above $218,000. The cost for higher-earning individuals can range from $284.10 to $689.90 per month in 2026. Part B premiums also can be higher if you don't enroll when you're first eligible unless you qualify for a Special Enrollment Period. A 10% Part B late enrollment penalty per each year you missed enrolling on time is added to the premium for as long as you have Part B.

As with Medicare Part A, you will pay an annual deductible for Part B ($283 in 2026), and some covered services require that you pay a percentage of the charges or a copayment amount approved by Medicare (which is 20% of costs for many items or services).

If you are already receiving a Social Security benefit payment or Railroad Retirement Board Benefit, payment for your monthly Part B premium is deducted from your Social Security payment or Railroad Retirement Board Benefit payment. If you're not yet collecting benefits, Medicare will send you a quarterly bill.

Medicare Advantage

When you enroll in a Medicare Advantage plan, you generally will continue to pay premiums for your Part B benefits, and Part A premiums if you have less than 40 quarters. Everyone who enrolls in the same Medicare Advantage plan pays the same premium, regardless of age, gender, or health status.

Tip: You can compare Medicare Advantage plans in your area with Medicare.gov's Medicare Plan Finder.

Medicare Part D

The amount that insurance companies charge for prescription drug coverage differs. The variation is based on how health insurance companies set up their deductibles and copayments, and the brand name and generic drugs (drug formulary) they cover.

For higher income individuals and couples, you'll pay more in monthly premiums for Part D coverage. (Part D premium may be based on the income-related monthly adjustment amount (IRMAA), plus the plan premium.) Premiums (PDF) vary depending on modified adjusted gross income (MAGI) and marital status.

For stand-alone Part D prescription drug plans, the maximum deductible is $615 in 2026. (A deductible is the amount you pay toward your costs before the insurance plan starts to contribute. After reaching your deductible, you'll pay your plan's copays and coinsurance for your covered drugs, based on the tiers within your plan's covered drug list, also known as their formulary.)

Tip: Compare Part D costs at Medicare.gov or your local State Health Insurance Assistance Program (SHIP) office.

Medicare Supplement

Although the benefits offered under a Medicare Supplement plan are standardized, premiums for these plans vary. If you plan to purchase a Medicare Supplement plan, compare costs before you buy one. Medicare Supplement policies are priced: (1) Community rated (i.e., priced the same for all enrolled in the same Medicare Supplement plan); (2) Issue-age rated (based on your age at the time of application); and (3) Attained-age rated (based on your current age and continues to increase as you get older). Your premium may vary by the way the insurance company has priced their plan, along with your geographical location, gender, and smoking status.

5. Which plan is right for me?

To figure out which Medicare option is the right one for you, it's always good to start by looking at the coverage you currently have with your current health care insurer. What would you keep or change?

Narrow your options by asking yourself:

• How much can I afford to spend to pay for my insurance (premiums) and to pay for my care (in the form of deductibles, copayments, and coinsurance)?
• What benefits do I need? (You might save money if you don't buy coverage for benefits you don't mind paying for out-of-pocket.)
• Do I want to choose my own doctors or health care providers?
• Does the plan include coverage for my unique situation? (Paying for emergencies outside your state or country may be important if you plan to travel.)
• How does the cost of each plan compare with other plans that have the same benefits?

Tip: Medicare.gov and your local SHIP office can help you compare plan features and costs for Medicare Supplement and Medicare Advantage plans in your state.

6. Where can I go for more help?

Now that you have answers to some common Medicare questions, you're likely to have more questions. Below are some resources that may be able to help provide additional assistance as you are researching your options.

• The official Medicare site, Medicare.gov, offers several helpful guides and interactive tools to help you compare your options.
• The Social Security site can provide guidance for Original Medicare.
• The Fidelity Medicare Services® Learning Center has in-depth articles, tools, and educational webinars that can help you learn more about Medicare.

Plan ahead

Having the right Medicare coverage is a key part of your retirement plan—along with your overall health and wellness in retirement. Among the many factors to consider in your Medicare decision are: health status, cost, coverage, use of prescription drugs, amount of travel you plan to do, and access to existing or preferred doctors and hospitals. Consider working with a professional from Fidelity Medicare Services^® to explore your options.