Medicare FAQ — 14 Common Questions Answered

Your Initial Enrollment Period (IEP) is a 7-month window: 3 months before your 65th birthday month, your birthday month, and 3 months after. Enroll in the first 3 months to ensure coverage starts the month you turn 65. If you are still working and covered by employer insurance through a company with 20+ employees, you can delay without penalty. You will have an 8-month Special Enrollment Period after losing employer coverage.

The Part B penalty is 10% added permanently to your monthly premium for each full 12-month period you delayed enrollment without qualifying coverage. The 2026 standard Part B premium is $202.90. A 2-year delay adds 20% — $40.58/month extra — forever. The Part D penalty is 1% of the national base premium ($38.99 in 2026) for each month without creditable coverage. Both penalties last for life.

Yes — if you are covered by employer group health insurance through an employer with 20 or more employees, you can delay Part B without penalty. When you retire or lose that coverage, you have an 8-month Special Enrollment Period. Important: COBRA and retiree health insurance do not qualify as employer coverage for this purpose. If you have COBRA your SEP clock already started when active employer coverage ended.

Original Medicare (Parts A and B) lets you see any doctor who accepts Medicare nationwide with no referrals needed. You pay 20% of costs with no annual cap unless you add a Medigap supplement. Medicare Advantage replaces Original Medicare with a private plan that usually has lower premiums but requires using a provider network, may require referrals, and has different (sometimes higher) cost-sharing. Advantage plans change their coverage annually. Original Medicare with a Medigap plan offers more predictability and flexibility.

For most new enrollees in 2026 Plan N offers better financial value if your doctors accept Medicare assignment. Plan N typically costs $25–$40/month less than Plan G. The trade-offs are small copays (up to $20 per doctor visit, up to $50 per ER visit) and no coverage for Part B excess charges. If your doctor visit frequency is average or below, and your doctors all accept Medicare assignment, Plan N usually saves $300–$480/year. Plan G makes more sense if you need very frequent specialist care or some of your doctors charge excess charges.

The best time is your 6-month Medigap Open Enrollment Period — which starts the month you are both 65 or older AND enrolled in Medicare Part B. During this window insurers must sell you any Medigap plan at the standard rate with no medical underwriting. After this window most states allow medical underwriting, meaning you could be charged more or denied coverage based on health history. A few states — Connecticut, Massachusetts, Maine, and New York — require year-round guaranteed issue.

Original Medicare and Medicare Supplement plans do not cover routine dental care, routine vision exams and eyeglasses, or hearing aids. These are significant gaps — the average retiree spends $1,000–$3,000+ annually on dental care alone. Separate dental, vision, and hearing plans are available and worth considering. Some Medicare Advantage plans include these benefits as extras, which is one reason people choose Advantage over Original Medicare despite the network restrictions.

Most people pay $0 for Part A. Part B is $202.90/month for most people in 2026 (higher for incomes over $106,000 — see IRMAA surcharges). A Medigap Plan G or N adds $90–$200/month depending on your age and state. A Part D drug plan adds $15–$60/month. Total all-in cost for comprehensive Original Medicare + Medigap + Part D is typically $350–$500/month for most 65-year-olds, plus the $283 annual Part B deductible.

IRMAA stands for Income-Related Monthly Adjustment Amount. If your modified adjusted gross income from 2 years prior exceeded $106,000 (single) or $212,000 (married filing jointly) in 2026, you pay higher Part B and Part D premiums. Medicare uses your 2024 tax return for 2026 IRMAA calculations. Higher-income individuals can pay $285.60 to $671.20/month for Part B instead of the standard $202.90. You can appeal IRMAA if your income has significantly decreased since the reference year.

In 2026 the out-of-pocket cap for covered Part D prescription drugs is $2,100. Once you have spent $2,100 out of pocket on covered drugs in a calendar year, your Part D plan covers 100% of covered drug costs for the rest of the year with no copays. This cap was introduced in 2025 as part of the Inflation Reduction Act and represents a major protection against catastrophic drug costs for Medicare beneficiaries.