Understand your health coverage options, compare plans, estimate costs, and make confident decisions — without the confusing jargon.
Medicare is the federal health insurance program for people 65 and older, and for younger people with certain disabilities or conditions. It's divided into four main parts.
Covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care. Most people don't pay a premium for Part A if they or their spouse paid Medicare taxes for at least 10 years.
Covers doctors' services, outpatient care, medical supplies, and preventive services. Part B requires a monthly premium, which can vary based on your income.
An alternative way to get Medicare coverage through a private insurance company approved by Medicare. Plans must cover everything Parts A and B cover, and most include Part D drug coverage plus extras like dental, vision, and hearing.
Helps cover the cost of prescription drugs. Part D is optional but has a late enrollment penalty if you go without creditable coverage. Plans are offered by private insurers approved by Medicare.
A 7-month window: 3 months before your 65th birthday month, your birthday month, and 3 months after. This is your primary chance to enroll without penalty.
January 1 – March 31 each year. For those who missed their IEP. Coverage begins July 1. A late enrollment penalty may apply to Part B.
If you delayed Medicare because you had employer coverage, you have 8 months after losing that coverage to sign up without penalty.
October 15 – December 7 each year. Switch, drop, or add Medicare Advantage or Part D plans. Changes take effect January 1.
Medigap (Medicare Supplement Insurance) is private insurance that helps pay costs that Original Medicare doesn't cover — like deductibles, copayments, and coinsurance. You must have Medicare Parts A and B to buy a Medigap policy.
The Affordable Care Act created Health Insurance Marketplaces where individuals and families can shop for and enroll in health coverage. Plans are categorized by "metal" tiers and financial assistance may be available.
* Percentages reflect actuarial value — the share of covered health costs the plan is designed to pay for an average enrollee.
Premium Tax Credits reduce your monthly premium. Eligibility is based on your household income relative to the Federal Poverty Level (FPL). The Inflation Reduction Act enhancements remain in effect for 2026.
Key costs for Medicare Parts A and B. Amounts update annually. Medicare Advantage and Part D costs vary by plan.
| Cost Type | Part A (Hospital) | Part B (Medical) | Notes |
|---|---|---|---|
| Monthly Premium | $0 (most people) Up to $533 if <30 quarters |
$185/month Higher for high earners (IRMAA) |
Part A Part B |
| Annual Deductible | $1,716 per benefit period | $263 per year | Part A deductible resets per benefit period, not per year |
| Coinsurance (Days 1–60) | $0/day (hospital) | 20% after deductible | No out-of-pocket max in Original Medicare |
| Coinsurance (Days 61–90) | $429/day | N/A | Hospital only |
| Lifetime Reserve Days | $858/day (days 91–150) | N/A | 60 lifetime reserve days available |
| Skilled Nursing (Days 21–100) | $214.50/day | N/A | Days 1–20 are covered fully after Part A deductible |
| Part D Out-of-Pocket Cap | $2,000 per year (2026) | Part D Major improvement from IRA | |
* Amounts are for 2026 and subject to annual adjustment by CMS. IRMAA surcharges apply to higher-income beneficiaries for both Part B and Part D.
Answer a few quick questions to get a personalized summary of your likely coverage options.
This tool provides general guidance only — always verify details with Medicare.gov, HealthCare.gov, or a licensed insurance counselor.
Answers to the most common Medicare and ACA questions we receive.
Generally, no — once you're enrolled in Medicare (Part A and/or Part B), you're no longer eligible for premium tax credits on the ACA Marketplace. If you already have a Marketplace plan and become Medicare-eligible, you should drop the Marketplace plan when Medicare starts. However, you can keep a Marketplace plan if you don't qualify for Medicare or choose not to enroll (though you'd lose subsidy eligibility).
Original Medicare (Parts A & B) is the federal government's direct coverage. You can see any provider that accepts Medicare and have no network restrictions. Medicare Advantage (Part C) bundles your coverage through a private insurer. Advantage plans often include extras like dental and vision, may have lower costs, but typically restrict you to a network of providers. Original Medicare has no out-of-pocket maximum unless you add Medigap; Advantage plans have a yearly cap on out-of-pocket spending.
There are different enrollment periods for different purposes: (1) Your Initial Enrollment Period (IEP) runs for 7 months around your 65th birthday. (2) The Annual Medicare Advantage & Part D Open Enrollment runs October 15–December 7 each year. (3) The Medicare Advantage Open Enrollment Period runs January 1–March 31 (switch Advantage plans or return to Original Medicare). (4) A General Enrollment Period for Parts A and B runs January 1–March 31 for those who missed their IEP.
Original Medicare does not cover: routine dental care (cleanings, fillings, dentures), routine vision care (glasses, contacts), hearing aids, long-term custodial care (nursing home care beyond skilled nursing), most care received outside the United States, and cosmetic surgery. Many of these services ARE covered by Medicare Advantage plans — but benefits vary significantly by plan, so review carefully before enrolling.
You can apply for Medicare online at ssa.gov, by calling 1-800-772-1213, or by visiting your local Social Security office. If you're already receiving Social Security benefits, you'll be automatically enrolled in Parts A and B at 65 — you'll receive your Medicare card in the mail about 3 months before your 65th birthday. If you're not receiving Social Security, you'll need to sign up yourself during your Initial Enrollment Period.
Under the ACA, health insurers cannot deny coverage or charge higher premiums based on pre-existing conditions. This applies to all individual and small-group health plans, including Marketplace plans. Insurers can still vary premiums based on age, tobacco use, geographic location, and family size — but not your health history. This protection was a landmark change from the pre-ACA era.
A Special Enrollment Period allows you to enroll in or change coverage outside the standard Open Enrollment window due to a qualifying life event. Qualifying events include: losing employer or other health coverage, getting married or divorced, having a baby or adopting a child, moving to a new coverage area, gaining citizenship, leaving incarceration, and income changes that affect your subsidy eligibility. You typically have 60 days from the qualifying event to enroll.
Yes — several programs exist: (1) Medicare Savings Programs (MSPs) help pay your Medicare premiums, deductibles, and copays if you have limited income and resources. (2) Extra Help (Low Income Subsidy) helps with Part D prescription drug costs. (3) Medicaid may cover additional costs if you qualify based on income. Contact your state Medicaid office or 1-800-MEDICARE to see if you qualify for any of these programs.
Health insurance terminology can be confusing. Here are the most important terms explained in plain language.
The monthly amount you pay for your health insurance plan, regardless of whether you use medical services that month.
The amount you pay for covered health services before your insurance plan starts to pay. Once met, your plan shares costs.
A fixed dollar amount you pay for a covered service, like $25 for a doctor visit, after you've paid your deductible.
Your share of costs of a covered service, calculated as a percentage (e.g., 20%) of the allowed amount, after the deductible.
The most you have to pay for covered services in a plan year. After this amount, your insurer pays 100% of covered costs.
A list of prescription drugs covered by a Medicare Part D or ACA plan. Drugs are organized into tiers affecting your cost.
Income-Related Monthly Adjustment Amount. A surcharge added to Part B and Part D premiums for higher-income Medicare beneficiaries.
A Part A benefit period begins the day you're admitted to a hospital or SNF and ends after 60 consecutive days without inpatient care.
Health or drug coverage that's at least as good as Medicare. Having this protects you from late enrollment penalties.
ACA benefit that lowers your deductible, copays, and out-of-pocket max. Only available with Silver plans if income qualifies.
A measure of income issued each year by the federal government, used to determine eligibility for ACA subsidies and Medicaid.
The facilities, providers, and suppliers your health insurer has contracted with to provide healthcare services at negotiated rates.
Always verify your coverage details with official government sources or a licensed insurance counselor.
The official U.S. government site for Medicare. Compare plans, find providers, and manage your Medicare account.
Shop and enroll in ACA Marketplace plans. Check subsidy eligibility and manage your Marketplace account.
Apply for Medicare online, manage Social Security benefits, and understand how the two programs interact.
State Health Insurance Assistance Programs offer free, unbiased Medicare counseling from trained volunteers across the U.S.
Learn about Medicaid eligibility, find your state's program, and understand how Medicaid coordinates with Medicare.
The federal agency that runs Medicare, Medicaid, and the ACA Marketplace. Access official data, statistics, and regulations.