2026 Coverage Guide

Medicare & ACA
Explained Clearly

Understand your health coverage options, compare plans, estimate costs, and make confident decisions — without the confusing jargon.

67M+
Medicare enrollees
21M+
ACA marketplace enrollees
$0
Part A premium (most people)
4
Metal plan tiers (ACA)

Understanding Medicare Coverage

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.

A

Part A — Hospital Insurance

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.

Inpatient hospital stays
Skilled nursing facility (SNF) care
Hospice care
Some home health services
2026 deductible: $1,716 per benefit period
B

Part B — Medical Insurance

Covers doctors' services, outpatient care, medical supplies, and preventive services. Part B requires a monthly premium, which can vary based on your income.

Doctor visits & specialist care
Outpatient procedures & surgery
Preventive screenings (many free)
Durable medical equipment (DME)
2026 standard premium: $185/month
C

Part C — Medicare Advantage

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.

Combines Parts A, B (and usually D)
Often includes dental, vision, hearing
May have lower out-of-pocket costs
Network restrictions may apply (HMO/PPO)
Many plans available for $0 additional premium
D

Part D — Prescription Drug Coverage

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.

Covers brand-name & generic drugs
$2,000 annual out-of-pocket cap (2026)
Formularies vary by plan — check your drugs
Extra Help available for low-income enrollees
Late enrollment penalty: 1% per month without coverage

Who Qualifies for Medicare?

  • Age 65 or older AND a U.S. citizen or permanent legal resident for at least 5 continuous years
  • Under 65 with a qualifying disability and received Social Security Disability Insurance (SSDI) for 24 months
  • Any age with End-Stage Renal Disease (ESRD) requiring dialysis or a kidney transplant
  • Any age with Amyotrophic Lateral Sclerosis (ALS / Lou Gehrig's Disease)
  • i
    You're automatically enrolled if you already receive Social Security benefits at age 65
  • !
    If you're still working with employer coverage, you may delay Part B without penalty — but consult Medicare first

Part A Premium Eligibility

  • $0 premium — You or your spouse worked & paid Medicare taxes for at least 40 quarters (10 years)
  • !
    $294/month — You paid Medicare taxes for 30–39 quarters (2026 amount)
  • !
    $533/month — You paid Medicare taxes for fewer than 30 quarters (2026 amount)
  • i
    Even if you pay a premium for Part A, you still need to sign up during your Initial Enrollment Period to avoid delays

Enrollment Periods

Initial Enrollment Period (IEP)

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.

General Enrollment Period (GEP)

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.

Special Enrollment Period (SEP)

If you delayed Medicare because you had employer coverage, you have 8 months after losing that coverage to sign up without penalty.

Open Enrollment (Medicare Advantage & Part D)

October 15 – December 7 each year. Switch, drop, or add Medicare Advantage or Part D plans. Changes take effect January 1.

Late Enrollment Penalties

  • !
    Part B Penalty: 10% added to your monthly premium for each full 12-month period you delayed without qualifying coverage. This penalty lasts as long as you have Medicare.
  • !
    Part D Penalty: 1% of the national base beneficiary premium multiplied by the number of uncovered months. This is added to your Part D premium permanently.
  • i
    Part A: No penalty if you qualify for premium-free Part A, but late enrollment can delay your start date.
  • Tip: If you have creditable employer coverage, you are protected from penalties while actively covered.

What Is Medigap?

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.

  • Sold by private insurers — benefits are standardized by letter (Plan G, Plan N, etc.)
  • Works alongside Original Medicare, not Medicare Advantage
  • Accepted by any provider that accepts Medicare — no networks
  • i
    Best time to buy: within 6 months of turning 65 and enrolling in Part B — insurers can't deny you or charge more during this Open Enrollment Period
  • !
    Medigap plans generally don't cover prescription drugs — you'll need a separate Part D plan

Popular Medigap Plans

  • Plan G (most popular): Covers nearly everything except the Part B deductible ($263 in 2026). Great all-around protection.
  • Plan N: Lower premiums than Plan G, but requires small copays for some office visits and ER visits.
  • i
    Plan A: Basic benefits only. Covers Part A coinsurance and some Part B coinsurance.
  • !
    Plans C & F are only available to those who became eligible for Medicare before January 1, 2020.
  • i
    Compare premiums across insurers — benefits for the same plan letter are identical, so price is the primary differentiator.

The ACA Marketplace Explained

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.

The 4 Metal Tiers

Br

Bronze

Lowest monthly premium, highest out-of-pocket costs. Best if you're healthy and rarely use healthcare. Insurer pays ~60% of costs.

60%
Ag

Silver

Mid-range premium and costs. The only tier eligible for Cost-Sharing Reductions (CSRs) if your income qualifies. Insurer pays ~70%.

70%
Au

Gold

Higher monthly premium but lower costs when you use care. Good if you have frequent medical needs or prescriptions. Insurer pays ~80%.

80%
Pt

Platinum

Highest monthly premiums, lowest out-of-pocket costs. Best if you use a lot of medical services. Insurer pays ~90% of costs.

90%

* Percentages reflect actuarial value — the share of covered health costs the plan is designed to pay for an average enrollee.

Premium Tax Credits (PTCs)

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.

100–150% FPL$0 premium (benchmark plan)
150–200% FPLUp to 0–2% of income
200–300% FPL2–6% of income cap
300–400% FPL6–8.5% of income cap
400%+ FPL8.5% income cap (no cliff)

Who Can Use the Marketplace?

  • U.S. citizens and nationals, and lawfully present immigrants
  • Not incarcerated
  • !
    Not eligible if you have affordable employer coverage that meets minimum standards
  • !
    Not eligible for subsidies if you qualify for Medicare or Medicaid
  • i
    Open Enrollment: November 1 – January 15 most years (check your state exchange for exact dates)

2026 Medicare Cost Reference

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.

Find Your Coverage Path

Answer a few quick questions to get a personalized summary of your likely coverage options.

Coverage Eligibility Checker

This tool provides general guidance only — always verify details with Medicare.gov, HealthCare.gov, or a licensed insurance counselor.

Your Coverage Outlook

    Frequently Asked Questions

    Answers to the most common Medicare and ACA questions we receive.

    Can I have both Medicare and ACA Marketplace coverage at the same time?

    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).

    What's the difference between Medicare Advantage and Original Medicare?

    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.

    When does Medicare open enrollment happen?

    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.

    What does Medicare NOT cover?

    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.

    How do I apply for Medicare?

    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.

    What is the ACA's pre-existing condition protection?

    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.

    What is a Special Enrollment Period (SEP) and when do I qualify?

    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.

    Can I get help paying for Medicare costs if I have limited income?

    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.

    Key Terms Defined

    Health insurance terminology can be confusing. Here are the most important terms explained in plain language.

    Premium

    The monthly amount you pay for your health insurance plan, regardless of whether you use medical services that month.

    Deductible

    The amount you pay for covered health services before your insurance plan starts to pay. Once met, your plan shares costs.

    Copayment

    A fixed dollar amount you pay for a covered service, like $25 for a doctor visit, after you've paid your deductible.

    Coinsurance

    Your share of costs of a covered service, calculated as a percentage (e.g., 20%) of the allowed amount, after the deductible.

    Out-of-Pocket Maximum

    The most you have to pay for covered services in a plan year. After this amount, your insurer pays 100% of covered costs.

    Formulary

    A list of prescription drugs covered by a Medicare Part D or ACA plan. Drugs are organized into tiers affecting your cost.

    IRMAA

    Income-Related Monthly Adjustment Amount. A surcharge added to Part B and Part D premiums for higher-income Medicare beneficiaries.

    Benefit Period (Medicare)

    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.

    Creditable Coverage

    Health or drug coverage that's at least as good as Medicare. Having this protects you from late enrollment penalties.

    Cost-Sharing Reduction (CSR)

    ACA benefit that lowers your deductible, copays, and out-of-pocket max. Only available with Silver plans if income qualifies.

    Federal Poverty Level (FPL)

    A measure of income issued each year by the federal government, used to determine eligibility for ACA subsidies and Medicaid.

    Network

    The facilities, providers, and suppliers your health insurer has contracted with to provide healthcare services at negotiated rates.

    Trusted Places to Learn More

    Always verify your coverage details with official government sources or a licensed insurance counselor.