New to Medicare? Start here.
Understand Medicare eligibility, enrollment dates, and costs before you choose coverage. Our Omaha-based team can help you connect the basics to your own situation.
What is Medicare?
Medicare is federal health insurance for people age 65 and older and some younger people who qualify through disability, ALS, or End-Stage Renal Disease (ESRD).
Part A helps cover hospital care, and Part B helps cover medical services. Together, they are Original Medicare. Part C, also called Medicare Advantage, is a private-plan alternative for receiving Part A and Part B benefits. Part D helps cover prescription drugs.
Medicare Supplement insurance, also called Medigap, can help pay certain costs left by Original Medicare. It is separate from Medicare Advantage.
Medicare Eligibility
Many people first qualify at age 65. Citizenship or lawful residency requirements and your work history can affect eligibility and premiums. Social Security can confirm when you qualify and whether you need to apply.
People under 65 generally become eligible after 24 months of Social Security disability benefits. With ALS, Medicare begins the month disability benefits start. ESRD follows different rules: coverage commonly begins in the fourth month of dialysis, with exceptions for qualifying home dialysis training or a transplant. A diagnosis alone does not always start coverage.
Some people already receiving Social Security benefits are enrolled automatically; others must apply. If you have coverage through current employment, check with your benefits administrator and Social Security before delaying Part B. Employer size and the type of coverage matter. COBRA and retiree coverage do not work the same way as active-employment coverage.
Medicare and Medicaid are different programs. Some people qualify for both. Medicaid and Medicare Savings Programs may help eligible people with certain Medicare costs.
When Do I Enroll in Medicare?
Initial Enrollment Period (IEP)
For most people first eligible at 65, the Initial Enrollment Period lasts seven months: the three months before your birthday month, your birthday month, and the three months after. Special timing applies if your birthday is on the first of a month. Coverage start dates depend on when you enroll. Ask about your own deadline and any late-enrollment penalties.
Annual Enrollment Period (AEP)
From October 15 through December 7, eligible people can change Medicare Advantage or Part D coverage for January 1 of the following year. This is also called Medicare Open Enrollment. Depending on your current coverage, you can:
• Switch from Original Medicare to Medicare Advantage
• Change from Medicare Advantage to Original Medicare
• Switch between Medicare Advantage plans
• Join, switch, or drop Medicare Part D coverage.
Medicare Advantage Open Enrollment Period (MA-OEP)
If you already have Medicare Advantage, January 1 through March 31 generally lets you make one change: switch to another Medicare Advantage plan
or return to Original Medicare and join a separate Part D plan. Coverage generally starts the first day of the next month. This period does not let someone with Original Medicare newly join Medicare Advantage.
Special Enrollment Periods (SEPs)
Certain events may create a Special Enrollment Period. The allowed change and deadline depend on your circumstances. Examples include:
• Moving outside your plan's service area
• Losing qualifying health or drug coverage
• Your plan ending its Medicare contract
• Qualifying for Medicaid or Extra Help, under the applicable enrollment rules
General Enrollment Period (GEP): If you missed your initial window and do not qualify for a Special Enrollment Period, you can sign up for Part B and premium Part A from January 1 through March 31. Coverage generally starts the month after you sign up. Late-enrollment penalties may apply.
Not sure which enrollment period applies to you?
Let’s review your current coverage and timing together.
What Does Medicare Cost?
Original Medicare Costs (2026)
Medicare Part A (Hospital Insurance) Most people qualify for premium-free Part A through their own or a spouse’s work record. In 2026, people who must buy Part A pay $311 or $565 per month, depending on work history. The inpatient hospital deductible is $1,736 per benefit period, not per calendar year.
Medicare Part B (Medical Insurance) The standard Part B premium is $202.90 per month in 2026, and the annual deductible is $283. You generally pay 20% of the Medicare-approved amount for covered Part B services after the deductible, with exceptions such as certain preventive services. Higher-income beneficiaries may pay an additional income-related amount.
Additional Coverage Costs
Medicare Advantage (Part C) Medicare Advantage plans must cover Medicare-covered Part A and Part B services, with hospice generally covered by Original Medicare. Many plans include Part D and additional benefits. You generally continue paying the Part B premium. Compare the plan’s network, cost sharing, coverage rules, and medical out-of-pocket limit.
Medicare Part D (Prescription Drug Coverage) Part D premiums, deductibles, and copayments vary by plan. The annual out-of-pocket threshold for covered Part D drugs is $2,100 in 2026. Premiums, non-covered drugs, and Part B drugs do not count toward that limit. Higher-income beneficiaries may pay an additional amount.
Looking ahead to 2027 For 2027, CMS has set the maximum standard Part D deductible at $700 and the annual out-of-pocket threshold for covered Part D drugs at $2,400. A plan may have a lower deductible. Use final CMS figures for 2027 Part A and Part B costs when available; those amounts are not estimated here.
Cost-Saving Tips
Review Coverage Regularly: Read your plan’s Annual Notice of Change, then review next year’s coverage during October 15–December 7.
Compare Plans: Look at total costs, not just the premium, based on your doctors, prescriptions, and pharmacy.
Consider Your Healthcare Needs: Consider specialist visits, hospital care, travel, and services you expect to use, as well as prescriptions.
Explore Medicare Savings Programs: Ask about Medicare Savings Programs and Extra Help. Eligibility rules apply, and these programs can help with different costs.
You do not have to sort through every detail alone. Bring your current coverage information and questions to a free consultation, and we will help you compare your next steps.
UNDERSTAND THE DIFFERENCE
Two ways to receive Medicare benefits.
The right comparison begins with access to care, total costs, and how you prefer to manage coverage.
Original Medicare, with optional additional coverage
Parts A and B are administered by Medicare. You can usually see any provider who accepts Medicare. You may add a separate Part D plan and, if eligible, Medigap. Original Medicare alone has no yearly limit on your out-of-pocket costs.
Medicare Advantage
A private plan provides your Part A and Part B benefits, with hospice generally covered by Original Medicare. Many plans include Part D. Networks and coverage rules may apply, and plans have a yearly limit on covered medical out-of-pocket costs.
Medigap and Medicare Advantage are different choices; Medigap does not pay Medicare Advantage cost sharing. Compare details in our coverage guide and Medicare’s official comparison. Cost sources: CMS 2026 Part A and B costs and CMS 2027 Part D limits. Enrollment sources: coverage start dates, ESRD eligibility, and disability and ALS eligibility. Figures checked September 28, 2026.
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