Medicare guides
Medicare questions, answered.
Parts, plans, costs and deadlines, in plain words. Every guide lists its sources and the date it was last reviewed.
Basics
6 guidesMedicare, in plain English.
Medicare is the federal health-insurance program for Americans 65 and older, plus some younger people with specific disabilities.
Updated May 2026Your Medicare card: what it shows and how to keep it safe
How to read your Medicare card, when to carry it, which card to show with Medicare Advantage or Part D, and the Medicare card scams to watch for now.
Updated October 2026Medicare explained: the parts, the costs, and how to enroll
Understand Medicare Parts A, B, C, and D, the verified 2026 costs, and when to enroll so you avoid penalties. A clear, plain-language guide with next steps.
Updated July 2026New to Medicare, the four things to know before you sign up
New to Medicare: your seven-month enrollment window and its lifelong penalty, the Original-vs-Advantage path decision that is hard to undo, why nothing is automatic, and the gaps (no out-of-pocket cap, dental, vision, hearing, long-term care).
Updated June 2026How to replace a lost Medicare card
Lost, stolen, or damaged Medicare card? Replace it at no cost through your Medicare.gov account or Social Security, print a copy the same day, and keep your Medicare Number safe from scams.
Medicare tax: what it is and how it pays for Part A
The Medicare tax is the payroll tax that funds Part A hospital insurance. How it works, how 40 quarters earns premium-free Part A, the extra tax on higher earners, and what it means for your coverage.
Choosing
5 guidesHMO vs. PPO Medicare Advantage plans: which fits you in 2027?
HMO vs. PPO Medicare Advantage for 2027: networks, referrals, pros and cons, the 2027 out-of-pocket caps, and how to check your doctors before Open Enrollment.
Updated October 2026Original Medicare or Medicare Advantage? How to choose, and Medigap vs Advantage
Medigap or Medicare Advantage? Compare costs, doctors, and limits side by side, learn the 6-month Medigap window, trial rights, and why switching back can be hard.
Updated October 2026NYP and UHC contract: Medicare Advantage status and dates
Is NewYork-Presbyterian in network with UnitedHealthcare Medicare Advantage? Status as of October 12, 2026, every extension date, care already under way, and your options.
Updated October 2026Medigap vs Medicare Advantage: which path locks you in
The real difference between Medigap and Medicare Advantage is reversibility. The six-month guaranteed-issue window, the underwriting asymmetry, and how to choose so the door back stays open.
Updated June 2026Finding a doctor with Medicare, networks and referrals
Provider access on Medicare: Original Medicare has no network (but assignment vs. non-participating vs. opted-out changes your bill), while Advantage uses networks and sometimes referrals. The smarter question to ask, and how to verify.
Updated June 2026
Costs
8 guidesMedicare 2026 premiums: what Parts A, B, and D will cost you
In 2026, the standard Part B premium is $202.90/month and Part A is free for most. See every verified 2026 Medicare cost, from hospital deductibles to the new Part D cap.
Updated September 2026Medicare IRMAA, the income brackets explained
Medicare IRMAA: the income-related surcharge on Part B and Part D above roughly $109,000 single / $218,000 joint. The two-year lookback that catches new retirees, the cliff structure, what counts as income, and when you can appeal.
Updated June 2026Medicare late enrollment penalties, in actual dollars
Medicare has three late-enrollment penalties. Part B adds 10% per full 12 months for life; Part D adds 1% of the base per month after 63 days without creditable coverage; Part A rarely applies. How each works, and how to avoid all of them.
Updated June 2026The Part B late enrollment penalty
The Part B late enrollment penalty is permanent: 10% per full 12 months you delayed, about $61/month on a 3-year delay. How it works, the 20-employee exception, why COBRA and retiree coverage do not protect you, and the 8-month SEP.
Updated June 2026How to appeal an IRMAA decision
Got an IRMAA letter? You can appeal. The qualifying life-changing events, Form SSA-44, the documents you need, and the step-by-step process for 2026.
Updated May 2026How much does Medicare actually cost in 2026?
There is no single Medicare price tag.
Updated May 2026Why your Part D premium may jump in 2027
A federal subsidy that held Part D plan premiums down ends after 2026. What the 2027 numbers mean, the auto-renew trap, and what to check before December 7.
Medicare deductibles in 2026
The three Medicare deductibles for 2026: the $1,736 Part A hospital deductible per benefit period, the $283 Part B annual deductible, and the Part D drug deductible of up to $615. How each one works.
Coverage
27 guidesDoes Medicare cover acupuncture?
Medicare Part B covers acupuncture only for chronic low back pain: up to 12 visits in 90 days and 20 a year. Who qualifies, who can treat you, and your 20% share.
Updated October 2026Does Medicare cover chiropractors?
Medicare Part B covers one thing a chiropractor does: hands-on spinal adjustments to fix a subluxation. What is not covered, the maintenance trap, and your 20% share.
Updated October 2026Does Medicare cover a colonoscopy?
Yes. A screening colonoscopy costs $0 if your doctor accepts assignment. How often Medicare pays, the 15% polyp removal charge, and Cologuard coverage.
Updated October 2026Does Medicare cover COVID, flu, and RSV vaccines?
Part B covers flu and COVID-19 shots at $0 if your provider accepts assignment. Part D covers the RSV shot, also at $0. Which card to bring and how to avoid a bill.
Updated October 2026Does Medicare cover hospice?
Medicare Part A pays for hospice care when a doctor says you have 6 months or less to live. Who qualifies, what is covered, the $5 drug copay, and what you still pay.
Updated October 2026Does Medicare cover annual wellness visits?
Yes. Medicare Part B covers a yearly wellness visit at no cost if your provider accepts assignment. What it includes, why it is not a physical, and when it can cost you.
Updated October 2026Does Medicare cover breast implant removal?
Medicare covers breast implant removal for problems like rupture, infection, or painful scar tissue, even for cosmetic implants. What is not covered and what you pay.
Updated October 2026Does Medicare cover dermatology?
Medicare Part B covers dermatologist visits for medical problems, like a changing mole, a rash, or skin cancer. Not cosmetic care. Skin checks, referrals, costs.
Updated October 2026Does Medicare cover knee replacement surgery?
Medicare covers knee replacement when it is medically necessary. The tests your doctor must meet, inpatient vs outpatient costs in 2026, and rehab after surgery.
Updated October 2026Does Medicare cover Suboxone?
Medicare covers Suboxone (buprenorphine and naloxone) for opioid use disorder. When Part D pays, when Part B pays at a treatment program, and what you pay in 2026.
Updated October 2026Does Medicare cover marriage counseling?
Medicare does not pay to work on a marriage. It can pay for couples or family sessions that treat a Medicare patient's mental health condition. The rule and your costs.
Updated October 2026Does Medicare cover toenail trimming?
Medicare does not pay for routine toenail trimming, except when diabetes, poor blood flow, or nerve damage makes it unsafe. Who qualifies and what you pay in 2026.
Updated October 2026Does Medicare require a referral to see a specialist?
Original Medicare does not require a referral to see a specialist in most cases. Medicare Advantage HMOs usually do; PPOs do not. What to check before you book.
Updated October 2026Medicare coverage for GLP-1 drugs: the $50 a month Bridge program
Medicare GLP-1 Bridge details: Wegovy, Zepbound KwikPen, and Foundayo for $50 a month through December 31, 2027. Who qualifies and how to get it.
Updated October 2026The WISeR Model: prior authorization in Original Medicare
What the CMS WISeR Model is, the six states and services it covers, how prior authorization works, how long decisions take, and how to appeal.
Updated October 2026Medicare home health care: who qualifies, what's covered, and how to start
Medicare covers skilled nursing and therapy at home with no copayment if you meet homebound and skilled-care criteria. Learn who qualifies, what's excluded, and how to start.
Updated September 2026Does Medicare cover you when you travel or live abroad?
Original Medicare rarely covers care outside the US. What Medigap and Medicare Advantage add for foreign travel, and how to plan coverage if you live abroad.
Updated August 2026Home health, hospice, nursing home, and long-term care
What Medicare covers across care settings: home health when homebound, a skilled-nursing stay after a hospital admission, hospice in full, and the long-term custodial care it does not cover. The skilled-vs-custodial line that decides it.
Updated June 2026Does Medicare cover long-term care?
Medicare does not cover long-term custodial care, the daily help someone may need for years. What it does cover (skilled nursing, home health, hospice), the skilled-vs-custodial line, and who pays: out of pocket, Medicaid, or LTC insurance.
Updated June 2026Medicare, dental, vision, and hearing
Original Medicare does not cover routine dental, vision, or hearing, but it does cover medically necessary exceptions like cataract surgery and doctor-ordered diagnostics. The three ways to fill the gap, and why the allowance is a cap.
Updated June 2026SilverSneakers and Medicare fitness
SilverSneakers is a real fitness program, but not a Medicare benefit: it comes from the plan, some Medicare Advantage plans and a few Medigap carriers, alongside Silver&Fit and Renew Active. How to check for it and keep it.
Updated June 2026Does Medicare cover physical therapy?
Yes, Medicare covers medically necessary physical therapy. Part B pays for outpatient therapy at 20 percent coinsurance after the deductible, Part A covers it during a hospital or skilled nursing stay, and the old therapy cap is gone.
Does Medicare cover cataract surgery?
Yes, Medicare covers cataract surgery when it is medically necessary. Part B pays for the outpatient procedure at 20 percent coinsurance after the $283 deductible, and Medicare even covers one pair of glasses or contacts afterward.
Does Medicare cover eye exams?
Original Medicare does not cover routine eye exams for glasses, but it does cover medical eye exams for conditions like glaucoma, diabetic retinopathy, and macular degeneration. What you pay, and how Advantage adds routine vision.
Does Medicare pay for assisted living?
Medicare does not pay the room, board, or personal care of assisted living, but it still covers your doctors, hospital stays, and drugs while you live there. Who actually pays: out of pocket, Medicaid, long-term care insurance, or VA benefits.
Does Medicare cover dental?
Original Medicare does not cover routine dental care like cleanings, fillings, or dentures. What the narrow medical exceptions are, where dental coverage can come from, and how to plan for the cost.
Does Medicare cover hearing aids?
Original Medicare does not cover routine hearing aids or the exams to fit them, but it does cover doctor-ordered diagnostic hearing tests. Where hearing aid help can come from, and how to plan for the cost.
Enrolling
8 guidesMedicare and employer coverage: who pays first, and how to sign up for Part B
How Medicare works with employer coverage: who pays first (20+ employees, 100+ for disability, the ESRD 30 months), the CMS-40B and CMS-L564 forms for Part B, and creditable drug coverage.
Updated October 2026Medicare secondary payer: who pays first and why it matters
Learn how Medicare secondary payer rules decide who pays first, how employer size affects order, and how to avoid coverage gaps. Contact us to discuss options.
Updated July 2026How to sign up for Medicare
How to sign up for Medicare: automatic vs. on-you enrollment, applying through Social Security, what to have ready, the HSA trap, and the Special Enrollment Period vs. penalty path if you missed your window.
Updated June 2026Medicare eligibility, who qualifies and when
Who qualifies for Medicare and when: the three doors (turning 65, 24 months of SSDI, ALS/ESRD), automatic vs. on-you enrollment, the seven-month IEP and its timing, and the working-at-65 exception.
Updated June 2026Medicare enrollment periods
Every Medicare enrollment period and what it is for: the IEP at 65, AEP (Oct 15 to Dec 7), MA-OEP, the penalty-prone GEP, and the life-event SEPs, plus the AEP-does-not-guarantee-Medigap myth.
Updated June 2026Working past 65, Medicare, COBRA, and the SEP trap
Working past 65: when delaying Part B is safe (a 20+ employer), the HSA trap and the six-month Part A backdating, why COBRA and retiree coverage do not protect your window, and timing the 8-month SEP so protection does not leave a coverage gap.
Updated June 2026Medicare for people with disabilities, before 65
How Medicare works for people with disabilities under 65: the 24-month SSDI waiting period, the ALS and ESRD exceptions that skip it, automatic enrollment in month 25, and what Part A and Part B cost, plus the savings programs that lower it.
What documents you need to sign up for Medicare
The documents you need to sign up for Medicare: Social Security number, proof of birth date, and proof of citizenship or lawful status, plus the employer-coverage form that protects your Part B window, and what to do if a document is missing.
Help paying for Medicare
6 guidesMedicare and VA benefits: do you need both?
How VA health care and Medicare work together, why Part B still matters for veterans, and when VA drug coverage lets you delay Part D. Contact us to discuss options.
Updated August 2026Medicare versus Medicaid: what each program covers and who qualifies
Medicare and Medicaid serve different populations with different rules. Learn who qualifies for each, what each covers, and what to do if you may qualify for both.
Updated August 2026Medicare Savings Programs, QMB, SLMB, and QI
The Medicare Savings Programs pay your Part B premium (worth roughly $2,400 a year), and QMB covers deductibles and coinsurance too. The three tiers, the higher-than-expected income limits, the QMB billing protection, and the Extra Help link.
Updated June 2026Help paying for Medicare
Programs that lower Medicare costs and stack: Extra Help for drug costs, the Medicare Savings Programs (QMB, SLMB, QI) that cover the roughly $2,400-a-year Part B premium, the QMB balance-billing protection, and dual eligibility.
Updated June 2026Qualified Medicare Beneficiary (QMB): the program that pays your Medicare costs
The Qualified Medicare Beneficiary program is the top Medicare Savings Program. It pays your Part B premium and Medicare deductibles and coinsurance, and it protects you from provider balance billing. Who qualifies and how to apply.
Extra Help: the program that lowers Medicare Part D drug costs
Extra Help, also called the Low-Income Subsidy, lowers or eliminates your Medicare Part D premium, deductible, and drug copays. Who qualifies, what it is worth in 2026, and how to apply through Social Security.
Parts
4 guidesOriginal Medicare, the unbundled federal program
What Original Medicare Parts A and B cover, the 80/20 gap and why Medigap exists, how to enroll, and when Original beats Medicare Advantage in 2026.
Updated May 2026Medicare Part A, hospital coverage
What Medicare Part A covers in 2026: inpatient hospital, skilled nursing, hospice, the $1,736 deductible and the per-day cost ladder, the observation-status trap, and the long-term-care gap.
Updated June 2026Medicare Part B, doctor and outpatient coverage
What Medicare Part B covers in 2026: doctors, outpatient, preventive care and the screening-to-diagnostic flip, the $202.90 premium and $283 deductible, and the uncapped 20% that drives Medigap and Advantage.
Updated June 2026Medicare Part D, prescription drug coverage
How Medicare Part D drug coverage works in 2026: formularies and tiers, the coverage phases and the $2,100 out-of-pocket cap, the late-enrollment penalty, and how to pick a plan by your actual drug list.
Updated June 2026
Plan Types
9 guidesMedicare Advantage (Part C), explained without the marketing
What Medicare Advantage really is in 2026: plan types, networks, prior authorization, the MOOP cap, star ratings, and how it compares to Original Medicare.
Updated May 2026Medicare Special Needs Plans (SNPs): D-SNP, C-SNP, and I-SNP for 2027
Medicare Special Needs Plans explained: who qualifies for a D-SNP, C-SNP, or I-SNP, the 15 chronic conditions CMS lists for C-SNPs, how SNP care management works, and when you can join.
Updated October 2026Medigap Plan G: what it covers, and Plan G vs Plan F
Medigap Plan G covers every Original Medicare gap but the Part B deductible. See Plan G vs Plan F side by side, who can still buy F, the math, and how to switch.
Updated October 2026What is a Medicare PPO plan? How it works and what it costs
A Medicare PPO is a Medicare Advantage plan that lets you see doctors out of network for a higher cost. Learn the rules, the 2027 cost caps, the downsides, and when to join.
Updated October 2026Medicare HMO plans: how they work and what they cost in 2026
Medicare HMO plans bundle hospital, doctor, and drug coverage into one network. Learn 2026 costs, prior authorization rules, and enrollment windows here.
Updated August 2026Medigap Plan N, the lower-premium option
Medigap Plan N vs. Plan G: the same standardized coverage for a lower premium, the three differences (office copay, ER copay waived if admitted, excess charges), and the arithmetic of choosing between them.
Updated June 2026Medigap Plan F, why it closed
Medigap Plan F closed to anyone Medicare-eligible on or after January 1, 2020 (MACRA). What it covered, keeping it vs. the closed-pool premium risk, and why Plan G is the near-identical substitute, the one Part B deductible apart.
Updated June 2026Medigap (Medicare Supplement), explained
How Medigap fills Original Medicare’s gaps: the standardized plan letters, why Plan G and Plan N lead, the three pricing methods, and the open-enrollment window that protects you.
Updated May 2026The Medicare grocery card, what it really is
There is no grocery card from Medicare itself. Some Medicare Advantage plans add a grocery or over-the-counter allowance, but eligibility, amounts, and rules are set by the plan, often tied to a chronic condition. What to check before you switch.
Medicare explained
9 guidesCGS Medicare: what this claims contractor does and when it matters
CGS is a Medicare Administrative Contractor that processes claims for Kentucky, Ohio, and home health nationwide. Learn what CGS does and how to reach help.
Updated September 2026What 'Medicare for All' means and how it compares to current Medicare
Medicare for All would cover all U.S. residents under one federal health program. Learn how proposals compare to today's Medicare and what they would add.
Updated September 2026What Medicare is, who qualifies, and how the four parts work
Medicare is federal health insurance for people 65 and older and qualifying younger adults. Learn what each part covers, what it costs in 2026, and how to enroll without a penalty.
Updated September 2026Medicare eligibility age: who qualifies at 65 and what opens the door earlier
Medicare eligibility begins at 65, but SSDI, ALS, and ESRD can qualify you earlier. Learn enrollment windows, late penalties, and how to avoid coverage gaps.
Updated September 2026Medicare Advantage programs: what they cover, what they cost, and when you can enroll
Medicare Advantage (Part C) bundles hospital, drug, and outpatient coverage into one plan with an annual spending cap. See 2026 costs, plan types, and enrollment windows.
Updated September 2026KanTime and Medicare home health: what patients should know
KanTime is home health agency software, not a Medicare plan. Learn what it does, how it relates to your Medicare benefit, and what to expect as a patient.
Updated September 2026How CMS shapes your Medicare coverage and costs
CMS sets every Medicare premium, deductible, and coverage rule. Learn what the 2026 figures are and how CMS decisions affect what you pay and what you get.
Updated September 2026Medicare eligibility age: 65 is the standard, but not the only path
Medicare eligibility starts at 65 for most. Disability or ESRD can qualify you earlier. Learn your enrollment window and how to avoid a lasting late penalty.
Updated September 2026Medicare eligibility age: when you can enroll and what happens if you wait
Most people become eligible for Medicare at 65, with a 7-month window to enroll. Learn the age rules, disability exceptions, and how to avoid late penalties.
Updated September 2026
More guides
3 guidesForm CMS L564: how to document employer coverage for a Medicare Part B special enrollment
CMS L564 documents employer coverage for Medicare Part B Special Enrollment, helping you avoid a permanent late-enrollment penalty. Learn how to fill it out and file it.
Updated September 2026Medicare supplement open enrollment: your guaranteed-issue window
Medigap open enrollment lasts 6 months starting when you turn 65 and enroll in Part B. Learn your rights, plan options, and what happens if you miss it.
Updated October 2026Your 2027 ANOC Is Not Junk Mail
Your Medicare plan's Annual Notice of Change arrives by September 30. Check your premium, your drug list, and whether your plan still covers your county in 2027.
Updated September 2026
Common Medicare questions
- Is Medicare free?
- When can I sign up for Medicare?
- What if I'm covered through my spouse's employer plan?
- Does Medicare Advantage cover the same things as Original?
- Why is Medigap Plan F not on the list anymore?
- What's the difference between Medicare and Medicaid?
- When do I become eligible for Medicare?
- What does Medicare Part A cover?
- How much is the Part B premium in 2026?
- Can I keep my doctor on Medicare Advantage?