Medicare Simplified

Start with the four parts of Medicare

• Part A helps cover inpatient hospital and certain facility-based care.
• Part B helps cover physician services, outpatient care and many preventive services.
• Part C Medicare Advantage is an alternative way to receive Part A and Part B benefits through a private Medicare-approved plan.
• Part D helps cover outpatient prescription drugs through private Medicare-approved plans.

Your first enrollment window

For most people turning 65, the Medicare Initial Enrollment Period lasts seven months: three months before the month you turn 65, your birthday month, and three months after. Different timing can apply if your birthday is on the first day of a month.

Working past 65

You may be able to delay Part B without a late penalty if you have qualifying current employer group health coverage. The rules depend on the coverage and employment situation, so verify your Special Enrollment Period before delaying Medicare.

Two common coverage paths

One path is Original Medicare Part A and Part B, usually paired with a separate Part D plan and optionally a Medigap policy. Another is Medicare Advantage, which provides Part A and Part B benefits through a private plan and often includes Part D coverage. Networks, referrals, prior authorization, cost sharing and supplemental benefits vary by plan.

2027 Part D cost parameters

For 2027, the standard Part D deductible is $700 and the annual out-of-pocket threshold for covered Part D drugs is $2,400. Your actual premium, copays, coinsurance, formulary and pharmacy network depend on the plan.

Avoid common first-time mistakes

• Do not assume your doctors participate in every Medicare Advantage network.
• Check each prescription against the plan’s current formulary and pharmacy network.
• Do not delay Part B solely because you have VA health care or retiree coverage without checking the rules.
• If you want Medigap, understand your Medigap Open Enrollment Period and any state-specific rights before switching later.